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Tamai K, Hamada J, Nagase Y, Morishige M, Naito M, Asai H, Tanaka S. Can magnetic resonance imaging distinguish clinical stages of frozen shoulder? A state-of-the-art review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:365-370. [PMID: 39157226 PMCID: PMC11329028 DOI: 10.1016/j.xrrt.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
Background Frozen shoulder (FS) is a common disorder causing shoulder pain and limited motion. Magnetic resonance imaging (MRI) is expected to help diagnose FS and realize the disease stage if stage-specific features are present. We aimed to survey stage-related MRI findings of FS in the literature. Methods MEDLINE, SCOPUS, and Google Scholar databases were searched with search terms "frozen shoulder" or "adhesive capsulitis" combined with "magnetic resonance imaging." Studies that discussed MRI findings in relation to FS stages were retrieved. The course of FS was divided into stages 1 to 4 according to Hannafin and Chiaia. Results Two of the noncontrast-enhanced MRI findings were stage-related. T2 signal hyperintensity of the joint capsule was more frequent in stages 1 and 2. The axillary capsule thickness was greater in stages 1 and 2. However, these findings were also seen in the later stages to a lesser degree. Effusion around the long head of biceps, subcoracoid fat obliteration, and coracohumeral ligament thickening were common in FS but their relation to the stages was not evident. Signal enhancement on contrast-enhanced MRI was not consistently linked to stages. Conclusion T2 signal hyperintensity and axillary capsule thickening are characteristic of the early stages of FS, although MRI alone cannot completely define the disease stage.
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Affiliation(s)
- Kazuya Tamai
- Department of Orthopedic Surgery, Tohto Bunkyo Hospital, Tokyo, Japan
| | - Junichiro Hamada
- Department of Orthopaedic Surgery, Kuwano Kyoritsu Hospital, Koriyama, Fukushima, Japan
| | - Yuichi Nagase
- Department of Rheumatology Surgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | | | - Masashi Naito
- Department of Orthopedic Surgery, National Hospital Organization Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Hideaki Asai
- Department of Orthopedic Surgery, Yashio Central General Hospital, Yashio, Saitama, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
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Rhim HC, Schon JM, Xu R, Schowalter S, Ha J, Hsu C, Andrew M, Robinson DM, Tenforde AS, Daneshvar DH. Targeting the Sweet Spot: A Systematic Review With Meta-Analysis of Anterior Versus Posterior Glenohumeral Joint Injections for Adhesive Capsulitis. Clin J Sport Med 2024:00042752-990000000-00191. [PMID: 38810121 DOI: 10.1097/jsm.0000000000001228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
OBJECTIVE To compare clinical outcomes following steroid injections using the anterior and posterior approaches. DESIGN Systematic review with meta-analysis. SETTING Embase, Web of Science, and Cochrane Center Register of Controlled Trials were searched for randomized control trials (RCTs) and prospective comparative studies. PATIENTS Patients with adhesive capsulitis. INTERVENTIONS Glenohumeral steroid injections using either anterior or posterior approach. MAIN OUTCOME MEASURES Pain visual analog scale (VAS) and shoulder range of motion (ROM) at 12 weeks, accuracy, and adverse events. Standardized mean difference (SMD) for VAS and weighted mean difference (WMD) for ROMs. RESULTS We identified 6 RCTs and one prospective comparative study with a total of 468 patients. While there was no difference in pain VAS at 12 weeks between the 2 approaches (SMD, -0.86; 95% CI, -1.76 to 0.04), the anterior approach resulted in greater improvements in external rotation (WMD, 8.08; 95% CI, 0.79-15.38) and abduction (WMD, 6.76; 95% CI, 3.05-10.48) compared with the posterior approach. Subgroup analysis with RCTs that utilized steroid injection with hydrodilatation for both approaches demonstrated greater reduction in pain VAS at 12 weeks with the anterior approach (SMD, -0.52; 95% CI, -0.98 to -0.07). Overall, procedures were well tolerated without major complications. CONCLUSIONS While pain reduction is similar, the anterior approach may be more beneficial in restoring shoulder external rotation and abduction compared with the posterior approach at 12 weeks. Steroid injection combined with hydrodilatation may further improve pain control when performed with the anterior approach at 12 weeks.
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Affiliation(s)
- Hye Chang Rhim
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Jason M Schon
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Raylin Xu
- Harvard Medical School, Boston, Massachusetts; and
| | - Sean Schowalter
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Jane Ha
- Clinical and Translational Epidemiology Unit, Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts
| | - Connie Hsu
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Michael Andrew
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - David M Robinson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Daniel H Daneshvar
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
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de Angelis Guerra Dotta T, Assunção JH, Baptista E, E Silva FBA, Gracitelli MEC, Neto AAF, Malavolta EA. Diagnostic accuracy of non-contrast MRI in frozen shoulder. Arch Orthop Trauma Surg 2024; 144:1149-1159. [PMID: 38231206 DOI: 10.1007/s00402-023-05184-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/14/2023] [Indexed: 01/18/2024]
Abstract
INTRODUCTION Despite being the most used exam today, few studies have evaluated the accuracy of findings on non-contrast magnetic resonance imaging (MRI). The primary objective of the study was to evaluate the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of non-contrast MRI findings in frozen shoulder, isolated and in combination. The secondary objectives were to define the interobserver and intraobserver agreement of the assessments and the odds ratio for frozen shoulder because of the various findings of MRI. METHODS A retrospective diagnostic accuracy study comparing non-contrast MRI findings between the frozen shoulder group and the control group. Sensitivity, specificity, positive and negative predictive value, accuracy, odds ratio, interobserver and intraobserver agreement were calculated for each finding and their possible associations. RESULTS The hyperintensity on capsule in the axillary recess presented 84% sensitivity, 94% specificity, and 89% accuracy. The obliteration of the subcoracoid fat triangle in the rotator interval had sensitivity 34%, specificity 82% and accuracy 58%. For coracohumeral ligament thickness ≥ 2 mm had specificity 66%, 48% specificity and 57% accuracy. Capsule thickness in the axillary recess ≥ 4 mm resulted in 54% sensitivity, 82% specificity, and 68% accuracy. Regarding interobserver agreement, only the posteroinferior and posterosuperior quadrants showed moderate results, and all the others showed strong reliability. The odds ratio for hyperintensity in the axillary recess was 82.3 for frozen shoulder. The association of these findings increased specificity (95%). CONCLUSION The accuracy of non-contrast magnetic resonance imaging is high for diagnosing frozen shoulder, especially when evaluating the hyperintensity of the axillary recess. The exam has high reliability and reproducibility. The presence of an association of signs increases the specificity of the test. LEVEL OF EVIDENCE Level III, study of diagnostic test.
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Affiliation(s)
- Thiago de Angelis Guerra Dotta
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo-IOTHCFMUSP, Rua Dr. Ovídio Pires de Campos 333 3 Floor, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil.
| | - Jorge Henrique Assunção
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo-IOTHCFMUSP, Rua Dr. Ovídio Pires de Campos 333 3 Floor, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil
| | - Eduardo Baptista
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo-IOTHCFMUSP, Rua Dr. Ovídio Pires de Campos 333 3 Floor, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil
| | - Fernando Brandão Andrade E Silva
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo-IOTHCFMUSP, Rua Dr. Ovídio Pires de Campos 333 3 Floor, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil
| | - Mauro Emilio Conforto Gracitelli
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo-IOTHCFMUSP, Rua Dr. Ovídio Pires de Campos 333 3 Floor, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil
| | - Arnaldo Amado Ferreira Neto
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo-IOTHCFMUSP, Rua Dr. Ovídio Pires de Campos 333 3 Floor, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil
| | - Eduardo Angeli Malavolta
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo-IOTHCFMUSP, Rua Dr. Ovídio Pires de Campos 333 3 Floor, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil
- Hospital do Coração-HCor, São Paulo, SP, Brazil
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Erber B, Hesse N, Goller S, Gilbert F, Ricke J, Glaser C, Heuck A. Diagnostic performance and interreader agreement of individual and combined non-enhanced and contrast-enhanced MR imaging parameters in adhesive capsulitis of the shoulder. Skeletal Radiol 2024; 53:263-273. [PMID: 37400604 PMCID: PMC10730686 DOI: 10.1007/s00256-023-04391-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/13/2023] [Accepted: 06/17/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE The aims of our study were to analyze agreement among readers with different levels of expertise and diagnostic performance of individual and combined imaging signs for the diagnosis of adhesive capsulitis of the shoulder. METHODS In a retrospective study, contrast-enhanced shoulder MRIs of 60 patients with and 120 without clinically diagnosed adhesive capsulitis were evaluated by three readers independently. As non-enhanced imaging signs, readers evaluated signal intensity and thickness of the axillary recess capsule, thickness of the rotator interval capsule and the coracohumeral ligament as well as obliteration of subcoracoid fat. Furthermore, contrast enhancement of axillary recess and rotator interval capsule were evaluated. Data analysis included interreader reliability, ROC analysis, and logistic regression (p < 0.05). RESULTS Contrast-enhanced parameters showed substantially higher agreement among readers (ICC 0.79-0.80) than non-enhanced parameters (0.37-0.45). AUCs of contrast-enhanced signs (95.1-96.6%) were significantly higher (p < 0.01) than of non-enhanced imaging signs (61.5-85.9%) when considered individually. Combined evaluation of axillary recess signal intensity and thicknesses of axillary recess or rotator interval-when at least one of two signs was rated positive-increased accuracy compared to individual imaging signs, however not statistically significant. CONCLUSION Contrast-enhanced imaging signs show both distinctly higher agreement among readers and distinctly higher diagnostic performance compared to non-enhanced imaging signs based on the imaging protocol used in this study. Combined evaluation of parameters showed a tendency to increase discrimination; however, the effect on diagnosis of ACS was not statistically significant.
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Affiliation(s)
- Bernd Erber
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Nina Hesse
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Sophia Goller
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Fabian Gilbert
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Christian Glaser
- Radiologisches Zentrum München, Pippinger Str. 25, 81245, Munich, Germany
| | - Andreas Heuck
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Radiologisches Zentrum München, Pippinger Str. 25, 81245, Munich, Germany
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5
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Kuhn I, Erber B, Goller SS. [Adhesive capsulitis]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:119-124. [PMID: 37801107 DOI: 10.1007/s00117-023-01217-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Adhesive capsulitis (CA; also called Frozen shoulder) is a common, usually unilateral disease of the shoulder joint primarily affecting middle-aged women. Primary, idiopathic, and secondary forms are distinguished. Painful active and passive movement restriction are the clinically leading symptoms. COURSE OF THE DISEASE The disease usually progresses in three successive stages: freezing phase, frozen phase, and thawing phase. CLINICAL DIAGNOSIS AND IMAGING CA is primarily diagnosed clinically, with imaging being used to assess or exclude differential diagnoses. Radiography as part of basic diagnostics allows exclusion of common differential diagnoses such as osteoarthritis of the shoulder or calcific tendinitis. Native magnetic resonance imaging (MRI) and MR arthrography (MRA) reveal pathomorphologies typical of CA. Intravenously administered gadolinium increases the sensitivity of MRI. Sonography may be used as a complementary diagnostic modality or as an alternative in case of contraindications to MRI. Fluoroscopy-guided arthrography has been replaced by MRI because of its invasiveness. Computed tomography (CT) has no role in diagnostics due to its radiation exposure and significantly lower sensitivity and specificity compared to MRI. TREATMENT Therapy of CA is stage-adapted and includes conservative measures such as analgesics and physiotherapy and surgical procedures such as arthroscopic arthrolysis. The therapeutic spectrum is supplemented by new, innovative procedures such as transarterial periarticular embolization. PROGNOSIS CA is self-limiting and usually persists for 2-3 years. However, the patients may even suffer from pain and limited range of motion beyond this time.
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Affiliation(s)
- Isabella Kuhn
- Muskuloskelettales Universitätszentrum München (MUM), LMU Klinikum, Ziemssenstr. 5, 80336, München, Deutschland
| | - Bernd Erber
- Klinik und Poliklinik für Radiologie, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, München, Deutschland
| | - Sophia Samira Goller
- Klinik und Poliklinik für Radiologie, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, München, Deutschland.
- Radiologie, Universitätsklinik Balgrist, Forchstr. 340, 8008, Zürich, Schweiz.
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Xu T, Xia Q, Zhang L, Yang X, Fu W. Type 2 diabetes and fasting glycemic traits are causal factors of frozen shoulder: a 2-sample Mendelian randomization analysis. J Shoulder Elbow Surg 2024; 33:399-408. [PMID: 37748531 DOI: 10.1016/j.jse.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/02/2023] [Accepted: 08/06/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND The causal relationship between type 2 diabetes (T2D) and frozen shoulder is unclear. This study aims to explore the genetic causal association between T2D and glycemic traits (fasting glucose [FG], fasting insulin [FI], glycated hemoglobin [HbA1c], and 2-hour postprandial glucose [2hGlu]) on frozen shoulder. METHODS Using 2-sample Mendelian randomization (MR), we analyzed nonconfounded estimates of the effects of T2D and glycemic traits on frozen shoulder. Single-nucleotide polymorphisms (SNPs) strongly associated (P < 5 × 10-8) with exposures from genome-wide association studies (GWAS) were identified. We employed fixed effect mode inverse variance weighting (IVW-FE), random effect mode IVW (IVW-MRE), MR-Egger, and weighted median to assess the association of exposures and outcome. Sensitivity analysis was conducted to test for heterogeneity and multidirectionality bias in MR. RESULTS We found a significant genetic causal correlation between T2D (IVW-MRE P = .007, odds ratio [OR] 1.093, 95% confidence interval [CI] 1.03-1.16), FG (IVW-FE P < .001, OR 1.455, 95% CI 1.173-1.806), and frozen shoulder, but no evidence for causal correlation between FI, HbA1c, and 2hGlu and frozen shoulder. Although there was certain heterogeneity, sensitivity analysis reveals no deviation from the MR assumptions. CONCLUSION This study supports a genetic causal relationship between T2D and FG and frozen shoulder.
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Affiliation(s)
- Tianhao Xu
- Sports Medicine Center, Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qinghong Xia
- Operating Room of Anesthesia Surgery Center, West China Hospital, Sichuan University West China School of Nursing, Chengdu, Sichuan, China
| | - Lei Zhang
- Sports Medicine Center, Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaolong Yang
- Sports Medicine Center, Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Weili Fu
- Sports Medicine Center, Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Chang EY, Bencardino JT, French CN, Fritz J, Hanrahan CJ, Jibri Z, Kassarjian A, Motamedi K, Ringler MD, Strickland CD, Tiegs-Heiden CA, Walker REA. SSR white paper: guidelines for utilization and performance of direct MR arthrography. Skeletal Radiol 2024; 53:209-244. [PMID: 37566148 PMCID: PMC10730654 DOI: 10.1007/s00256-023-04420-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/23/2023] [Accepted: 07/29/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE Direct magnetic resonance arthrography (dMRA) is often considered the most accurate imaging modality for the evaluation of intra-articular structures, but utilization and performance vary widely without consensus. The purpose of this white paper is to develop consensus recommendations on behalf of the Society of Skeletal Radiology (SSR) based on published literature and expert opinion. MATERIALS AND METHODS The Standards and Guidelines Committee of the SSR identified guidelines for utilization and performance of dMRA as an important topic for study and invited all SSR members with expertise and interest to volunteer for the white paper panel. This panel was tasked with determining an outline, reviewing the relevant literature, preparing a written document summarizing the issues and controversies, and providing recommendations. RESULTS Twelve SSR members with expertise in dMRA formed the ad hoc white paper authorship committee. The published literature on dMRA was reviewed and summarized, focusing on clinical indications, technical considerations, safety, imaging protocols, complications, controversies, and gaps in knowledge. Recommendations for the utilization and performance of dMRA in the shoulder, elbow, wrist, hip, knee, and ankle/foot regions were developed in group consensus. CONCLUSION Although direct MR arthrography has been previously used for a wide variety of clinical indications, the authorship panel recommends more selective application of this minimally invasive procedure. At present, direct MR arthrography remains an important procedure in the armamentarium of the musculoskeletal radiologist and is especially valuable when conventional MRI is indeterminant or results are discrepant with clinical evaluation.
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Affiliation(s)
- Eric Y Chang
- Radiology Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego Medical Center, San Diego, CA, USA
| | - Jenny T Bencardino
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Cristy N French
- Department of Radiology, Penn State Hershey Medical Center, Hummelstown, PA, USA
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Zaid Jibri
- GNMI in Mississauga, Greater Toronto Area, Toronto, ON, Canada
| | - Ara Kassarjian
- Department of Radiology, Division of Musculoskeletal Imaging, Olympia Medical Center, Elite Sports Imaging, Madrid, Spain
| | - Kambiz Motamedi
- Department of Radiology, University of California, Los Angeles Medical Center, Los Angeles, CA, USA
| | | | - Colin D Strickland
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Richard E A Walker
- McCaig Institute for Bone and Joint Health, Calgary, Canada.
- Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
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Kapoor R, Husseini JS, Staffa SJ, Palmer WE, Torriani M, Chang CY, Joseph Simeone F. Posterior capsule edema in adhesive capsulitis: comparison with established non-contrast MRI findings and multivariable analysis. Eur Radiol 2024; 34:260-269. [PMID: 37542655 DOI: 10.1007/s00330-023-09966-6] [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: 01/04/2023] [Revised: 04/26/2023] [Accepted: 05/26/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVES To evaluate posterior glenohumeral capsule edema compared to other MRI findings in adhesive capsulitis (AC). METHODS This study was approved by the local Institutional Review Board and it is HIPAA compliant. A retrospective search identified subjects who received fluoroscopically guided intra-articular corticosteroid injections for AC and had an MRI within 6 months prior to injection. The study group was compared with an age-, sex-, and side-matched control group who underwent the same procedures but did not have AC. MRIs were evaluated for edema of posterior capsule, anterior capsule, axillary pouch, coracohumeral ligament (CHL) and rotator interval (RI), thickness of axillary pouch and CHL, thickness of anterior capsule, RI and subcoracoid fat replacement, and teres minor atrophy and edema. Multivariable analysis was performed. RESULTS A total of 57 subjects with AC and 57 matched controls were studied: mean age 52 ± 7 (range 31-71) years, 37 female and 20 male, 22 right and 35 left. Posterior capsule edema was more common in the AC group vs. control group (66.7 vs 17.5%, p < 0.001). Multivariable analysis showed posterior capsule edema, CHL edema, and axillary pouch (glenoid) thickness (optimum cutoff = 4 mm) were significant independent predictors of AC. Simplified analysis using these three variables had an area under the curve of 0.860 (95%CI: 0.792-0.928). With all three variables present, the sensitivity and specificity for AC were 32% and 98%, respectively. CONCLUSIONS Posterior joint capsule edema may be helpful to confirm AC. Posterior capsule edema, CHL edema, and axillary pouch (glenoid) thickness produce a strong model for distinguishing AC from controls. CLINICAL RELEVANCE STATEMENT Edema involving the posterior shoulder joint capsule is an imaging marker of capsulitis and is useful in differentiating patients with adhesive capsulitis from those without in conjunction with other proven MRI findings. KEY POINTS • Posterior capsule edema has a sensitivity of 66.7% and a specificity of 82.5% for the detection of adhesive capsulitis. • Posterior capsule edema, coracohumeral ligament (CHL) edema, and axillary pouch (glenoid) thickness were significant independent predictors of adhesive capsulitis, and combining these variables together produces a very strong model for distinguishing cases from controls (AUC = 0.860). • Optimal cutoff values for CHL, axillary pouch (humeral), axillary pouch (glenoid), and axillary pouch (total) thickness were 2.5, 2.6, 4, and 6.3 mm, respectively.
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Affiliation(s)
- Rajdeep Kapoor
- Gainesville Radiology Group, Gainesville, FL, USA
- Northeast Georgia Health System, Gainesville, FL, USA
| | - Jad S Husseini
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - William E Palmer
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Martin Torriani
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Connie Y Chang
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - F Joseph Simeone
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street - YAW 6046, Boston, MA, 02114, USA.
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Yoon JY, Han H, Shin MY, Jeong HJ, Kang Y, Jeon YD, Kim JU, Oh JH. What is the most predictive magnetic resonance imaging finding of rotator cuff tear concomitant with shoulder stiffness? JSES Int 2023; 7:756-762. [PMID: 37719831 PMCID: PMC10499857 DOI: 10.1016/j.jseint.2023.05.001] [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] [Indexed: 09/19/2023] Open
Abstract
Background Common magnetic resonance imaging (MRI) findings in adhesive capsulitis are not often evident in rotator cuff tear concomitant with shoulder stiffness. This study aimed to determine the most predictive MRI finding of rotator cuff tear with shoulder stiffness to differentiate from that without stiffness. Materials and methods The data of patients who underwent arthroscopic rotator cuff repair between January 2014 and October 2019 were retrospectively reviewed. Stiffness was defined as forward flexion <120°, external rotation at side <30°, and internal rotation at back Results Anterior capsular thickness, glenoid capsular thickness in the axillary recess, and anterior and axillary capsular hyperintensities were significantly more dominant in the stiff group (all P < .05) than in the control group. Anterior capsular thickness and anterior capsular abnormal hyperintensity could be used to differentiate between the stiff and control groups (P < .05). Anterior capsular thickness showed high diagnostic performance with an area under the receiver operating characteristic curve of 0.993. The cut-off value for stiffness was 3.07 mm (sensitivity, 96.1%; specificity, 100%). Conclusion Anterior capsular thickening and abnormal hyperintensity were the most predictive MRI findings for stiffness in patients with rotator cuff tear and stiffness to differentiate from patients with rotator cuff tear without stiffness.
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Affiliation(s)
- Ji Young Yoon
- Department of Orthopaedic Surgery, National Police Hospital, Seoul, Republic of Korea
| | - HeeSoo Han
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Myoung Yeol Shin
- Department of Orthopaedic Surgery, National Police Hospital, Seoul, Republic of Korea
| | - Hyeon Jang Jeong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Young Dae Jeon
- Department of Orthopaedic Surgery, Ulsan University College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Ji Un Kim
- Department of Orthopaedic Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Joo Han Oh
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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10
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Zhang X, Liu K, Ying H, Yao G, Fu X, Zhou B, Zhou Z, Wang Z. A Modified Arthroscopic Outside-in Shoulder Release Approach for Severe Shoulder Stiffness. Orthop Surg 2023; 15:2167-2173. [PMID: 36321605 PMCID: PMC10432466 DOI: 10.1111/os.13568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE Arthroscopic release is effective for patients with shoulder stiffness, but the traditional inside-out procedure cannot effectively alleviate the mobility of some severe stiff shoulder and even cause itrogenic injuries sometimes. The aim of this study is to evaluate the clinical efficacy and advantages of a modified outside-in shoulder release approach for severe shoulder stiffness. METHODS Included in this retrospective study were 15 patients (five male and 10 female) with severe shoulder stiffness who underwent modified outside-in shoulder release surgery at our hospital between June 2019 and March 2021. Of them, 10 patients had a primary frozen shoulder and five had secondary shoulder stiffness, involving the right shoulder in six cases and the left shoulder in nine cases. The mean age of the 15 patients was 56.7 (34-69) years. The patients were instructed to exercise passively from second-day post-operation and enhance the rehabilitation exercise gradually. All patients received a range of motion (ROM) examination before and after surgery. The American Shoulder and Elbow Surgeon's Score (ASES), Constant Score (CS), and Visual Analog Scale (VAS) score for pain were recorded. All data were tested by normal distribution first and then by paired T test, otherwise by Wilcoxon rank sum test. RESULTS The mean follow-up period was 18.2 (12-33) months. Compared with the preoperative value, the mean ASES score at the final follow-up improved from 38.4 ± 7.37 to 88.13 ± 6.33 points; the mean CS score from 43.27 ± 6.71 to 78.74 ± 6.93 points; the mean VAS score from 5.07 ± 1.03 to 0.81 ± 0.83 points; forward flexion from 81.93° ± 11.45° to 156.73° ± 9.12°; abduction from 65.93° ± 16.82° to 144.80° ± 8.83°; neutral external rotation from 13.53° ± 10.38° to 51.20° ± 4.77°; internal rotation from the buttock to waist (L3), all showing a significant difference (P < 0.0001). No serious complication was observed in any patient during the postoperative follow-up periods. CONCLUSION The present study has demonstrated that the modified arthroscopic outside-in shoulder release approach can improve ROM of patients and alleviate pain effectively, proving it to be an appropriate surgical option for the treatment of severe shoulder stiffness.
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Affiliation(s)
- Xu‐chao Zhang
- Department of Joint and Orthopaedic SurgeryThe First Affiliated Hospital of the Naval Medical UniversityShanghaiChina
| | - Kang Liu
- Department of Joint and Orthopaedic SurgeryThe First Affiliated Hospital of the Naval Medical UniversityShanghaiChina
| | - Hua Ying
- Department of Orthopaedic Surgery, Shanghai Ninth People's HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Gai Yao
- Department of Joint and Orthopaedic SurgeryThe First Affiliated Hospital of the Naval Medical UniversityShanghaiChina
| | - Xia‐wei Fu
- Department of Joint and Orthopaedic SurgeryThe First Affiliated Hospital of the Naval Medical UniversityShanghaiChina
| | - Bo‐le Zhou
- Department of Joint and Orthopaedic SurgeryThe First Affiliated Hospital of the Naval Medical UniversityShanghaiChina
| | - Zhi‐you Zhou
- Department of Joint and Orthopaedic SurgeryThe First Affiliated Hospital of the Naval Medical UniversityShanghaiChina
| | - Zi‐min Wang
- Department of Joint and Orthopaedic SurgeryThe First Affiliated Hospital of the Naval Medical UniversityShanghaiChina
- Department of Orthopaedic Surgery, Shanghai Ninth People's HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
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11
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Dyer BP, Rathod-Mistry T, Burton C, van der Windt D, Bucknall M. Diabetes as a risk factor for the onset of frozen shoulder: a systematic review and meta-analysis. BMJ Open 2023; 13:e062377. [PMID: 36599641 PMCID: PMC9815013 DOI: 10.1136/bmjopen-2022-062377] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Summarise longitudinal observational studies to determine whether diabetes (types 1 and 2) is a risk factor for frozen shoulder. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, Embase, AMED, PsycINFO, Web of Science Core Collection, CINAHL, Epistemonikos, Trip, PEDro, OpenGrey and The Grey Literature Report were searched on January 2019 and updated in June 2021. Reference screening and emailing professional contacts were also used. ELIGIBILITY CRITERIA Longitudinal observational studies that estimated the association between diabetes and developing frozen shoulder. DATA EXTRACTION AND SYNTHESIS Data extraction was completed by one reviewer and independently checked by another using a predefined extraction sheet. Risk of bias was judged using the Quality In Prognosis Studies tool. For studies providing sufficient data, random-effects meta-analysis was used to derive summary estimates of the association between diabetes and the onset of frozen shoulder. RESULTS A meta-analysis of six case-control studies including 5388 people estimated the odds of developing frozen shoulder for people with diabetes to be 3.69 (95% CI 2.99 to 4.56) times the odds for people without diabetes. Two cohort studies were identified, both suggesting diabetes was associated with frozen shoulder, with HRs of 1.32 (95% CI 1.22 to 1.42) and 1.67 (95% CI 1.46 to 1.91). Risk of bias was judged as high in seven studies and moderate in one study. CONCLUSION People with diabetes are more likely to develop frozen shoulder. Risk of unmeasured confounding was the main limitation of this systematic review. High-quality studies are needed to confirm the strength of, and understand reasons for, the association. PROSPERO REGISTRATION NUMBER CRD42019122963.
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Affiliation(s)
- Brett Paul Dyer
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Trishna Rathod-Mistry
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Claire Burton
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Danielle van der Windt
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Milica Bucknall
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Newcastle-under-Lyme, UK
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12
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Mohammed MH, Fahmi FM, Shehata KA, Elia RZ. Shoulder adhesive capsulitis: can clinical data correlate with fat-suppressed T2 weighted MRI findings? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [PMCID: PMC8961268 DOI: 10.1186/s43055-022-00751-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Adhesive capsulitis (AC) of the shoulder or frozen shoulder is a debilitating condition characterized by progressive pain, stiffness and limited range of motion about the glenohumeral joint, the term (adhesive capsulitis) to describe the findings of chronic inflammation and fibrosis of the joint capsule, characterized by significant restriction of both active and passive shoulder motion that occurs in the absence of a known intrinsic shoulder disorder. The goal of the trial was to examine the association between clinical features (stages) and magnetic resonance imaging (MRI) findings in adhesive capsulitis of the shoulder.
Results
In our study, Regarding the diagnostic performance of shoulder MRI there is a statistically significant difference between degree of pain intensity according to Capsular thickening regarding humeral “mm” with p-value (p < 0.05). The highest value was found moderate and severe pain group (5.67 ± 1.39) compared to absent, minimal and mild pain group (4.42 ± 1.29), there was a statistically significant difference between two groups according to axillary recess regarding height “mm” with p-value (p < 0.05). The highest value was found absent, minimal and mild pain group (7.02 ± 2.68) compared to moderate and severe pain group (5.73 ± 2.25). There is no statistically significant association between pain intensity and MRI finding regarding capsular edema, extra capsular edema, obliteration of subcoracoid fat triangle, effusion of biceps tendon sheath, capsular thickening of glenoid (mm) and humeral portions of axillary recess and axillary recess width and height (mm), with p-value (p > 0.05 NS).
Conclusions
MRI is useful for assessing clinical impairment and predicting the clinical stage of adhesive capsulitis.
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McKean D, Teh J. Imaging of the Long Head of Biceps Tendon and Rotator Interval. Semin Musculoskelet Radiol 2022; 26:566-576. [DOI: 10.1055/s-0042-1758850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AbstractThis article reviews the imaging and common pathology of the long head of biceps tendon and rotator interval (RI). This area of complex anatomy plays a crucial role in normal shoulder function. Injury or abnormality of the RI may contribute to a range of shoulder pathology, such as biceps instability, tendinopathy, and frozen shoulder. Understanding the normal and pathologic appearances of the RI structures is crucial for a correct diagnosis and directing treatment.
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Affiliation(s)
- David McKean
- Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, United Kingdom
- Cleveland Clinic London, London, United Kingdom
| | - James Teh
- The Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
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14
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Ozbalci AB, Piskin A. Clinical Significance of Shear Wave Ultrasound Elastography in Patients With Idiopathic Adhesive Capsulitis: Can It Be Used Instead of Magnetic Resonance Imaging as an Early Indicator? Ultrasound Q 2022; 38:250-256. [PMID: 35394993 DOI: 10.1097/ruq.0000000000000603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT The aim of this study was to evaluate the elasticity of the supraspinatus (SSp) and infraspinatus (ISp) tendons and coracohumeral ligament (CHL), as well as the thickness of CHL in patients diagnosed with adhesive capsulitis (AC) using ultrasound (US) and 2D shear wave elastography (2D-SWE), determining their contributions to diagnosis and stage differentiation.This prospective case-control study was conducted between January 2020 and May 2021. In all cases, the ultrasound examinations were performed using the virtual touch quantification and expressed as shear wave velocity (SWV) in meters per second. After US examinations, magnetic resonance imaging (MRI) was planned for all cases.The measurements made in US and MRI revealed that CHL thicknesses and SWV values of CHL and SSp and ISp tendons were statistically substantially higher in the patient group. The diagnostic performance of 2D-SWE in predicting AC was evaluated using receiver operating characteristics curve analysis. When the cutoff value of the mean SWE for CHL was taken as 4.67 m/s, the sensitivity of SWE was found to be 90.2% and the specificity 85.7%.Our study results suggest that CHL thickness on B-mode US, as well as SWV values of CHL and SSp and ISp tendons in 2D-SWE examination, can be used as a useful tool for AC diagnosis without the need for MRI, a costly and time-consuming examination.
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Affiliation(s)
| | - Ahmet Piskin
- Department of Orthopedics and Traumatology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
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15
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Lin P, Yang M, Huang D, Lin H, Wang J, Zhong C, Guan L. Effect of proprioceptive neuromuscular facilitation technique on the treatment of frozen shoulder: a pilot randomized controlled trial. BMC Musculoskelet Disord 2022; 23:367. [PMID: 35443651 PMCID: PMC9020070 DOI: 10.1186/s12891-022-05327-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/15/2022] [Indexed: 11/17/2022] Open
Abstract
Background and objectives Frozen shoulder is a common painful disease of the shoulder joint characterized by structural changes in the shoulder joint, restricting both active and passive shoulder joint activities. Proprioceptive neuromuscular facilitation (PNF) effectively improved and maintained the range of motion; however, it is not clear whether it can improve the shoulder joint structure in patients with frozen shoulder. This pilot study used magnetic resonance imaging (MRI) observation to assess the improvement of the local structure of the shoulder joint upon PNF treatment to elucidate a target based on structure for the treatment of frozen shoulder. Materials and methods Forty-eight patients with frozen shoulder were randomly divided into the traditional manual therapy group and the PNF technique group. Changes in the thicknesses of the coracohumeral ligament (CHL) and capsule in axillary recess (CAR) of the shoulder joint were observed via MRI upon admission and at 4 weeks after treatment. A visual analog scale (VAS) and passive shoulder range of motion (ROM) at abduction, anteflexion and external rotation position were used to evaluate the improvement of shoulder joint pain and function in the initial, mid-term, and discharge of the two groups of patients. Results The primary outcome results shown that the PNF joint mobilization significantly reduced the thickness of the CHL (p = 0.0217) and CAR (p = 0.0133). Compared with simple joint mobilization, The mid-term and discharge rehabilitation assessment results showed that PNF has a better effect on shoulder pain. At the mid-term evaluation, the ROM of the PNF group was significantly better than that of the Control group in the three directions (p < 0.05). Conclusion As an adjunctive therapy, PNF can improve the shoulder joint structure of patients with frozen shoulder and is an effective treatment strategy for frozen shoulder.
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Affiliation(s)
- Ping Lin
- Department of Rehabilitation Medicine, The Fushun People's Hospital, 47 Xiangyun Street West section, Zigong, China
| | - Moudan Yang
- Department of Rehabilitation Medicine, The Fushun People's Hospital, 47 Xiangyun Street West section, Zigong, China
| | - Deqing Huang
- Department of Rehabilitation Medicine, The Fushun People's Hospital, 47 Xiangyun Street West section, Zigong, China
| | - Huan Lin
- Department of Radiology, The Fushun People's Hospital, 490 Jixiang Road, Fushi Street Zigong, Fushun, China
| | - Jialin Wang
- Department of Radiology, The Fushun People's Hospital, 490 Jixiang Road, Fushi Street Zigong, Fushun, China
| | - Chaoping Zhong
- Department of Rehabilitation Medicine, The Fushun People's Hospital, 47 Xiangyun Street West section, Zigong, China
| | - Li Guan
- Department of Rehabilitation Medicine, The Fushun People's Hospital, 47 Xiangyun Street West section, Zigong, China.
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MR imaging detection of adhesive capsulitis of the shoulder: impact of intravenous contrast administration and reader's experience on diagnostic performance. Skeletal Radiol 2022; 51:1807-1815. [PMID: 35224657 PMCID: PMC9283172 DOI: 10.1007/s00256-022-03994-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/07/2022] [Accepted: 01/09/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Correct identification of adhesive capsulitis of the shoulder (ACS) has an important impact on adequate therapy. The aim of our study was to investigate the influence of intravenous contrast administration and of reader's experience on sensitivity and specificity of MRI in diagnosing ACS. MATERIALS AND METHODS A total of 180 patients were included in a retrospective study: 60 subjects with at least 4 of 5 clinical signs of adhesive capsulitis of the shoulder and 120 patients with other shoulder diseases who underwent contrast-enhanced MRI. In a first session, only non-enhanced images and in a second session also contrast-enhanced (CE) series were independently evaluated by three radiologists with various levels of professional experience. Readers were blinded to all clinical information and had to rate the shoulder MRIs for absence or presence of adhesive capsulitis. Data analysis included McNemar's test, t test, and U test (p < .05). RESULTS Using non-enhanced MRI, readers achieved a mean sensitivity of 63.9% and a mean specificity of 86.4%. By additional use of CE sequences, the mean sensitivity (85.5%) and the sensitivity for each reader increased significantly (p = .046, p < .01, p < .001, p = .045) while the improvement in mean specificity was not significant. Reader's experience had a positive effect on sensitivity and specificity, which was in part but not consistently significant. CONCLUSION The addition of CE sequences can significantly increase the sensitivity of MRI in the diagnosis of ACS. Reader's experience has shown to be another important factor for the diagnostic outcome.
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Miyatake K, Fujisawa T, Otoshi A, Kawabata Y, Kusaba Y, Tsujiku S, Inaba Y. Silent Manipulation for Adhesive Capsulitis. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00332-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Gillet R, Zhu F, Padoin P, Rauch A, Hossu G, Teixeira PAG, Blum A. MR Imaging Biomarkers for Clinical Impairment and Disease Progression in Patients with Shoulder Adhesive Capsulitis: A Prospective Study. J Clin Med 2021; 10:jcm10173882. [PMID: 34501330 PMCID: PMC8432015 DOI: 10.3390/jcm10173882] [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: 08/03/2021] [Revised: 08/21/2021] [Accepted: 08/27/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND MRI diagnostic criteria of shoulder adhesive capsulitis (AC) are nowadays widely used, but there is little information available on the association between MRI findings and clinical impairment. PURPOSE To determine the correlation of MRI findings with the Constant-Murley Score (CMS), pain duration and symptoms at the one-year follow-up in AC patients. MATERIALS AND METHODS This monocentric prospective study included 132 patients with a clinical diagnosis of shoulder AC who underwent shoulder MRI. Mean patient age was 54.1 ± 9.3 years, and there were 55 men and 77 women. A radiologist examined all patients and completed the CMS just prior to MRI. Pain duration was assessed along with the signal intensity and measured the maximal thickness of the inferior glenohumeral ligament (IGHL) by two radiologists. Medical record analysis was performed in a sub-group of 49 patients to assess prognosis approximately one year after the MRI examination. Linear regression analysis with the Pearson test and the Fisher exact test were used to determine the association between MRI findings and clinical impairment. RESULTS There was a significant difference in mean pain duration score (3.8 ± 1.2 versus 3.2 ± 0.9 and 3.8 ± 1.2 versus 3.2 ± 0.9, respectively, for readers 1 and 2) and in mean mobility scores (15.7 ± 8 points versus 19.6 ± 10.1 points and 15.8 ± 8.2 points versus 19.4 ± 10 points, respectively, for readers 1 and 2) in patients with a high IGHL signal compared to those with a low IGHL signal (p < 0.05). IGHL was thicker in patients with clinical improvement at one-year follow-up compared to those presenting clinical stability or worsening (p < 0.05). CONCLUSIONS In patients with shoulder AC, the degree of signal intensity at the IGHL was inversely related to shoulder pain duration and range of motion, and a thickened IGHL indicated a favorable outcome at one-year follow-up.
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Affiliation(s)
- Romain Gillet
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 54000 Nancy, France; (F.Z.); (P.P.); (A.R.); (P.A.G.T.); (A.B.)
- Correspondence: ; Tel.: +33-3-83-85-21-61; Fax: +33-3-83-85-97-25
| | - François Zhu
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 54000 Nancy, France; (F.Z.); (P.P.); (A.R.); (P.A.G.T.); (A.B.)
| | - Pierre Padoin
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 54000 Nancy, France; (F.Z.); (P.P.); (A.R.); (P.A.G.T.); (A.B.)
| | - Aymeric Rauch
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 54000 Nancy, France; (F.Z.); (P.P.); (A.R.); (P.A.G.T.); (A.B.)
| | - Gabriela Hossu
- CIC-IT, CHRU Nancy, Université de Lorraine, 54000 Nancy, France;
| | - Pedro Augusto Gondim Teixeira
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 54000 Nancy, France; (F.Z.); (P.P.); (A.R.); (P.A.G.T.); (A.B.)
| | - Alain Blum
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 54000 Nancy, France; (F.Z.); (P.P.); (A.R.); (P.A.G.T.); (A.B.)
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Zhao H, Kong L, Shen J, Ma Y, Wu Z, Li H, He Y. Tetrandrine inhibits the occurrence and development of frozen shoulder by inhibiting inflammation, angiogenesis, and fibrosis. Biomed Pharmacother 2021; 140:111700. [PMID: 34044279 DOI: 10.1016/j.biopha.2021.111700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Frozen shoulders (FS) is a major clinical concern, where chronic synovial inflammation, abnormal angiogenesis, and fibrosis represent the critical pathologies in the glenohumeral capsule. However, no pharmacotherapy has been introduced to treat this pathology. Tetrandrine (TET) has been proposed as a treatment for many diseases due to its strong anti-inflammatory, anti-angiogenic, and anti-fibrotic effects. PURPOSE To study the anti-inflammatory, anti-angiogenic, and anti-fibrotic effects of TET on FS, and identify whether TET can prevent the development of FS in rats. STUDY DESIGN A controlled laboratory study. METHODS Forty-eight male Sprague-Dawley (SD) rats were randomly divided into control, TET, and FS groups. The TET group was intraperitoneally injected with TET every 2 days. TET and saline treatment were started on the day of FS surgery. After 8 weeks, the animals were sacrificed, and samples were collected for X-ray examination, glenohumeral range of motion (ROM) evaluation, histology and immunohistochemistry analysis, transmission electron microscopy (TEM) observation, and profibrogenic factors as well as proinflammatory cytokines measurements. RESULTS No significant difference in shoulder ROM was observed between the TET and control groups, but a significant difference was noted between these groups and the FS group (P < 0.01). Immunohistochemical staining showed no abnormal angiogenesis or fibrosis in the TET group or the control group. However, significant angiogenesis, collagen remodeling, and fibrosis were observed in the FS group, and the expression and proportion of type I and type III collagen in the FS group were significantly higher than those in the TET group or the control group (P < 0.01). TEM observation showed that TET protected the ultrastructure of collagen fibrous reticular arrangement of the articular capsule and prevented the formation of scar-like fibrotic structures, which are unique to FS. The significantly increased expression of Smad7 and the suppressed expression of Smad 2 in the TET group compared with that of the FS group indicated that TET also significantly inhibited the TGF-β1 intracellular signal pathway. The expression of profibrogenic factors and proinflammatory cytokines in the TET group and the control group was significantly lower than that in the TET group (P < 0.01). CONCLUSION The results demonstrated that TET protected the normal reticular structure of the capsule during the freezing period and prevented the development of FS by inhibiting inflammation, angiogenesis, and fibrosis in a rat FS model. CLINICAL RELEVANCE TET may be a safe and effective clinical medication for preventing and treating FS.
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Affiliation(s)
- Huakun Zhao
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Lingzhi Kong
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Ji Shen
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Yanhong Ma
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Zhi Wu
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, School of Biomedical Engineering and School of Biomedical Engineering, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai 200030, China
| | - Haiyan Li
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, School of Biomedical Engineering and School of Biomedical Engineering, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai 200030, China; Chemical and Environmental Engineering, School of Engineering, RMIT University, 124 La Trobe St, Melbourne, VIC 3000, Australia.
| | - Yaohua He
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China.
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Chellathurai A, Subbiah K, Elangovan A, Kannappan S. Adhesive capsulitis: MRI correlation with clinical stages and proposal of MRI staging. Indian J Radiol Imaging 2021; 29:19-24. [PMID: 31000937 PMCID: PMC6467040 DOI: 10.4103/ijri.ijri_116_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective: The purpose of this study was to correlate the magnetic resonance imaging (MRI) findings of adhesive capsulitis with clinical stages and thereby propose a MR staging system. Materials and Methods: This study consisted of 74 patients with clinically diagnosed adhesive capsulitis. The edema of the inferior glenohumeral ligament (IGHL), pericapsular edema, thickness of anterior band of IGHL, axillary pouch, thickness of coracohumeral ligament, and obliteration of fat in the subcoracoid triangle were evaluated by MRI. Results: Thickening of the anterior band of IGHL showed most significant correlation with the clinical stages. The distribution of edema of IGHL and pericapsular edema also showed significant correlation with the clinical stages of adhesive capsulitis. Pericapsular edema and IGHL edema was not observed in stage IV. Conclusion: MR is a useful tool for evaluation and prediction of clinical stage of adhesive capsulitis.
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Affiliation(s)
- Amarnath Chellathurai
- Department of Radio Diagnosis, Govt Stanley Medical College, Affiliated to The Tamilnadu Dr. MGR Medical University, No 69, Anna Salai, Guindy, Chennai, India
| | - Komalavalli Subbiah
- Department of Radio Diagnosis, Govt Stanley Medical College, Affiliated to The Tamilnadu Dr. MGR Medical University, No 69, Anna Salai, Guindy, Chennai, India
| | - Atchaya Elangovan
- Department of Radio Diagnosis, Govt Stanley Medical College, Affiliated to The Tamilnadu Dr. MGR Medical University, No 69, Anna Salai, Guindy, Chennai, India
| | - Sivakumar Kannappan
- Department of Radio Diagnosis, Govt Stanley Medical College, Affiliated to The Tamilnadu Dr. MGR Medical University, No 69, Anna Salai, Guindy, Chennai, India
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McKean D, Chung SL, Naudé RTW, McElroy B, Baxter J, Pendse A, Papanikitas J, Teh J, Hughes R. Elasticity of the coracohumeral ligament in patients with frozen shoulder following rotator interval injection: a case series. J Ultrason 2021; 20:e300-e306. [PMID: 33500798 PMCID: PMC7830058 DOI: 10.15557/jou.2020.0052] [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: 05/11/2020] [Accepted: 09/05/2020] [Indexed: 11/22/2022] Open
Abstract
Aim of the study: To evaluate changes in the elasticity of the coracohumeral ligament in patients with adhesive capsulitis of the shoulder treated with ultrasound-guided rotator interval injections. Methods: Shear wave elastography was used to evaluate elasticity of the coracohumeral ligament in symptomatic and asymptomatic shoulders in the shoulder-neutral position and 30° external rotation. A total of 24 shoulders were assessed. Symptomatic shoulders were treated with targeted steroid injection via the rotator interval and manipulation under local anaesthetic block. Follow-up assessment of the elasticity of the coracohumeral ligament was obtained at 10 weeks post-injection. Results: In all subjects, the coracohumeral ligament elastic modulus was larger at 30° external rotation than in the neutral position. In patients with adhesive capsulitis, the coracohumeral ligament thickness and elastic modulus was significantly greater in the symptomatic shoulder in the neutral position and 30° ER. Treated patients had an excellent response with improved Oxford Shoulder Score and reduced visual analogue scale pain scores. Median Oxford Shoulder Score was 13.5 pre-injection and 34 at 10 weeks post-injection. Median visual analogue scale pain scores measured 8.5 pre-injection, 3.5 at 1 day, 2 at 1 week, and 2.5 at 10 weeks. Improved Oxford Shoulder Score and visual analogue scale pain score was associated with a trend to normalisation of the elastic modus of the coracohumeral ligament. Conclusion: In patients with adhesive capsulitis of the shoulder, shear wave elastography demonstrated the coracohumeral ligament is stiffer in the symptomatic shoulder than in the unaffected shoulder. Treatment with the ultrasound-guided rotator interval injection is associated with improved Oxford Shoulder Score, reduced visual analogue scale pain scores, and reduced stiffness in the coracohumeral ligament.
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Affiliation(s)
- David McKean
- Radiology Department, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, UK
| | - Siok Li Chung
- Radiology Department, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, UK
| | - Rebecca Te Water Naudé
- Radiology Department, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, UK
| | - Bernard McElroy
- Orthopaedic Department, Chiltern Hospital, Great Missenden, UK
| | - Jonathan Baxter
- Orthopaedic Department, Buckinghamshire Healthcare NHS Trust, UK
| | - Aniruddha Pendse
- Orthopaedic Department, Buckinghamshire Healthcare NHS Trust, UK
| | - Joseph Papanikitas
- Radiology Department, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, UK
| | - James Teh
- Radiology Department, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, UK
| | - Richard Hughes
- Radiology Department, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, UK
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Correlations Between Range of Motion and Elasticity of the Coracohumeral Ligament Evaluated With Shear-Wave Elastography. J Sport Rehabil 2021; 30:9-15. [DOI: 10.1123/jsr.2019-0279] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 10/19/2019] [Accepted: 11/30/2019] [Indexed: 11/18/2022]
Abstract
Context: Range of motion (ROM) in the glenohumeral joint decreases with age in healthy subjects; however, the underlying mechanism remains unclear. The process of aging of the joint capsule, including the coracohumeral ligament (CHL), could affect ROM limitation. Objective: This study investigated correlations between elasticity of the CHL, evaluated by means of shear-wave elastography, and age, side dominance, and ROM in healthy individuals. Design: Experimental study. Setting: Laboratory. Subjects: Eighty-four healthy volunteers (39 men and 45 women, mean age: 42.6 y) were included. Main Outcome Measures: Subjects were divided into 3 age groups: younger (20–39 y), middle (40–59 y), and older (≥60 y) age groups. With participants in the supine position, CHL elasticity in both shoulders was evaluated in both neutral and 30° external rotation, with arms at the sides. ROM, including forward flexion, lateral elevation, external rotation, 90° abduction with external rotation, and hand behind the back were measured with participants in the standing position. Results: The CHL elastic modulus was higher in the older group than in the younger group in the neutral (78.4 kPa [SD: 37.1] and 56.6 kPa [SD: 31.7], respectively) and 30° external rotation positions (135.5 kPa [SD: 63.5] and 71.4 kPa [SD: 32.2], respectively). Negative correlations were found between the CHL elastic modulus and ROM in terms of 30° external rotation and both external rotation (R = −.59, P = .02) and 90° abduction with external rotation (R = −.71, P = .003) in the older group, with correlation coefficients increasing with age. Conclusions: Significant correlations were identified between CHL elasticity and ROM in both external rotation and 90° abduction with external rotation with increasing age. Decreased CHL elasticity was strongly associated with decreased shoulder ROM in middle-aged and older individuals.
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Suzuki K, Hamada J, Hagiwara Y. Anterior subluxation of the glenohumeral joint during hyperextension. J Orthop Sci 2020; 25:915-919. [PMID: 29428827 DOI: 10.1016/j.jos.2017.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/20/2017] [Accepted: 12/29/2017] [Indexed: 01/02/2023]
Affiliation(s)
- Kazuaki Suzuki
- Department of Orthopedic Surgery, Sendai Hospital of East Japan Railway Company, 1-1-5 Itsutsubashi, Aoba-ku, Sendai, Miyagi, 980-8508, Japan
| | - Junichirou Hamada
- Department of Orthopaedic Surgery, Kuwano Kyoritsu Hospital, 2-9-18 Shima, Koriyama, Fukushima, 963-8034, Japan.
| | - Yoshihiro Hagiwara
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
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Choi YH, Kim DH. Correlations between clinical features and MRI findings in early adhesive capsulitis of the shoulder: a retrospective observational study. BMC Musculoskelet Disord 2020; 21:542. [PMID: 32791997 PMCID: PMC7427071 DOI: 10.1186/s12891-020-03569-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/04/2020] [Indexed: 12/05/2022] Open
Abstract
Background This retrospective study investigated the association between clinical features and MRI findings in patients with early adhesive capsulitis of the shoulder. Methods The study included 29 patients with early adhesive capsulitis of the shoulder. The clinical diagnostic criteria were significantly restricted passive range of motion (ROM) and a symptom duration of up to 9 months. Various measurements related to adhesive capsulitis, including humeral and glenoid capsular thickness in the axillary recess, maximal axillary capsular thickness, coracohumeral ligament thickness, and anterior capsular thickness were measured on MRI. Abnormal humeral and glenoid capsular hyperintensity in the axillary recess, abnormal hyperintensity in the rotator interval, and obliteration of the subcoracoid fat triangle were also evaluated. Correlations between MRI findings and clinical features, including limited ROM, pain, and symptom duration were sought. Results Maximal axillary and humeral capsular thickness measured on MRI were negatively correlated with ROM for internal rotation. Also, hyperintensity in axillary recess and glenoid capule were correlated with ROM for abduction. Humeral capsular hyperintensity was correlated with ROM for forward flexion. There were no MRI findings that showed correlations with ROM for external rotation and severity of pain. The hyperintensity in the humeral capsule among MRI findings was only correlated with duration of symptoms. Conclusions MRI can be useful for assessment of several measures of clinical impairment in patients with adhesive capsulitis. Thickening and hyperintensity of the joint capsule in the axillary recess on MRI is associated with limited ROM and duration of symptoms.
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Affiliation(s)
- Yoon-Hee Choi
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Hospital Seoul, Soonchunhyang University College of Medicine, Seoul, 04401, South Korea
| | - Dong Hyun Kim
- Department of Radiology, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, 07061, South Korea.
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Wu PY, Hsu PC, Chen TN, Huang JR, Chou CL, Wang JC. Evaluating Correlations of Coracohumeral Ligament Thickness with Restricted Shoulder Range of Motion and Clinical Duration of Adhesive Capsulitis with Ultrasound Measurements. PM R 2020; 13:461-469. [PMID: 32500656 DOI: 10.1002/pmrj.12432] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 05/04/2020] [Accepted: 05/28/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The primary objective of this study is to evaluate, using ultrasound measurements, the correlation between coracohumeral ligament (CHL) thickness and restricted shoulder range of motion (ROM) in patients with adhesive capsulitis (AC). The secondary objective is to investigate the correlation between CHL thickness and disease duration. DESIGN Prospective cross-sectional survey. SETTING Clinical research of a tertiary care hospital. METHODS Overall, 65 patients with clinically diagnosed AC were enrolled. Ultrasound measurements of CHL thickness in the axial oblique plane were obtained under maximal external rotation of the glenohumeral joint. Both Shoulder Pain and Disability Index (SPADI) and shoulder ROM were prospectively evaluated by an experienced investigator. CHL thickness was compared with shoulder ROM and SPADI. The association between CHL thickness and disease duration was also investigated. RESULTS Simple linear regression analysis showed significant inverse correlation between CHL thickness and shoulder ROM including external rotation (ER) (r = -0.335, P = .006) and internal rotation (IR) (r = -0.409, P = .001). CHL thickness also correlated with disease duration (r = -0.352, P = .004). Multiple linear regression analysis demonstrated that CHL thickness was significantly associated with restricted ER (r = -0.293, P = .02) and IR (r = -0.363, P = .003) after adjusting for age and disease duration. On the other hand, CHL thickness showed no significant correlation with abduction (r = -0.210, P = .09), flexion (r = -0.170, P = .176), or total SPADI score (r = 0.176, P = .16). Moreover, CHL was significantly thicker in patients with disease duration >6 months (P = .004, difference in means: 0.55 mm, 95% confidence interval: -0.922, -0.183). CONCLUSIONS CHL was significantly thicker in later-stage AC. CHL thickness correlated negatively with ER and IR of the shoulder. Furthermore, CHL thickening could be observed in the early stage of the disease course. These imaging findings may assist in confirming the diagnosis of AC, leading to early intervention and treatment options.
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Affiliation(s)
- Pin-Yi Wu
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, 11217, Taiwan
| | - Po-Cheng Hsu
- Department of Physical Medicine and Rehabilitation, National Yang Ming University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, 10845, Taiwan
| | - Tzu-Ning Chen
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, 11217, Taiwan
| | - Jian-Ru Huang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, 11217, Taiwan
| | - Chen-Liang Chou
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, 11217, Taiwan.,Department of Physical Medicine and Rehabilitation, National Yang Ming University, Taipei, Taiwan
| | - Jia-Chi Wang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, 11217, Taiwan.,Department of Physical Medicine and Rehabilitation, National Yang Ming University, Taipei, Taiwan
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26
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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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27
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Cho HR, Cho BH, Kang KN, Kim YU. Optimal Cut-Off Value of the Coracohumeral Ligament Area as a Morphological Parameter to Confirm Frozen Shoulder. J Korean Med Sci 2020; 35:e99. [PMID: 32301291 PMCID: PMC7167408 DOI: 10.3346/jkms.2020.35.e99] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 02/17/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Thickened coracohumeral ligament (CHL) is one of the important morphological changes of frozen shoulder (FS). Previous research reported that coracohumeral ligament thickness (CHLT) is correlated with anterior glenohumeral instability, rotator interval and eventually FS. However, thickness may change depending on the cutting angle, and measurement point. To reduce measurement mistakes, we devised a new imaging criteria, called the coracohumeral ligament area (CHLA). METHODS CHL data were collected and analyzed from 52 patients with FS, and from 51 control subjects (no evidence of FS). Shoulder magnetic resonance imaging was performed in all subjects. We investigated the CHLT and CHLA at the maximal thickened view of the CHL using our picture archiving and communications system. The CHLA was measured as the whole area of the CHL including the most hypertrophied part of the MR images on the oblique sagittal plane. The CHLT was measured at the thickest point of the CHL. RESULTS The average CHLA was 40.88 ± 12.53 mm² in the control group and 67.47 ± 19.88 mm² in the FS group. The mean CHLT was 2.84 ± 0.67 mm in the control group and 4.01 ± 1.11 mm in the FS group. FS patients had significantly higher CHLA (P < 0.01) and CHLT (P < 0.01) than the control group. The receiver operator characteristic analysis showed that the most suitable cut-off score of the CHLA was 50.01 mm², with 76.9% sensitivity, 76.5% specificity, and area under the curve (AUC) of 0.87. The most suitable cut-off value of the CHLT was 3.30 mm, with 71.2% sensitivity, 70.6% specificity, and AUC of 0.81. CONCLUSION The significantly positive correlation between the CHLA, CHLT and FS was found. We also demonstrate that the CHLA has statistically equivalent power to CHLT. Thus, for diagnosis of FS, the treating physician can refer to CHLA as well as CHLT.
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Affiliation(s)
- Hyung Rae Cho
- Department of Anesthesiology and Pain Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Byong Hyon Cho
- Department of Anesthesiology and Pain Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Keum Nae Kang
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University, College of Medicine, International St. Mary's Hospital, Incheon, Korea.
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Husseini JS, Levin M, Chang CY. Capsular Injury and Inflammation. Magn Reson Imaging Clin N Am 2020; 28:257-267. [PMID: 32241662 DOI: 10.1016/j.mric.2019.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The capsular and ligamentous structures of the glenohumeral joint are important for stability of the shoulder. These structures are best evaluated by MR imaging. Familiarity with normal and abnormal appearance of the capsular structures of the shoulder is important to ensure that important pathology is not overlooked. Injury to the capsular structures can occur in the setting of trauma and most commonly involves the inferior glenohumeral ligament and axillary pouch. Adhesive capsulitis is a common inflammatory condition with characteristic imaging features that should be considered in the absence of alternative diagnoses.
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Affiliation(s)
- Jad S Husseini
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 6E, Boston, MA 02114, USA
| | - Marc Levin
- Department of Radiology, Mt. Auburn Hospital, 330 Mount Auburn Street, Cambridge, MA 02138, USA
| | - Connie Y Chang
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 6E, Boston, MA 02114, USA.
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29
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Typische Veränderungen bei der „frozen shoulder“ in der bildgebenden MRT-Untersuchung. Unfallchirurg 2019; 122:944-949. [DOI: 10.1007/s00113-019-00728-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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30
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McKean D, Yoong P, Brooks R, Papanikitas J, Hughes R, Pendse A, McElroy BJ. Shoulder manipulation under targeted ultrasound-guided rotator interval block for adhesive capsulitis. Skeletal Radiol 2019; 48:1269-1274. [PMID: 30446788 DOI: 10.1007/s00256-018-3105-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/08/2018] [Accepted: 10/18/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe and evaluate the outcome following shoulder manipulation under rotator interval block for the treatment of adhesive capsulitis. MATERIALS AND METHODS Patients with adhesive capsulitis referred by our local orthopaedic shoulder surgeons consented to targeted ultrasound-guided injection of the glenohumeral joint via the rotator interval. Inclusion criteria included a failure to respond to conservative treatment and the absence of a full-thickness rotator cuff tear. Twelve millilitres of a mixture of local anaesthetic and steroid was injected into the rotator interval using a 21-gauge needle, with a small volume of the same solution instilled into the subacromial bursa. Following injection, under local anaesthetic block, patients were gently manipulated into abduction, external rotation and internal rotation as far as they could comfortably tolerate. Patients were assessed pre-injection with documented pain scores from 0 to 10 on a visual analogue scale (VAS) and the Oxford Shoulder Score (OSS) questionnaire. Initial follow-up comprised a VAS pain score at 1 h, 24 h and 2 weeks. Clinical review by the referring orthopaedic surgeon was performed at 2 months post-injection. Long-term follow-up involved a VAS pain score and the OSS questionnaire at 5 months. RESULTS Forty patients were suitable for inclusion in the study. Twenty-three were female (57.5%) and 17 were male. The mean age was 52 years (range, 31-73 years). Twelve patients were post-operative. The duration of symptoms ranged from 3 months to 18 months. Mean pre-procedure OSS was recorded as 23.3 (range, 4-36). The mean VAS pain score was 7.7 before the procedure (range, 4 - 10), 3.4 at 1 h (range, 0-8), 2.9 at 24 h (range, 0-8), and 1.8 at 2 weeks (range 1-4). Orthopaedic follow-up at an average of 66 days post-injection was recorded in 18 patients. All patients reported initial improvement of their shoulder pain and return to near full range of movement; however, recurrence of adhesive capsulitis symptoms was recorded in 5 patients. One case of rupture of the long head of the biceps tendon was reported, but the patient remained asymptomatic. Long-term follow-up at 5 months was obtained in 31 patients, with a mean OSS of 42 (range, 21-60) and VAS of 2.3 (range, 0-7). CONCLUSION Manipulation under general anaesthesia is a well-recognised treatment for adhesive capsulitis. We report that targeted ultrasound-guided injection of the rotator interval and manipulation of the shoulder under local anaesthetic blockade result in good outcomes in reducing shoulder pain and symptoms of adhesive capsulitis with low recurrence and complication rates.
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Affiliation(s)
- David McKean
- Radiology Department, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, HP21 8AL, UK.
| | - Philip Yoong
- Radiology Department, Royal Berkshire Hospital, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Rebecca Brooks
- Radiology Department, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, HP21 8AL, UK
| | - Joseph Papanikitas
- Radiology Department, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, HP21 8AL, UK
| | - Richard Hughes
- Radiology Department, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, HP21 8AL, UK
| | - Aniruddha Pendse
- Orthopaedic Department, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
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31
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Adhesive capsulitis: review of imaging findings, pathophysiology, clinical presentation, and treatment options. Skeletal Radiol 2019; 48:1171-1184. [PMID: 30607455 DOI: 10.1007/s00256-018-3139-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/11/2018] [Accepted: 12/17/2018] [Indexed: 02/02/2023]
Abstract
Adhesive capsulitis, commonly referred to as "frozen shoulder," is a debilitating condition characterized by progressive pain and limited range of motion about the glenohumeral joint. It is a condition that typically affects middle-aged women, with some evidence for an association with endocrinological, rheumatological, and autoimmune disease states. Management tends to be conservative, as most cases resolve spontaneously, although a subset of patients progress to permanent disability. Conventional arthrographic findings include decreased capsular distension and volume of the axillary recess when compared with the normal glenohumeral joint, in spite of the fact that fluoroscopic visualization alone is rarely carried out today in favor of magnetic resonance imaging (MRI). MRI and MR arthrography (MRA) have, in recent years, allowed for the visualization of several characteristic signs seen with this condition, including thickening of the coracohumeral ligament, axillary pouch and rotator interval joint capsule, in addition to the obliteration of the subcoracoid fat triangle. Additional findings include T2 signal hyperintensity and post-contrast enhancement of the joint capsule. Similar changes are observable on ultrasound. However, the use of ultrasound is most clearly established for image-guided injection therapy. More aggressive therapies, including arthroscopic release and open capsulotomy, may be indicated for refractory disease, with arthroscopic procedures favored because of their less invasive nature and relatively high success rate.
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32
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Park J, Choi YH, Chai JW, Cha SW, Lim JH, Jo CH, Kim DH. Anterior capsular abnormality: another important MRI finding for the diagnosis of adhesive capsulitis of the shoulder. Skeletal Radiol 2019; 48:543-552. [PMID: 30206678 DOI: 10.1007/s00256-018-3064-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/26/2018] [Accepted: 08/30/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the usefulness of anterior capsular abnormality, thickening, and abnormal signal intensity on MRI for the diagnosis of adhesive capsulitis of the shoulder. MATERIALS AND METHODS This retrospective study included 29 patients with adhesive capsulitis and 20 controls. Clinical criteria with significant restricted passive motion was used for the diagnosis of adhesive capsulitis. The anterior capsular thickness and signal intensity were evaluated on the thickest portion of anterior glenohumeral joint capsule, located deep to the subscapularis muscle. In addition, the previously known MR findings of adhesive capsulitis, such as humeral and glenoid capsular thickness in axillary recess, maximal axillary capsular thickness, and coracohumeral ligament thickness, were measured. The presence of humeral and glenoid capsular abnormal hyperintensity in axillary recess, abnormal hyperintensity, and obliteration of the subcoracoid fat triangle were also evaluated. RESULTS All MRI findings significantly differed between adhesive capsulitis and controls. Among MR findings, multivariable analysis showed that anterior capsular thickness, maximal axillary capsular thickness, and anterior capsular abnormal hyperintensity were variables that could differentiate adhesive capsulitis from the control group, with odds ratios of 7.97, 17.75, and 12.41, respectively (p < 0.05). In ROC analysis, the anterior capsular thickness showed high diagnostic performances with an AUC of 0.897. The cut-off value of anterior capsular thickness at 3.5 mm showed excellent diagnostic accuracy, with sensitivity of 68.97% and specificity of 100%. CONCLUSIONS Anterior capsular abnormality, thickening, and abnormal hyperintensity can be used for the diagnosis of adhesive capsulitis of shoulder, in addition to previously known abnormal MRI findings.
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Affiliation(s)
- Jina Park
- Department of Radiology, Seoul National University College of Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Yoon-Hee Choi
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Jee Won Chai
- Department of Radiology, Seoul National University College of Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Seung Woo Cha
- Department of Radiology, Seoul National University College of Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Joo Hee Lim
- Department of Radiology, Seoul National University College of Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Chris Hyunchul Jo
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Dong Hyun Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea.
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Determination of magnetic resonance imaging criteria for diagnosis of adhesive capsulitis. Rheumatol Int 2019; 39:453-460. [PMID: 30617512 DOI: 10.1007/s00296-018-04238-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 12/29/2018] [Indexed: 10/27/2022]
Abstract
The objective of this study was to identify optimal magnetic resonance imaging (MRI) parameters and their cutoff values for diagnosing adhesive capsulitis (AC). One hundred shoulder MRI images with stage 2 AC (AC group) and 100 MRI images without AC (control group) were randomly reviewed by two experienced shoulder specialists. They were asked whether MRI findings were compatible with AC and measurement of MRI parameters. Sensitivity, specificity, and accuracy were calculated. Correlation between MRI parameters and the range of motions was also analyzed. The mean capsular thickness in the axillary recess (AR) (5.9 mm in the AC group vs. 3.6 mm in the control group) on coronal oblique T2-weighted images and the rotator interval (RI) (7.2 mm vs. 4.8 mm, respectively) on oblique sagittal proton-density images were significantly greater in the AC group than in the control group, whereas the width of RI showed no significant difference between two groups. The highest diagnostic cutoff values were 4.5 mm for the AR and 6 mm for the RI, with sensitivity (91% and 88%, respectively), specificity (90% and 90%), and accuracy (90% and 89%). Capsular thickness in the AR and RI was significantly correlated with external rotation (P = 0.047) and internal rotation (P = 0.023). On conventional MRI, capsular thickness greater than 4.5 mm in the AR or 6 mm in the RI can be an optimal criterion for diagnosing AC. Capsular thickness in the AR and RI was correlated with the range of rotational motion.
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SM CM. Is next-generation radiologist ready for the challenges? Indian J Radiol Imaging 2019; 29:2-3. [PMID: 31000933 PMCID: PMC6467028 DOI: 10.4103/ijri.ijri_124_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Chander Mohan SM
- Director, Interventional Radiology, BLK Superspeciality Hospital, Pusa Road, New Delhi, India
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Kanazawa K, Hagiwara Y, Sekiguchi T, Suzuki K, Koide M, Ando A, Yabe Y. Correlations between Capsular Changes and ROM Restriction in Frozen Shoulder Evaluated by Plain MRI and MR Arthrography. Open Orthop J 2018; 12:396-404. [PMID: 30450143 PMCID: PMC6198418 DOI: 10.2174/1874325001812010396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 09/13/2018] [Accepted: 09/13/2018] [Indexed: 12/02/2022] Open
Abstract
Background: Evaluation of the Range Of Motion (ROM) is one of the important procedures for shoulder disorders. The purpose of this study was to investigate correlations between capsular changes and ROM restrictions evaluated by both plain magnetic resonance imaging (MRI) and Magnetic Resonance Arthrography (MRA) in the same patients with frozen shoulder. Methods: Between March 2015 and June 2016, 24 patients with frozen shoulders (13 male and 11 female patients, mean age 60.5) with severe ROM restriction who underwent both MRI and MRA on the same affected side were evaluated. We evaluated 1) ROM, 2) the coracohumeral ligament (CHL) thickness, 3) the joint capsule thickness in the axillary recess (humeral and glenoid sides), 4) the area of the axillary recess, and 5) the capsular area of the axillary recess. Results: Positive correlations were found between the axillary area and forward flexion (FF) (R = 0.43, P = 0.035), lateral elevation (LE) (R = 0.66, P<0.001), external rotation (ER)(R = 0.43, P = 0.035), 90° abduction with external rotation (AER)(R = 0.56, P = 0.004), and hand behind the back (HBB)(R = 0.6, P = 0.002) on MRA. Negative correlations were found between the joint capsule at the glenoid side and ER and HBB in both MRI and MRA. Conclusion: The axillary area was significantly correlated with ROM restriction in FF, LE, ER, AER, and HBB on MRA. Thickness of the joint capsule at the glenoid side is an important factor for ROM restriction in frozen shoulder. Level of Evidence: Level 3, Study of Diagnostic Test.
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Affiliation(s)
- Kenji Kanazawa
- Department of Orthopaedic Surgery, South Miyagi Medical Center, Oogawara, Miyagi, Japan
| | - Yoshihiro Hagiwara
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Takuya Sekiguchi
- Department of Orthopaedic Surgery, Iwate Prefectural Central Hospital, Morioka, Iwate, Japan
| | - Kazuaki Suzuki
- Department of Orthopaedic Surgery, JR Sendai Hospital, Sendai, Miyagi, Japan
| | - Masashi Koide
- Department of Orthopaedic Surgery, Matsuda Hospital, Sendai, Miyagi, Japan
| | - Akira Ando
- Department of Orthopaedic Surgery, Matsuda Hospital, Sendai, Miyagi, Japan
| | - Yutaka Yabe
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Miyagi, Japan
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Ogul H, Tas N, Tuncer K, Polat G, Ogul Y, Pirimoglu B, Kantarci M. 3D volumetric MR arthrographic assessment of shoulder joint capacity in patients with primary adhesive capsulitis. Br J Radiol 2018; 92:20180496. [PMID: 30394797 DOI: 10.1259/bjr.20180496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To evaluate the three-dimensional (3D) volumetric MR arthrographic findings of shoulder joint capacity in patients with primary adhesive capsulitis. METHODS Thin-section 3D volumetric MR arthrography sequences of the shoulder joint were obtained in 28 patients with clinically and radiologically proven primary adhesive capsulitis and in 25 controls. Volumetric measurements of the total glenohumeral joint capacity, extra-articular contrast material leakage, and the rotator interval, axillary recess, and biceps tendon sheath capacities were performed for the study and control groups. RESULTS Mean volume of the rotator interval was 7.67 ± 2.6 cm3 in the study group, which was significantly lower than in the control group (12.31 ± 2.5 cm3) (p < 0.0001). Mean volume of the bicipital groove was significantly decreased in the patient group compared to the control group (1.67 ± 0.9 cm3 vs 2.88 ± 0.9 cm3) (p ≤ 0.0001). Mean volume of extra articular contrast material extravasation was 9.93 ± 1.7 cm3 in the patient group, which was significantly higher than in the control group (5.1 ± 1.4 cm3) (p = 0.002). Mean total glenohumeral joint volume was 22.52 ± 1.1 cm3 in the patient group and 26.01 ± 1.2 cm3 in the control group (p = 0.003). CONCLUSION On 3D volumetric MR arthrographic examination, obliterations in the biceps tendon sheath and rotator interval as well as decreased joint capacity may be useful imaging criteria for diagnosing primary adhesive capsulitis. ADVANCES IN KNOWLEDGE In the present study, MR arthrography showed contrast material extravasation in 71% of the patients and showed extra articular contrast material extravasation in 48% of the control subjects. On 3D volumetric MR arthrographic examination, obliterations in the biceps tendon sheath and rotator interval as well as decreased joint capacity may be useful imaging criteria for diagnosing primary adhesive capsulitis.In patients with primary adhesive capsulitis, thin-section 3D volumetric MR arthrography is a useful imaging modality to evaluate both joint capacity and capsular structure.
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Affiliation(s)
- Hayri Ogul
- 1 Department of Radiology, Medical Faculty, Ataturk University , Erzurum , Turkey
| | - Nurmuhammet Tas
- 2 Department of Physical Medicine Rehabilitation and Rheumatology, MedicalFaculty, Ataturk University , Erzurum , Turkey
| | - Kutsi Tuncer
- 3 Department of Orthopaedics and Traumatology, Medical Faculty, AtaturkUniversity , Erzurum , Turkey
| | - Gokhan Polat
- 1 Department of Radiology, Medical Faculty, Ataturk University , Erzurum , Turkey
| | - Yasemin Ogul
- 4 Department of Biochemistry, Erzurum Training and Research Hospital , Erzurum , Turkey
| | - Berhan Pirimoglu
- 1 Department of Radiology, Medical Faculty, Ataturk University , Erzurum , Turkey
| | - Mecit Kantarci
- 1 Department of Radiology, Medical Faculty, Ataturk University , Erzurum , Turkey
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Yukata K, Goto T, Sakai T, Fujii H, Hamawaki J, Yasui N. Ultrasound-guided coracohumeral ligament release. Orthop Traumatol Surg Res 2018; 104:823-827. [PMID: 29567320 DOI: 10.1016/j.otsr.2018.01.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 11/13/2017] [Accepted: 01/17/2018] [Indexed: 02/02/2023]
Abstract
Long-term follow-up of patients with adhesive capsulitis (AC) reveals that approximately half of them suffer from a limited range of shoulder motion, particularly external and/or internal rotation. We report the surgical technique and short-term clinical outcomes of ultrasound-guided release of the thickened coracohumeral (CH) ligament in 8 patients (9 shoulders) with AC. Passive external rotation with the arm by the side significantly increased from an average of 18° preoperatively to 47° immediately after CH ligament release. VAS and ASES scores were improved at 3months follow-up in all 9 shoulders, and maintained at 6months follow-up in 6 shoulders. No procedure-related adverse events developed over the 6-month follow-up period. Ultrasound-guided release for thickened CH ligament is a reliable and effective minimally invasive surgery for persistent limited external rotation due to AC of the shoulder.
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Affiliation(s)
- K Yukata
- Department of Orthopedics, Tokushima University Hospital, 3-18-15 Kuramoto, 770-8503 Tokushima, Japan; Department of Orthopedic Surgery, Hamawaki Orthopaedic Hospital, 4-6-6 Otemachi Naka-ku, 730-0051 Hiroshima, Japan; Department of Orthopedic Surgery, Ogori Daiichi General Hospital, 862-3 Ogori-Shimogo, 754-0002 Yamaguchi, Japan.
| | - T Goto
- Department of Orthopedics, Tokushima University Hospital, 3-18-15 Kuramoto, 770-8503 Tokushima, Japan.
| | - T Sakai
- Department of Orthopedics, Tokushima University Hospital, 3-18-15 Kuramoto, 770-8503 Tokushima, Japan.
| | - H Fujii
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, 862-3 Ogori-Shimogo, 754-0002 Yamaguchi, Japan.
| | - J Hamawaki
- Department of Orthopedic Surgery, Hamawaki Orthopaedic Hospital, 4-6-6 Otemachi Naka-ku, 730-0051 Hiroshima, Japan.
| | - N Yasui
- Department of Orthopedics, Tokushima University Hospital, 3-18-15 Kuramoto, 770-8503 Tokushima, Japan.
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Suh CH, Yun SJ, Jin W, Lee SH, Park SY, Park JS, Ryu KN. Systematic review and meta-analysis of magnetic resonance imaging features for diagnosis of adhesive capsulitis of the shoulder. Eur Radiol 2018; 29:566-577. [DOI: 10.1007/s00330-018-5604-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/02/2018] [Accepted: 06/07/2018] [Indexed: 12/13/2022]
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Early postoperative magnetic resonance imaging findings after arthroscopic rotator cuff repair: T2 hyperintensity of the capsule can predict reduced shoulder motion. Arch Orthop Trauma Surg 2018; 138:247-258. [PMID: 29128967 DOI: 10.1007/s00402-017-2834-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The purpose of this study was to investigate whether postoperative shoulder magnetic resonance imaging (MRI) findings correlate with postoperative shoulder range of motion (ROM) at about 4 months after arthroscopic rotator cuff repair (ARCR). MATERIALS AND METHODS Signal-intensity changes of the capsule, pericapsular soft tissue at the axillary recess, and subcoracoid fat triangle, as well as the thickness of the capsule at the axillary recess and coracohumeral ligament were assessed on preoperative and postoperative MR images of 232 patients. The ROM was evaluated preoperatively and at about 4 months after ARCR. RESULTS T2 hyperintensity of the capsule, pericapsular soft tissue at the axillary recess, and signal change of the subcoracoid fat triangle were detected in 155, 107, and 89 cases, respectively, on postoperative MRI. Among these cases, 129, 98, and 69 cases, respectively, showed newly developed signal changes. The mean thicknesses of the capsule and coracohumeral ligament were 1.89 ± 0.69 and 1.64 ± 0.51 mm, respectively, on preoperative MRI and 3.74 ± 1.12 and 2.42 ± 0.56 mm, respectively, on postoperative MRI. At the 4-month follow-up, the mean external rotation (ER), internal rotation (IR), abduction, forward flexion, and extension were 77, 73, 76, 83, and 82%, respectively, of the contralateral side. Newly developed T2 hyperintensity of the capsule and pericapsular soft tissue at the axillary recess on postoperative MRI significantly correlated with the postoperative limitation of ER (p = 0.039) and IR (p = 0.020). CONCLUSIONS Newly developed signal changes of the capsule, pericapsular soft tissue at the axillary recess, and subcoracoid fat triangle were often detected on postoperative MRI at 4 months after ARCR. Furthermore, newly developed T2 hyperintensity of the capsule and pericapsular soft tissue at the axillary recess correlated with limited ROM in ER and IR at 4 months after ARCR.
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The diagnostic value of a modified Neer test in identifying subacromial impingement syndrome. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:1063-1067. [PMID: 28534226 DOI: 10.1007/s00590-017-1979-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 05/15/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Subacromial impingement syndrome (SAIS) is characterized by pain experienced through an arc of elevation as the shoulder abducts and diagnosed commonly by Neer test (NT). However, the diagnostic accuracy of NT for SAIS is still limited. Here, a modified Neer test (MNT) was introduced to improve the accuracy of the clinical examination in diagnosing SAIS and differentiating it from frozen shoulder. The aim of this study was to investigate the diagnostic values of MNT in diagnosing SAIS and differentiating it from frozen shoulder. METHODS Between January 2015 and June 2015, a prospective study assessed 85 shoulders among 82 patients with shoulder joint disease; 42 patients underwent arthroscopic surgery, and all 82 patients received X-rays, magnetic resonance imaging (MRI) or MRI contrast examinations. The diagnostic criteria are based on arthroscopy and MRI scanning. RESULTS Using clinical epidemiology and diagnostic tests, we calculated the sensitivity, specificity, positive predictive value, negative predictive value and degree of accuracy of MNT in diagnosing SAIS. The diagnostic accuracy rate of MNT in identifying shoulder SAIS was 90.59%, and the specificity was 95.56%. CONCLUSIONS In the diagnosis of SAIS, MNT is a reliable and highly accurate maneuver and seems useful to distinguish this syndrome from frozen shoulder.
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Idowu BM, Ayoola OO, Adetiloye VA, Komolafe MA. Sonographic Evaluation of Structural Changes in Post-Stroke Hemiplegic Shoulders. Pol J Radiol 2017; 82:141-148. [PMID: 28382186 PMCID: PMC5360429 DOI: 10.12659/pjr.899684] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 07/08/2016] [Indexed: 12/15/2022] Open
Abstract
Background Stroke and hemiplegia are frequent complications of stroke. This study was performed to sonographically evaluate post-stroke hemiplegic shoulders and explore possible relationship(s) between the sonographic findings and clinical indices. Material/Methods Forty-five stroke patients and 45 age- and sex-matched controls were recruited. Standard sonographic examination of both shoulders was performed to assess for joint subluxation, rotator cuff tears, tendinosis, subacromial-subdeltoid bursitis or effusion and adhesive capsulitis. Results Hemiplegic shoulders exhibited significantly higher number of pathologies compared to the unaffected shoulders and shoulders of controls (p=0.000). One or more structural abnormalities were found in all 45 (100%) hemiplegic shoulders, 25 (55.6%) unaffected shoulders of the stroke subjects, and 39 (43.3%) control shoulders. The most frequent pathologies in the hemiplegic shoulders were the following: tendinosis of the long head of bicep tendon (48.9%), inferior shoulder subluxation (44.4%), co-existing subacromial-subdeltoid bursa/long head of bicep tendon sheath effusion (44.4%), and long head of bicep tendon sheath effusion only (40%). Tendinosis of the long head of bicep tendon was commoner in hemiplegic shoulders with poor motor status than those with good motor status. Conclusions Hemiplegic shoulders have significantly higher number of structural abnormalities than unaffected shoulders and the shoulders of controls. Hemiplegic stroke patients should undergo ultrasonography of the hemiplegic shoulder to define the nature and extent of soft tissue injuries prior to physical therapy.
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Affiliation(s)
- Bukunmi Michael Idowu
- Department of Radiology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun, Nigeria
| | | | - Victor Adebayo Adetiloye
- Department of Radiology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun, Nigeria
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Nacey NC, Geeslin MG, Miller GW, Pierce JL. Magnetic resonance imaging of the knee: An overview and update of conventional and state of the art imaging. J Magn Reson Imaging 2017; 45:1257-1275. [PMID: 28211591 DOI: 10.1002/jmri.25620] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 11/04/2016] [Indexed: 12/28/2022] Open
Abstract
Magnetic resonance imaging (MRI) has become the preferred modality for imaging the knee to show pathology and guide patient management and treatment. The knee is one of the most frequently injured joints, and knee pain is a pervasive difficulty that can affect all age groups. Due to the diverse pathology, complex anatomy, and a myriad of injury mechanisms of the knee, the MRI knee protocol and sequences should ensure detection of both soft tissue and osseous structures in detail and with accuracy. The knowledge of knee anatomy and the normal or injured MRI appearance of these key structures are critical for precise diagnosis. Advances in MRI technology provide the imaging necessary to obtain high-resolution images to evaluate menisci, ligaments, and tendons. Furthermore, recent advances in MRI techniques allow for improved imaging in the postoperative knee and metal artifact reduction, tumor imaging, cartilage evaluation, and visualization of nerves. As treatment and operative management techniques evolve, understanding the correct application of these advancements in MRI of the knee will prove to be valuable to clinical practice. LEVEL OF EVIDENCE 5 J. MAGN. RESON. IMAGING 2017;45:1257-1275.
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Affiliation(s)
- Nicholas C Nacey
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
| | - Matthew G Geeslin
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
| | - Grady Wilson Miller
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
| | - Jennifer L Pierce
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
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Sasanuma H, Sugimoto H, Fujita A, Kanaya Y, Iijima Y, Saito T, Takeshita K. Characteristics of dynamic magnetic resonance imaging of idiopathic severe frozen shoulder. J Shoulder Elbow Surg 2017; 26:e52-e57. [PMID: 27539943 DOI: 10.1016/j.jse.2016.06.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/03/2016] [Accepted: 06/07/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the effectiveness of current techniques for dynamic 3-dimensional magnetic resonance imaging (MRI) in the diagnosis of idiopathic severe frozen shoulder (FS). MATERIALS AND METHODS Subjects consisted of 5 healthy volunteers and 16 patients with idiopathic severe FS. We defined severe idiopathic FS as follows: range of motion ≤100° in forward flexion, ≤10° in external rotation, and ≤L5 in internal rotation. All patients suffered from continued global range of motion loss for at least 6 months. We evaluated the diagnostic characteristics of 3-dimensional dynamic MRI in FS patients compared with those in healthy volunteers. RESULTS MRI of all FS patients displayed an abnormal intake of blood flow from the acromial arterial network and the branches of circumflex humeral arteries into the axillary pouch and the rotator interval. We named this finding "burning sign." The burning sign was present at all phases of the condition. In the FS group, the patients with enhanced deposition of contrast medium in the axillary pouch in the delayed phase (n = 11) had a statistically significant score for pain during exercise, higher than that of patients with reduced deposition of contrast medium at the same site (n = 5; P = .027). CONCLUSION Burning sign is an abnormal finding that appears in dynamic MRI of severe FS. Hence, the burning sign may be associated with pain and inflammation in idiopathic FS.
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Affiliation(s)
- Hideyuki Sasanuma
- Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan.
| | | | - Akifumi Fujita
- Department of Radiology, Jichi Medical University, Tochigi, Japan
| | - Yuji Kanaya
- Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan
| | - Yuki Iijima
- Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan
| | - Toshihiro Saito
- Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan
| | - Katsushi Takeshita
- Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan
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Correlations of coracohumeral ligament and range of motion restriction in patients with recurrent anterior glenohumeral instability evaluated by magnetic resonance arthrography. J Shoulder Elbow Surg 2017; 26:233-240. [PMID: 27814944 DOI: 10.1016/j.jse.2016.09.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 08/22/2016] [Accepted: 09/07/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Evaluation of range of motion (ROM) restriction before treatment of shoulder disorders is important for predicting the final functional outcomes. The purpose of this study was to investigate correlations of thickness of the coracohumeral ligament (CHL) and ROM restriction in patients with recurrent anterior glenohumeral instability. METHODS Between January 2005 and March 2015, 181 shoulders (137 male and 44 female patients; mean age, 29.3 years) with recurrent anterior glenohumeral instability treated with an arthroscopic Bankart repair were enrolled in this study. We evaluated preoperative ROM, thickness of the CHL, and obliteration of the subcoracoid fat triangle on magnetic resonance arthrography. ROM measurements, including forward flexion (FF), external rotation with the arm at the side (ER), and hand behind the back (HBB), were made in a standing position. RESULTS There were significant negative correlations between FF and age (P < .001) and between HBB and age (P < .001) but not between ER and age (P = .11). The thickness of the CHL significantly increased with age (P < .001). FF, ER, and HBB were significantly restricted in patients with obliteration compared with those without obliteration (P < .001, P = .004, P < .001, respectively). CONCLUSIONS Obliteration of the subcoracoid fat triangle and the thickness of the CHL positively correlated with ROM restrictions, and these changes were greater with age in patients with recurrent anterior glenohumeral instability.
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Adhesive Capsulitis of the Shoulder Joint: Value of Glenohumeral Distance on Magnetic Resonance Arthrography. J Comput Assist Tomogr 2017; 41:116-120. [PMID: 27560018 DOI: 10.1097/rct.0000000000000475] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the usefulness of glenohumeral distance (GHD) on axial images of magnetic resonance (MR) arthrography for diagnosis of adhesive capsulitis and to compare this finding with previously reported classic MR arthrographic findings of adhesive capsulitis. MATERIALS AND METHODS Our study was approved by the institutional ethical review board of our institute. We evaluated 41 patients (M-F, 35:6; mean age, 46 years; adhesive capsulitis, 21; no adhesive capsulitis, 20) who underwent MR arthrography. Two radiologists measured GHD, width of the axillary recess, and capsular thickness in consensus. The GHD was measured from the subchondral bone of the glenoid fossa to the subchondral bone of the humeral head at the level of the midline of the humeral head. Glenohumeral distance (anterior, middle, posterior, and mean), width of the axillary recess, and capsular thickness (anterior, posterior, and mean) were compared in the adhesive capsulitis and no adhesive capsulitis groups using the Mann-Whitney U test. RESULTS The mean GHD of the no adhesive capsulitis group was longer than that of the adhesive capsulitis group. The length differences were statistically significant (P < 0.05). The mean width of the axillary recess of the no adhesive capsulitis group was significantly wider than that of the adhesive capsulitis group (P < 0.001). The mean capsular thickness of the no adhesive capsulitis group was significantly thinner than that in the adhesive capsulitis group (P = 0.001). CONCLUSIONS A decreased GHD on MR arthrography can be another useful feature to diagnose adhesive capsulitis in addition to previously presented radiologic features such as capsular thickening and reduced axillary recess capacity.
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Evaluation of Adhesive Capsulitis of the Shoulder With Fat-Suppressed T2-Weighted MRI: Association Between Clinical Features and MRI Findings. AJR Am J Roentgenol 2016; 207:135-41. [DOI: 10.2214/ajr.15.15200] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Wu CH, Chen WS, Wang TG. Elasticity of the Coracohumeral Ligament in Patients with Adhesive Capsulitis of the Shoulder. Radiology 2015; 278:458-64. [PMID: 26323030 DOI: 10.1148/radiol.2015150888] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate the elasticity of the coracohumeral ligament (CHL) in healthy individuals and patients with clinical findings suggestive of unilaterally involved adhesive capsulitis of the shoulder (ACS). MATERIALS AND METHODS The institutional review board approved this single-institution prospective study, which was performed between November 15, 2012, and July 8, 2014. Informed consent was obtained from all subjects. Measurement of CHL thickness was performed in the axial oblique plane under shoulder maximal external rotation. Shear-wave elastography (SWE) was used to evaluate elasticity of the CHL in healthy individuals (11 men, 19 women aged 22-62 years) and those with clinical findings suggestive of ACS (nine men, 11 women aged 41-70 years). SWE was performed in the shoulder-neutral position and under maximal external rotation. The Wilcoxon signed-rank test was performed to compare the thickness and elastic modulus of the CHL between bilateral shoulders. RESULTS In all subjects, the CHL elastic modulus was larger under maximal external rotation than in the neutral position (P < .001 for all). For healthy subjects, there was no significant difference in the CHL elastic modulus between the dominant and nondominant shoulders. For patients presumed to have ACS, the CHL thickness was significantly greater in the symptomatic shoulder than in the unaffected shoulder (P < .001). The CHL elastic modulus of the symptomatic shoulder (median, 234.8 kPa; interquartile range [IQR], 174.4-256.7 kPa) was significantly greater than that of the unaffected shoulder (median, 203.3 kPa; IQR, 144.1-242.7 kPa) in the shoulder-neutral position (P = .004) but not under maximal external rotation (P = .123). When bilateral shoulders were maintained at the same angle of external rotation, the CHL elastic modulus was greater in the symptomatic shoulder than in the unaffected shoulder (P = .005). CONCLUSION In patients with clinical findings suggestive of ACS, SWE showed that the CHL is stiffer in the symptomatic shoulder than in the unaffected shoulder.
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Affiliation(s)
- Chueh-Hung Wu
- From the Department of Physical Medicine and Rehabilitation, National Taiwan Hospital, College of Medicine, National Taiwan University, 7 Chan-Shan South Rd, 100 Taipei, Taiwan
| | - Wen-Shiang Chen
- From the Department of Physical Medicine and Rehabilitation, National Taiwan Hospital, College of Medicine, National Taiwan University, 7 Chan-Shan South Rd, 100 Taipei, Taiwan
| | - Tyng-Guey Wang
- From the Department of Physical Medicine and Rehabilitation, National Taiwan Hospital, College of Medicine, National Taiwan University, 7 Chan-Shan South Rd, 100 Taipei, Taiwan
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Ueda Y, Sugaya H, Takahashi N, Matsuki K, Kawai N, Tokai M, Onishi K, Hoshika S. Rotator Cuff Lesions in Patients with Stiff Shoulders: A Prospective Analysis of 379 Shoulders. J Bone Joint Surg Am 2015; 97:1233-7. [PMID: 26246257 DOI: 10.2106/jbjs.n.00910] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Idiopathic adhesive capsulitis is defined as a frozen shoulder with severe and global range-of-motion loss of unknown etiology. The purpose of our study was to clarify the prevalence of rotator cuff lesions according to patterns and severity of range-of-motion loss in a large cohort of patients with stiff shoulders. METHODS Rotator cuff pathology was prospectively investigated with use of magnetic resonance imaging (MRI) or ultrasonography in a series of 379 stiff shoulders; patients with traumatic etiology, diabetes, or radiographic abnormalities were excluded. Eighty-nine shoulders demonstrated severe and global loss of passive motion (≤100° of forward flexion, ≤10° of external rotation with the arm at the side, and internal rotation not more cephalad than the L5 level) and were classified as having severe and global loss of motion (Group 1). The remaining 290 shoulders were divided into two groups: those with severe but not global loss (Group 2; 111 shoulders) and mild to moderate limitation (Group 3; 179 shoulders). RESULTS Among all shoulders, imaging demonstrated an intact rotator cuff in 51%, a full-thickness tear in 35%, and a partial-thickness tear in 15%. In Group 1, 91% had an intact rotator cuff and 9% had a partial-thickness rotator cuff tear. No patient in this group demonstrated a full-thickness tear. In Group 2 and Group 3, respectively, 44% and 35% of the shoulders were intact, 17% and 16% had a partial-thickness tear, and 39% and 50% had a full-thickness tear. CONCLUSIONS Shoulder stiffness with severe and global loss of passive range of motion is not associated with full-thickness rotator cuff tears, although some patients may have a partial-thickness tear. Shoulders with severe and global loss of range of motion at a first visit are likely to be cases of idiopathic adhesive capsulitis and may not require further imaging studies.
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Affiliation(s)
- Yusuke Ueda
- Shoulder & Elbow Center, Funabashi Orthopaedic Hospital, 1-833 Hazama, Funabashi, Chiba 2740822, Japan. E-mail address for H. Sugaya:
| | - Hiroyuki Sugaya
- Shoulder & Elbow Center, Funabashi Orthopaedic Hospital, 1-833 Hazama, Funabashi, Chiba 2740822, Japan. E-mail address for H. Sugaya:
| | - Norimasa Takahashi
- Shoulder & Elbow Center, Funabashi Orthopaedic Hospital, 1-833 Hazama, Funabashi, Chiba 2740822, Japan. E-mail address for H. Sugaya:
| | - Keisuke Matsuki
- Shoulder & Elbow Center, Funabashi Orthopaedic Hospital, 1-833 Hazama, Funabashi, Chiba 2740822, Japan. E-mail address for H. Sugaya:
| | - Nobuaki Kawai
- Shoulder & Elbow Center, Funabashi Orthopaedic Hospital, 1-833 Hazama, Funabashi, Chiba 2740822, Japan. E-mail address for H. Sugaya:
| | - Morihito Tokai
- Shoulder & Elbow Center, Funabashi Orthopaedic Hospital, 1-833 Hazama, Funabashi, Chiba 2740822, Japan. E-mail address for H. Sugaya:
| | - Kazutomo Onishi
- Shoulder & Elbow Center, Funabashi Orthopaedic Hospital, 1-833 Hazama, Funabashi, Chiba 2740822, Japan. E-mail address for H. Sugaya:
| | - Shota Hoshika
- Shoulder & Elbow Center, Funabashi Orthopaedic Hospital, 1-833 Hazama, Funabashi, Chiba 2740822, Japan. E-mail address for H. Sugaya:
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Abstract
The rotator cuff is a complex network of interwoven tendons that plays a key role in glenohumeral movement and stability. Cuff abnormality is a common source of shoulder pain, but the clinical presentation is often nonspecific and, as a result, diagnostic imaging, especially magnetic resonance imaging, plays a key role in evaluating these patients. This article reviews imaging modalities available for evaluating the cuff, normal cuff anatomy, and common pathologic conditions that affect it.
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Affiliation(s)
- Mark W Anderson
- Department of Radiology, The University of Virginia Health Sciences Center, Charlottesville, VA 22908-0170, USA.
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Chung SG. What Is on the Horizon? Adding a New Item to Our List: Mechanical Connective Soft Tissue. PM R 2012; 4:247-51. [DOI: 10.1016/j.pmrj.2012.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 03/01/2012] [Indexed: 11/16/2022]
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