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Xu W, Xu J, Zhou Y, Yang W, Huang H, Xue J, Zhang J. Diagnostic Value of Superb Microvascular Imaging of the Rotator Cuff Interval for the Early Diagnosis of Frozen Shoulder. Int J Gen Med 2024; 17:3039-3046. [PMID: 39006912 PMCID: PMC11246654 DOI: 10.2147/ijgm.s465952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/28/2024] [Indexed: 07/16/2024] Open
Abstract
Purpose To explore the early diagnostic value of superb microvascular imaging (SMI) features within the rotator cuff gap for frozen shoulder. Patients and Methods This prospective study enrolled patients with acute early-stage frozen shoulder seeking treatment at Zhabei Central Hospital in Jing'an District, Shanghai, between July 2021 and December 2022 were enrolled in this study. Healthy controls were collected in a 1:1 ratio from the same hospital's physical examination center. All participants underwent SMI and power Doppler ultrasound (PDUS) of the rotator cuff gap. Results The study included 79 patients with frozen shoulder and 77 healthy controls. Compared with the healthy control group, the patient group had a higher proportion of hypoechoic rotator cuff gap (81.0% vs 48.1%, P<0.001), a thicker coracohumeral ligament (2.60±1.01 vs 2.03±0.97, P<0.001), a thicker glenohumeral joint capsule (3.10±0.99 vs 2.46±1.17, P<0.001), and elevated blood grading using SMI (P<0.001) and PDUS (P=0.014). The highest area under the curve (AUC) was observed for SMI blood flow grading (AUC=0.824, 95% CI: 0.755-0.880, P<0.001), resulting in 82% sensitivity and 77% specificity when using a cutoff of 1. SMI blood flow grading was associated with external rotation <30° (P=0.007) and abduction <30° (P=0.013) but not with internal rotation <30° (P=0.630) or flexion <30° (P=0.562). Conclusion The grading of SMI blood flow may emerge as a valuable predictive indicator for the early stages of frozen shoulder. This simple ultrasound technique holds the potential to enhance the diagnostic process, enabling early initiation of treatment and potentially improving patient outcomes.
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Affiliation(s)
- Weihua Xu
- Ultrasound Medicine Department, Zhabei Central Hospital in Jing'an District, Shanghai, People's Republic of China
| | - Jiayu Xu
- Ultrasound Medicine Department, Zhabei Central Hospital in Jing'an District, Shanghai, People's Republic of China
| | - Yingying Zhou
- Ultrasound Medicine Department, Zhabei Central Hospital in Jing'an District, Shanghai, People's Republic of China
| | - Weiwei Yang
- Ultrasound Medicine Department, Zhabei Central Hospital in Jing'an District, Shanghai, People's Republic of China
| | - Hui Huang
- Ultrasound Medicine Department, Zhabei Central Hospital in Jing'an District, Shanghai, People's Republic of China
| | - Jun Xue
- Ultrasound Medicine Department, Zhabei Central Hospital in Jing'an District, Shanghai, People's Republic of China
| | - Jing Zhang
- Ultrasound Medicine Department, Daning Community Health Service Center in Jing'an District, Shanghai, People's Republic of China
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Dimitri-Pinheiro S, Klontzas ME, Vassalou EE, Pimenta M, Soares R, Karantanas AH. Long-Term Outcomes of Ultrasound-Guided Hydrodistension for Adhesive Capsulitis: A Prospective Observational Study. Tomography 2023; 9:1857-1867. [PMID: 37888739 PMCID: PMC10610723 DOI: 10.3390/tomography9050147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/04/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023] Open
Abstract
Ultrasound-guided hydrodistention has been established as an effective minimally invasive treatment option for glenohumeral joint adhesive capsulitis (AC). Nonetheless, the long-term outcomes of the procedure have not yet been established. A total of 202 patients with AC were prospectively recruited and followed up for a total of 2 years. Pain and functionality were assessed with the use of the visual analogue scale (VAS) and the disabilities of the arm, shoulder, and hand (DASH) score, respectively, at the beginning and the end of the follow-up period. The relapse of AC over the 2-year period and the effect of diabetes were also evaluated in the treatment cohort. The Mann-Whitney U test was used to compare mean scores at the two time points, and Cox survival analysis and χ2 test were used to assess the effect of diabetes on AC relapse. VAS and DASH scores were significantly lower at 2 years compared with the beginning of the follow-up period (p < 0.001). Diabetes was diagnosed in 38/202 patients (18.8%) and was found to be significantly associated with recurrence of the disease (p < 0.001). In conclusion, in this observational study, we have demonstrated that ultrasound-guided hydrodistention is linked to excellent long-term outcomes for the treatment of AC, which are significantly worse in patients with diabetes.
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Affiliation(s)
- Sofia Dimitri-Pinheiro
- Radiology Department, Portuguese Institute of Oncology of Porto—Francisco Gentil EPE, Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal;
- Unit of Biochemistry, Biomedicine Department, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal;
| | - Michail E. Klontzas
- Department of Medical Imaging, University Hospital of Heraklion, 71110 Heraklion, Crete, Greece; (M.E.K.); (E.E.V.)
- Department of Radiology, School of Medicine, University of Crete, Voutes Campus, 71003 Heraklion, Crete, Greece
| | - Evangelia E. Vassalou
- Department of Medical Imaging, University Hospital of Heraklion, 71110 Heraklion, Crete, Greece; (M.E.K.); (E.E.V.)
| | - Madalena Pimenta
- Radiology Department, São João Hospital Centre, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal;
| | - Raquel Soares
- Unit of Biochemistry, Biomedicine Department, Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal;
- I3S—Institute for Innovation and Health Research, University of Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
| | - Apostolos H. Karantanas
- Department of Medical Imaging, University Hospital of Heraklion, 71110 Heraklion, Crete, Greece; (M.E.K.); (E.E.V.)
- Department of Radiology, School of Medicine, University of Crete, Voutes Campus, 71003 Heraklion, Crete, Greece
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Al Khayyat SG, Falsetti P, Conticini E, Frediani B, Galletti S, Stella SM. Adhesive capsulitis and ultrasound diagnosis, an inseparable pair: a novel review. J Ultrasound 2023; 26:369-384. [PMID: 36284048 PMCID: PMC10247624 DOI: 10.1007/s40477-022-00725-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/27/2022] [Indexed: 10/31/2022] Open
Abstract
PURPOSE Adhesive Capsulitis (AC) is a musculoskeletal disorder initially described by Codman in 1934. The disease is characterized by pain-limited restriction in active and passive glenohumeral range of motion (ROM) despite the lack of a structural deficit. In the last decades, arthroscopy and magnetic resonance imaging (MRI) has been the only diagnostic tools able to highlight the characteristic alterations of the glenohumeral capsular-ligament apparatus in AC; nevertheless, both arthroscopy and MRI are burdened by intrinsic limitations. The aim of this narrative review is to summarize the most significant evidence supporting the use of ultrasound (US) for the diagnosis of AC. METHODS We extensively searched via PubMed library the terms "frozen-shoulder" and "adhesive capsulitis" each combined with "ultrasound". RESULTS We found 3723 papers on PubMed and selected those inherent to AC diagnosis, US imaging, correlation with arthroscopic and MRI findings. Forty papers which were strictly related to the topic of this narrative review were initially chosen, then 20 studies which described and exploited US for AC diagnosis were finally included. Coracohumeral ligament (2.65 ± 0.4 mm) and axillary pouch thickening (3.34 ± 0.8 mm), as well as an increase in vascularity at rotator interval (78/214, 36.44%), represented the commonest US signs useful for AC diagnosis and for which the most significant cut-off values were reported. CONCLUSIONS The evidence collected in this review testify that musculoskeletal US is as reliable as MRI for AC diagnosis, therefore we believe that in this context US should be considered a first-line imaging technique.
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Affiliation(s)
- S G Al Khayyat
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy.
| | - P Falsetti
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - E Conticini
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - B Frediani
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - S Galletti
- Advanced Musculoskeletal Ultrasound, SIUMB School of Bologna, Maggiore Hospital, Bologna, Italy
| | - S M Stella
- SIUMB Advanced School for Musculoskeletal Ultrasound, Department of Clinical and Experimental Medicine, University Post-Graduate Course, Santa Chiara University Hospital, Pisa, Italy
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Shrestha-Taylor S, Clarke JL, Poulos A, Ginn K. Ultrasound Features for the Diagnosis of Adhesive Capsulitis/Frozen Shoulder: A Systematic Review. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:2379-2397. [PMID: 36058800 DOI: 10.1016/j.ultrasmedbio.2022.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 07/02/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
While ultrasound has become a preferred tool for musculoskeletal imaging, differing ultrasound findings that have been reported in patients with adhesive capsulitis can create confusion and misconceptions. This systematic review was aimed at summarizing all the ultrasound features currently described in the literature and providing a critical analysis of the sources to allow the readers to make a well-informed decision on the reliability of these features in the diagnosis of this condition. Databases were searched for original studies up to August 2021. Twenty-three studies were included. The QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) tool was used to assess the quality of each selected article. Fourteen ultrasound features were identified. A quality analysis of all ultrasound features was performed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) framework. All studies exhibited considerable heterogeneity in investigated ultrasound features and methodologies employed; therefore, meta-analysis was not considered to be appropriate. Hence, narrative synthesis was performed. The overall quality of each ultrasound outcome was found to be of "low" to "very low" level, and the generalisability of the results was also thought to be limited. Cautious interpretation and clinical correlation are recommended while applying these ultrasound features in clinical practice.
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Affiliation(s)
| | - Jillian L Clarke
- Discipline of Medical Imaging Science, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Ann Poulos
- Discipline of Medical Imaging Science, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Karen Ginn
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
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Sequential Ultrasound Assessment of Peri-Articular Soft Tissue in Adhesive Capsulitis of the Shoulder: Correlations with Clinical Impairments—Sequential Ultrasound in Adhesive Capsulitis. Diagnostics (Basel) 2022; 12:diagnostics12092231. [PMID: 36140631 PMCID: PMC9497809 DOI: 10.3390/diagnostics12092231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 11/17/2022] Open
Abstract
Recently, ultrasound measurements of the shoulder such as thickening of the rotator interval (RI) and the axillary recess (AR) are suggested as specific indicators of adhesive capsulitis. Herein, we evaluated the sequential changes in ultrasound parameters and clinical impairments and the correlation between the two in the case of adhesive capsulitis through a prospective observational study of 56 patients with adhesive capsulitis. Clinical assessments and ultrasound parameters, including the thicknesses of the RI and AR, were surveyed at baseline and after 1, 3, and 6 months. In 56 patients with adhesive capsulitis, the thickness of the AR significantly decreased at each follow-up evaluation, but the thickness of the RI showed a significant decrease only between the baseline and 1-month evaluation. In repeated analyses of correlation, the thickness of the AR was strongly correlated with all clinical impairments except the pain at rest and range of internal rotation in the affected shoulder. The thickness of AR was correlated with clinical impairments in patients with adhesive capsulitis during the 6 months follow up and could be useful as a surrogate marker in patients with adhesive capsulitis.
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Lee JG, Peo H, Cho JH, Cho CH, Kim DK, Kim DH. Dynamic Ultrasonographic Measurement of Inferior Joint Capsule Thickness in Patients with Unilateral Frozen Shoulder. Diagnostics (Basel) 2021; 11:diagnostics11050898. [PMID: 34070046 PMCID: PMC8158117 DOI: 10.3390/diagnostics11050898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/06/2021] [Accepted: 05/13/2021] [Indexed: 11/16/2022] Open
Abstract
The diagnostic value of ultrasonography (US) for frozen shoulder (FS) is not well established. This study aimed to assess the diagnostic value of US measurement of inferior joint capsule (IJC) thickness and evaluate changes in the thickness of the IJC by US depending on arm position. A total of 71 patients with clinically diagnosed unilateral FS who underwent bilateral US measurement of the IJC were enrolled in this study. The US measurement of the IJC was performed with a linear transducer positioned around the anterior axillary line with the shoulder 40° abducted and with neutral rotation of the glenohumeral joint (neutral position). We also measured the IJC thickness in the externally rotated and internally rotated positions with the shoulder 40° abducted. In the neutral position, as well as in the internally rotated and externally rotated positions, the thickness of the IJC on US was significantly higher in the affected shoulder than that in the unaffected shoulder (all p < 0.001). On both the affected and unaffected sides, the US thickness of the IJC in the neutral position was significantly higher than that in the externally rotated position (p < 0.001), but lower than that in the internally rotated position (p < 0.001). Regarding IJC thickness in the neutral position, a 3.2-mm cutoff value yielded the highest diagnostic accuracy for FS, with a sensitivity and specificity of 73.2% and 77.5%, respectively. The area under the curve for IJC thickness was 0.824 (95% confidence interval, 0.76–0.89). US measurement of the IJC in the neutral position yielded good diagnostic accuracy for FS. Because IJC thickness is affected by arm rotation, it is important to measure the IJC thickness in a standardized posture to ensure diagnostic value.
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Affiliation(s)
- Jun-Gyu Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, Seoul 06973, Korea; (J.-G.L.); (H.P.); (D.-K.K.)
| | - Hyungsun Peo
- Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, Seoul 06973, Korea; (J.-G.L.); (H.P.); (D.-K.K.)
| | - Jang-Hyuk Cho
- Department of Rehabilitation Medicine, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu 42601, Korea;
| | - Chul-Hyun Cho
- Department of Orthopedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu 42601, Korea;
| | - Don-Kyu Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, Seoul 06973, Korea; (J.-G.L.); (H.P.); (D.-K.K.)
| | - Du-Hwan Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, Seoul 06973, Korea; (J.-G.L.); (H.P.); (D.-K.K.)
- Correspondence: ; Tel.: +82-2-6299-1884
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7
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Do JG, Hwang JT, Yoon KJ, Lee YT. Correlation of Ultrasound Findings With Clinical Stages and Impairment in Adhesive Capsulitis of the Shoulder. Orthop J Sports Med 2021; 9:23259671211003675. [PMID: 33997079 PMCID: PMC8113659 DOI: 10.1177/23259671211003675] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/15/2020] [Indexed: 11/22/2022] Open
Abstract
Background: Ultrasound is an essential tool for diagnosing shoulder disorders. However, the role of ultrasound in assessing and diagnosing adhesive capsulitis has not been fully studied. Purpose: To evaluate the ultrasound features of adhesive capsulitis and estimate the correlations between clinical impairment and ultrasound parameters. Study Design: Case series; Level of evidence, 4. Methods: A total of 61 patients with clinically diagnosed unilateral adhesive capsulitis were retrospectively reviewed using high-resolution ultrasound. To compare ultrasound parameters, we performed ultrasound examinations on both affected and unaffected shoulders. Ultrasound parameters, including thickness of the coracohumeral ligament (CHL), rotator interval (RI), axillary recess (AR), hypervascularity of the RI, and effusion of the long head of the biceps tendon sheath, were measured. Passive range of motion (PROM), visual analog scale for pain, and the Shoulder Pain and Disability Index were used for clinical assessment. Results: The CHL, the RI, and the AR in affected shoulders were significantly thicker than in unaffected shoulders (P < .05). CHL thickness in affected shoulders was significantly correlated with PROM limitation, which included forward elevation, abduction, external rotation (ER), and internal rotation (IR) (P < .05). AR thickness correlated with passive forward elevation limitation and passive IR limitation (P < .05). The CHL was significantly thicker in stage 2 compared with stage 1, and the RI was thicker in stage 2 compared with stage 3. The diagnostic cutoff values for adhesive capsulitis were 2.2 mm for CHL thickness (77% sensitivity, 91.8% specificity) and 4 mm for AR thickness (68.9% sensitivity, 90.2% specificity). Conclusion: The ultrasound parameters associated with structural changes were correlated with clinical characteristics of adhesive capsulitis. Thickened CHL, RI, and AR were observed in affected shoulders. The cutoff values of 2.2 mm for CHL thickness and 4 mm for AR thickness can be used as cutoff diagnostic values for adhesive capsulitis.
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Affiliation(s)
- Jong Geol Do
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin Tae Hwang
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung Jae Yoon
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong-Taek Lee
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Comparison of Shoulder Ultrasonographic Assessments between Polymyalgia Rheumatica and Frozen Shoulder in Patients with Bilateral Shoulder Pain: A Comparative Retrospective Study. J Pers Med 2021; 11:jpm11050372. [PMID: 34063666 PMCID: PMC8147595 DOI: 10.3390/jpm11050372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 11/22/2022] Open
Abstract
This study aimed to assess and compare the ultrasonographic (US) pathologic findings in patients with polymyalgia rheumatica (PMR) and bilateral frozen shoulder (FS). We included 19 patients with clinically diagnosed PMR and 19 patients with stage II bilateral FS. The US evaluation included the assessment of subacromial-subdeltoid (SASD) bursitis, long head of biceps (LHB) tenosynovitis, and posterior and inferior glenohumeral (GH) synovitis. Unilateral SASD bursitis was noted significantly more frequently in PMR patients than in bilateral FS patients (p = 0.001). There were no significant differences in the incidence of unilateral LHB tenosynovitis and posterior GH synovitis between PMR and bilateral FS patients (p = 0.108 and p = 0.304, respectively). Unilateral inferior GH synovitis was more common among bilateral FS patients than among PMR patients (p < 0.001). Bilateral SASD bursitis and LHB tenosynovitis were noted significantly more frequently in PMR patients than in bilateral FS patients (p < 0.001 and 0.049, respectively). Significant differences were not observed in the incidence of bilateral posterior GH synovitis between PMR and bilateral FS patients (p = 0.426). Bilateral inferior GH synovitis was more common among bilateral FS patients than among PMR patients (p = 0.044). The US evidence for bilateral inferior GH synovitis without bilateral SASD showed high specificity (94.7%) with sensitivity (78.9%) for the diagnosis of bilateral FS. SASD bursitis, representing periarticular synovial inflammation, was more common among the patients with PMR than among the patients with bilateral FS. Inferior GH synovitis without SASD bursitis suggests FS rather than PMR in patients with bilateral shoulder pain.
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Yun SJ, Jin W, Cho NS, Ryu KN, Yoon YC, Cha JG, Park JS, Park SY, Choi NY. Shear-Wave and Strain Ultrasound Elastography of the Supraspinatus and Infraspinatus Tendons in Patients with Idiopathic Adhesive Capsulitis of the Shoulder: A Prospective Case-Control Study. Korean J Radiol 2020; 20:1176-1185. [PMID: 31270981 PMCID: PMC6609436 DOI: 10.3348/kjr.2018.0918] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 04/04/2019] [Indexed: 01/05/2023] Open
Abstract
Objective To compare the elasticity of the supraspinatus tendon (SST) and infraspinatus tendon (IST) in patients with idiopathic adhesive capsulitis of the shoulder (ACS) with those in the control groups and to evaluate the relationship between age and tendon elasticity. Materials and Methods The Institutional Review Board approved this prospective, case-control study, which was conducted between November 2017 and March 2018, and informed consent was obtained from all participants. Control groups comprised healthy individuals or those with asymptomatic contralateral shoulders. Twenty-five shoulders in 20 participants in the ACS group (14 women; 53.5 ± 7.9 years) and 24 shoulders in 18 participants in the control group (6 women; 52.6 ± 10.5 years) were included. Elastography was performed in the oblique coronal plane at the neutral shoulder position. Mean/maximum/minimum velocity and stiffness from the shear-wave ultrasound elastography (SWE) and strain ratio (subcutaneous fat/target-tendon) from the strain ultrasound elastography (SE) of the SST and IST were evaluated. Statistical analyses were performed using the Mann-Whitney U test, receiver operating characteristic (ROC) curve, and Spearman correlation. Results Both velocity and stiffness in SWE were higher, and the strain ratio in SE was lower in participants with symptomatic shoulders than in those with normal shoulders (p < 0.001). SST- and IST-mean velocity, mean stiffness, and strain ratios showed excellent area under the ROC curve (> 0.970). The elastic modulus was little correlated with age (ρ = −0.340–0.239). Conclusion SWE and SE indicated that SST and IST were stiffer in patients with ACS than in those with normal shoulders regardless of aging.
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Affiliation(s)
- Seong Jong Yun
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Wook Jin
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea.
| | - Nam Su Cho
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Kyung Nam Ryu
- Department of Radiology, Kyung Hee University Hospital, Seoul, Korea
| | - Young Cheol Yoon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jang Gyu Cha
- Department of Radiology, Soonchunhyang Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Ji Seon Park
- Department of Radiology, Kyung Hee University Hospital, Seoul, Korea
| | - So Young Park
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Na Young Choi
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea
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Kim DH, Choi YH, Oh S, Kim HJ, Chai JW. Ultrasound Microflow Imaging Technology for Diagnosis of Adhesive Capsulitis of the Shoulder. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:967-976. [PMID: 31782541 DOI: 10.1002/jum.15181] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/21/2019] [Accepted: 11/05/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To assess the diagnostic accuracy of Superb Microvascular Imaging (SMI; Canon Medical Systems, Otawara, Japan) at the subcoracoid triangle for adhesive capsulitis of the shoulder, to compare the diagnostic value of SMI with that of conventional ultrasound (US) and power Doppler ultrasound (PDUS) findings, and to investigate the correlation between vascular flow on SMI with clinical features. METHODS Our study included 39 patients with a diagnosis of adhesive capsulitis and 35 healthy patients as a control group. The echogenicity in the rotator interval and coracohumeral ligament thickness were assessed with conventional US. Vascular flow in the subcoracoid fat triangle was evaluated with SMI and PDUS (SMI and PDUS areas). A receiver operating characteristic curve analysis was performed to evaluate diagnostic accuracy. The correlation between US findings and the range of motion, pain intensity, and duration of symptoms was also evaluated. RESULTS The SMI area was higher in the adhesive capsulitis group than in the control group (2.95 versus 0 mm2 ; P < .01). The visualization of vascular flow at the subcoracoid fat triangle was superior with SMI compared with PDUS (P < .01). In the receiver operating characteristic analysis, the SMI area showed higher diagnostic performance, with an area under the curve of 0.90 compared with other US findings. The area of SMI vascular flow was also negatively correlated with external rotation and forward flexion (P < .05) in the adhesive capsulitis group. CONCLUSIONS Measurement of vascular flow at the subcoracoid fat triangle using SMI facilitated the diagnosis of adhesive capsulitis. Superb Microvascular Imaging was superior to PDUS in diagnostic performance. Vascular flow was negatively correlated with the range of motion of external rotation and forward flexion.
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Affiliation(s)
- Dong Hyun Kim
- Departments of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Yoon-Hee Choi
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sohee Oh
- Biostatistics, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hyo Jin Kim
- Departments of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jee Won Chai
- Departments of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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11
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Value of Anterior Band of the Inferior Glenohumeral Ligament Area as a Morphological Parameter of Adhesive Capsulitis. Pain Res Manag 2019; 2019:9301970. [PMID: 31205575 PMCID: PMC6530218 DOI: 10.1155/2019/9301970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 03/18/2019] [Accepted: 03/28/2019] [Indexed: 11/25/2022]
Abstract
Objective Thickened inferior glenohumeral ligament (IGHL) is considered as one of the major morphological parameters of adhesive capsulitis (AC). Previous studies reported that the anterior band of inferior glenohumeral ligament thickness (aIGHLT) is correlated with shoulder capsular contracture, luxatio erecta humeri, and AC. However, the thickness varies from the measured angle. To reduce this measurement error, we devised a new morphological parameter, called the anterior band of inferior glenohumeral ligament area (aIGHLA). Methods The aIGHL samples were collected from 54 patients with AC and from 50 control subjects who underwent shoulder magnetic resonance imaging (MRI) without any evidence of AC. Coronal T2-weighted MRI images were obtained at the shoulder level from each patient. We measured the aIGHLA and aIGHLT at the maximal view of the IGHL in the coronal plane using our picture archiving and communication system. The aIGHLA was measured at the whole cross-sectional area of the IGHL in the most hypertrophied segment of the coronal MR images. The aIGHLT was measured at the thickest point of the IGHL. Results The average aIGHLA was 55.58 ± 14.16 mm2 in the control group and 83.71 ± 28.45 mm2 in the AC group. The average aIGHLT was 3.47 ± 0.99 mm in the control group and 4.52 ± 1.02 mm in the AC group. AC patients showed significantly greater aIGHLA (p < 0.001) and aIGHLT (p < 0.001) than control subjects. Receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off score of the aIGHLA was 63.37 mm2, with 79.6% sensitivity, 80.0% specificity, and AUC of 0.84 (95% CI, 0.76–0.92). The optimal cut-off point of the IGHLT was 3.81 mm, with 74.1% sensitivity, 74.0% specificity, and AUC of 0.77 (95% CI, 0.68–0.86). Conclusions Although the aIGHLA and aIGHLT were both significantly associated with AC, the aIGHLA was a more sensitive diagnostic parameter.
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Sernik RA, Vidal Leão R, Luis Bizetto E, Sanford Damasceno R, Horvat N, Guido Cerri G. Thickening of the axillary recess capsule on ultrasound correlates with magnetic resonance imaging signs of adhesive capsulitis. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2019; 27:183-190. [PMID: 32549898 DOI: 10.1177/1742271x19840063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 03/04/2019] [Indexed: 11/17/2022]
Abstract
Objective To correlate the thickness of the axillary recess capsule measured by ultrasound with magnetic resonance imaging signs of adhesive capsulitis in patients with shoulder pain. Materials and methods We prospectively evaluated 193 consecutive patients (141 women and 52 men, aged 40-69 years) with shoulder pain lasting 1-9 months from January 2015 to December 2016 who underwent shoulder ultrasound. All participants had routine shoulder ultrasound with additional measurement of axillary recess capsule thickness. After examinations, two groups were formed: negative ultrasound group, composed of patients with a capsule thickness of 2.0 mm or less, and positive ultrasound group, composed of individuals with a capsule thickness greater than 2.0 mm. All patients from the positive ultrasound group and 27 randomly chosen patients from the negative ultrasound group underwent shoulder magnetic resonance imaging. Results In all, 169/193 patients (88%) had an axillary recess capsule thickness of 2.0 mm or less (negative ultrasound group) and 24/193 patients (12%) had a capsule thickness greater than 2.0 mm (positive ultrasound group). Twenty-seven patients from negative ultrasound group (27/169) were randomly selected to undergo shoulder magnetic resonance imaging. None of them had magnetic resonance imaging criteria for adhesive capsulitis. All patients from positive ultrasound group (24/24) underwent shoulder magnetic resonance imaging and 23 of them (23/24) had magnetic resonance imaging signs of adhesive capsulitis, with a sensitivity of 100% and a specificity of 96%. Conclusion In patients with shoulder pain, a thickness greater than 2.0 mm of the axillary recess capsule measured by ultrasound correlates to magnetic resonance imaging signs of adhesive capsulitis with good sensitivity and specificity.
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Affiliation(s)
- Renato A Sernik
- Department of Radiology, Hospital Sírio-Libanês, São Paulo, Brazil
| | | | | | | | - Natally Horvat
- Department of Radiology, Hospital Sírio-Libanês, São Paulo, Brazil
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Park GY. Role of Ultrasonography in Diagnosis and Treatment of Frozen Shoulder. JOURNAL OF RHEUMATIC DISEASES 2019. [DOI: 10.4078/jrd.2019.26.3.149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Gi-Young Park
- Department of Rehabilitation Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
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Kim DH, Cho CH, Sung DH. Ultrasound measurements of axillary recess capsule thickness in unilateral frozen shoulder: study of correlation with MRI measurements. Skeletal Radiol 2018; 47:1491-1497. [PMID: 29770850 DOI: 10.1007/s00256-018-2959-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 04/02/2018] [Accepted: 04/23/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aims of this study were to compare the ultrasound thickness of the affected axillary recess capsule (ARC) with that of the unaffected ARC in patients with frozen shoulder (FS), to analyze whether the ultrasound measurements of the ARC thickness correlate with those obtained using MRI, and to assess whether the ultrasound thickness of the ARC correlates with the patterns of range of motion limitation. MATERIALS AND METHODS Forty-four patients with clinically diagnosed unilateral FS and MRI evaluation performed ultrasound measurement of ARC. The ultrasound measurement of the ARC thickness was performed with the patients in a supine position with their shoulder abducted by 40°. The ARC thickness was also measured by MRI on oblique coronal images by another physician blinded to the ultrasound measurements. With both ultrasound and MRI, ARC thickness was determined at the widest portion of the capsule. RESULTS The ultrasound thickness of ARC was significantly higher in the affected shoulder (4.4 ± 1.1 mm) than in the unaffected one (2.2 ± 0.5 mm) (p < 0.001). The ultrasound thickness of the ARC in the affected shoulder correlated with that measured by MRI (8.9 ± 1.9 mm) (p < 0.001, r = 0.83). The ARC thickness, whether measured by ultrasound or MRI, was not significantly related to the limitation of movement in specific directions. CONCLUSION Ultrasound can demonstrate the difference in ARC thickness between affected and unaffected shoulders in patients with unilateral FS. The ARC thickness measured by ultrasound correlates with that measured by MRI.
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Affiliation(s)
- Du Hwan Kim
- Department of Rehabilitation Medicine, Dongsan Medical Center, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu, 41931, South Korea.
| | - Chul-Hyun Cho
- Department of Orthopedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, South Korea
| | - Duk Hyun Sung
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Park GY, Park JH, Kwon DR, Kwon DG, Park J. Do the Findings of Magnetic Resonance Imaging, Arthrography, and Ultrasonography Reflect Clinical Impairment in Patients With Idiopathic Adhesive Capsulitis of the Shoulder? Arch Phys Med Rehabil 2017; 98:1995-2001. [DOI: 10.1016/j.apmr.2017.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/29/2017] [Accepted: 06/01/2017] [Indexed: 10/19/2022]
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Ahn JH, Lee DH, Kang H, Lee MY, Kang DR, Yoon SH. Early Intra-articular Corticosteroid Injection Improves Pain and Function in Adhesive Capsulitis of the Shoulder: 1-Year Retrospective Longitudinal Study. PM R 2017; 10:19-27. [DOI: 10.1016/j.pmrj.2017.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 05/25/2017] [Accepted: 06/03/2017] [Indexed: 11/24/2022]
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Carr BJ, Canapp SO, Canapp DA, Gamble LJ, Dycus DL. Adhesive Capsulitis in Eight Dogs: Diagnosis and Management. Front Vet Sci 2016; 3:55. [PMID: 27471728 PMCID: PMC4943935 DOI: 10.3389/fvets.2016.00055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 07/01/2016] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To describe clinical and diagnostic findings as well as management of adhesive capsulitis in dogs. BACKGROUND Adhesive capsulitis, also known as frozen shoulder, is a syndrome defined by loss of range of motion of the shoulder and may be the end-stage manifestation of several primary conditions. EVIDENTIARY VALUE This is a case series report of eight dogs with chronic forelimb lameness diagnosed with adhesive capsulitis. METHODS Medical records (June 1, 2010-September 1, 2015) including, physical examination findings, radiographic findings, magnetic resonance imaging (MRI) findings, arthroscopy findings, and treatment plans were reviewed. RESULTS All dogs presented with a chronic, grade III-VI/VI forelimb lameness. On orthopedic examination, all dogs had moderate to significant discomfort on shoulder extension and flexion and severe restriction of range of motion. Six of the eight dogs had evidence of bone remodeling and sclerosis in the affected shoulder on radiographs. Six of the dogs had an initial diagnostic ultrasound performed, which revealed evidence of fibrous scar tissue. Five dogs had MRI performed that revealed moderate shoulder effusion and enhancement of the synovial lining of the shoulder. Arthroscopy was performed in five of the eight patients. Three were noted to have significant contracture, adhesions, and fibrous scar tissue of the joint capsule. Severe inflammation was noted throughout the synovium of two patients. All eight patients tried conservative management consisting of oral medications and rehabilitation therapy. Five of the eight patients received extracorporeal shockwave therapy. Three patients received regenerative medicine treatment in the affected supraspinatus and shoulder. Regardless of the treatment elected, none of the dogs were reported to have significant improvement. CONCLUSION Adhesive capsulitis is an uncommon cause of chronic forelimb lameness. Further investigation is needed to describe the etiology and pathogenesis of adhesive capsulitis in dogs to evaluate the effectiveness of both non-surgical and surgical treatment modalities, establish treatment protocols, and evaluate short- and long-term clinical outcome of patients. APPLICATION Adhesive capsulitis should be considered in patients with chronic forelimb lameness and moderate to significant discomfort and restriction on shoulder range of motion.
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Affiliation(s)
- Brittany J Carr
- Veterinary Orthopedic and Sports Medicine , Annapolis Junction, MD , USA
| | - Sherman O Canapp
- Veterinary Orthopedic and Sports Medicine , Annapolis Junction, MD , USA
| | - Debra A Canapp
- Veterinary Orthopedic and Sports Medicine , Annapolis Junction, MD , USA
| | - Lauri-Jo Gamble
- Veterinary Orthopedic and Sports Medicine , Annapolis Junction, MD , USA
| | - David L Dycus
- Veterinary Orthopedic and Sports Medicine , Annapolis Junction, MD , USA
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Kim KT, Lee DG, Lee S, Kim DH. Ultrasonographic Measurement of the Thickness of Axillary Recess Capsule in Healthy Volunteers. Ann Rehabil Med 2016; 40:502-8. [PMID: 27446788 PMCID: PMC4951370 DOI: 10.5535/arm.2016.40.3.502] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 10/20/2015] [Indexed: 11/13/2022] Open
Abstract
Objective To evaluate the inter-rater and intra-rater reliability of ultrasonographic measurements of axillary recess (AR) thickness in healthy individuals, and to analyze the factors affecting the thickness of the AR capsule. Methods We recruited 20 healthy individuals (10 male, 10 female) with a mean age of 37 years (standard deviation ±10). Two physiatrists (an experienced and a novice rater) independently investigated the AR thickness in three rounds. The AR thickness was measured for each individual at three shoulder abduction angles (50°, 70°, and 90°). Intra-class correlation (ICC) coefficients were used to assess the reproducibility of each measurement. Results Excellent intra-rater reliability coefficients were observed at the three shoulder abduction angles, in the analysis of both raters. The inter-rater reliability coefficient was also was excellent in both studies. There were significant differences in the AR thickness, according to the angle of shoulder abduction. The AR was thicker at 50° than at 70° and 90° (all p<0.001), and the AR was thicker at 70° than at 90° (p<0.001). Height (r=0.62, p=0.003) and body mass index (r=0.52, p=0.019) were positively correlated with AR thickness. Males had a thicker AR capsule than females at all three angles (all p<0.001). Conclusion Ultrasonographic measurements of AR thickness in healthy individuals demonstrate excellent intra-rater and inter-rater reliability. AR thickness may depend on anthropometric variables and position of the shoulder.
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Affiliation(s)
- Kyoung Tae Kim
- Department of Rehabilitation Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Dong Gyu Lee
- Department of Rehabilitation Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Soyoung Lee
- Department of Rehabilitation Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Du Hwan Kim
- Department of Rehabilitation Medicine, Keimyung University School of Medicine, Daegu, Korea.; Pain Research Center, Keimyung University School of Medicine, Daegu, Korea.; Institute for Medical Science, Keimyung University School of Medicine, Daegu, Korea
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Clinical identifiers for early-stage primary/idiopathic adhesive capsulitis: are we seeing the real picture? Phys Ther 2014; 94:968-76. [PMID: 24652474 DOI: 10.2522/ptj.20130398] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Adhesive capsulitis is often difficult to diagnose in its early stage and to differentiate from other common shoulder disorders. OBJECTIVE The aim of this study was to validate any or all of the 8 clinical identifiers of early-stage primary/idiopathic adhesive capsulitis established in an earlier Delphi study. DESIGN This was a cross-sectional study. METHODS Sixty-four patients diagnosed with early-stage adhesive capsulitis by a physical therapist or medical practitioner were included in the study. Eight active and 8 passive shoulder movements and visual analog scale pain scores for each movement were recorded prior to and immediately following an intra-articular injection of corticosteroid and local anesthetic. Using the local anesthetic as the reference standard, pain relief of ≥70% for passive external rotation was deemed a positive anesthetic response (PAR). RESULTS Sixteen participants (25%) demonstrated a PAR. Univariate logistic regression identified that of the proposed identifiers, global loss of passive range of movement (odds ratio [OR]=0.26, P=.03), pain at the end of range of all measured active movements (OR=0.06, P=.02), and global loss of passive glenohumeral movements (OR=0.23, P=.02) were associated with a PAR. Following stepwise removal of the variables, pain at the end of range of all measured active movements remained the only identifier but was associated with reduced odds of a PAR. LIMITATIONS The lack of a recognized reference standard for diagnosing early-stage adhesive capsulitis remains problematic in all related research. CONCLUSIONS None of the clinical identifiers for early-stage adhesive capsulitis previously proposed by expert consensus have been validated in this study. Clinicians should be aware that commonly used clinical identifiers may not be applicable to this stage.
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