Optimal Cut-Off Value of the Coracohumeral Ligament Area as a Morphological Parameter to Confirm Frozen Shoulder

Magnetic resonance imaging features for diagnosing adhesive capsulitis of the shoulder: a systematic review and meta-analysis

BACKGROUND

Various magnetic resonance imaging (MRI) characteristics are frequently employed to aid diagnose adhesive capsulitis of the shoulder (ACS) and offer valuable therapeutic insights. To identify and summarize the diagnostic accuracy of these features, a systematic review and meta-analysis were performed.

METHODS

Four databases, including PubMed, EMBASE, Web of Science, and Cochrane Library, were searched. Overlapping descriptions used to represent the same imaging in different studies are grouped into one MRI feature. Pooled diagnostic accuracy, including sensitivity and specificity, was calculated using a bivariate random-effects model.

RESULTS

The screening identified 21 studies involving 928 ACS patients and 873 non-ACS patients considered eligible for inclusion in this meta-analysis. A total of 106 overlapping descriptions were classified into 7 features, including axillary capsular thickening, axillary capsular hyperintensity, axillary capsular enhancement, fat obliteration of the rotator interval (RI), RI enhancement, RI joint capsule thickening, and coracohumeral ligament (CHL) thickening. All seven features were considered informative for the diagnosis of ACS. Axillary capsular enhancement had the highest pooled sensitivity (95%, 95% CI [91%- 98%]), the highest diagnostic odds ratios (107, 95% CI [32, 357]), and the highest area under the curve(0.96 [0.94-0.97]). All features except fat obliteration of the RI and CHL thickening showed a pooled sensitivity of > 80%. Three of seven (axillary capsular thickening, axillary capsular hyperintensity, and axillary capsular enhancement) showed a pooled specificity of > 80%.

CONCLUSION

Seven informative MRI features were identified in this study, with axillary capsular enhancement and RI joint capsule thickening showing the highest diagnostic accuracy. Clinicians can refer to these MRI features to increase confidence in diagnosing ACS and rule out other confused diagnoses.

Diagnostic value of high-frequency ultrasound combined with magnetic resonance in different clinical stages of frozen shoulder: A retrospective cohort study

BackgroundFrozen shoulder (FS) is a common musculoskeletal disease. Imaging plays an active role in the clinical diagnosis and staging of FS.ObjectiveThis study is undertaken to assess the application value of high-frequency ultrasound (HFU) combined with magnetic resonance (MR) in clinical staging diagnosis of FS.MethodsThis was a retrospective cohort study. The medical records of FS patients (from January 2021 to February 2022, n = 100) were collected. Patients were categorized into stage I (n = 30), stage II (n = 35) and stage III (n = 35) groups. The diagnostic value of HFU-related and MR-related indicators was assessed by the receiver operating characteristic (ROC) curve. The correlation between HFU/MR indicator and passive range of motion-related indicators was analyzed by Spearman rank method.ResultsThere were no statistically significant differences in gender, age, height, weight, and affected shoulder (left: right) among the three groups at different stages (p > 0.05). HFU and MR in combination had a higher diagnostic coincidence rate when compared to their single use (96.00% vs. 91.00% or 93.00%). There was high diagnostic value for inferior capsule thickness (ICT) (area under the curve (AUC) = 0.914, p < 0.001, 95%CI (0.836-0.992)), glenohumeral distance (GHD) (AUC = 0.999, p < 0.001, 95%CI (0.996-1.000)) and articular capsule thickness (ACT) (AUC = 1.000, p < 0.001, 95%CI (0.998-1.000)) in stage I FS, for ICT (AUC = 0.947, p < 0.001, 95%CI (0.885-1.000)) and GHD (AUC = 0.974, p < 0.001, 95%CI (0.949-0.999)) in stage II FS, and for ACT (AUC = 0.989, p < 0.001, 95%CI (0.975-1.000)) in stage III FS. ICT/ACT positively correlated with internal rotation (IR), and negatively correlated with external rotation (ER)/extension (EX)/flexion (FL)/abduction (AB). GHD had a negative correlation with IR, and a positive correlation with ER/EX/FL/AB.ConclusionHigh-frequency ultrasound combined with magnetic resonance can improve the accuracy in clinical diagnosis of FS, promote better staging of FS, and provide a more reliable basis for clinical diagnosis and treatment of FS.

Prevalence of prediabetes in patients with idiopathic frozen shoulder: a prospective study

Background

The association between diabetes and frozen shoulder is well established. However, the data regarding prediabetes and primary frozen shoulder (PFS) are still lacking.

Methods

In a prospective study, 158 patients with PFS were included. The prediabetes status was ascertained by estimating serum hemoglobin A1c (HbA1c) levels in patients with PFS. According to the level of HbA1c, patients were classified into normoglycemic, prediabetic, and diabetic. In addition, random blood sugar (RBS) was also performed.

Results

Out of 158 participants, 84 (53.2%) were male and 74 (46.8%) were female. Nine patients had bilateral shoulder involvement, and all were diabetics; 47.5% (n = 75) of the patients were in the age group of 51-60 years, 16.5% (n = 26) of the participants were normoglycemic, 37.3% (n = 59) were prediabetics, and 46.2% (n = 73) were diabetics. The difference in mean HbA1c values between the 3 groups was statistically significant (P < .001). However, there was no statistical difference in various age groups (P = .86) or gender (P = .68) between normoglycemics, prediabetics, and diabetics. The difference in mean RBS values between diabetic-nondiabetic and diabetic-prediabetic groups were statistically significant (P < .001), whereas no significant difference was detected between nondiabetic and prediabetic (P = .355).

Conclusion

The prevalence of prediabetes is 37.5% in patients with PFS. Single-point HbA1c estimation is an acceptable tool to detect prediabetes, whereas RBS estimation should not be used to detect prediabetes.

Current concepts in the diagnosis and treatment of adhesive capsulitis: role of diagnostic imaging and ultrasound-guided interventional procedures

Adhesive capsulitis is a common cause of painful shoulder, characterized by pain and restricted range of motion of the glenohumeral joint. With a well-known clinical presentation, and an increasing understanding of its clinical and radiologic features, early diagnosis of adhesive capsulitis is becoming a reality. Although often treated conservatively, for refractory cases arthroscopic release and open capsulotomy have been the only therapeutic option for a long time. Therefore, in the last years, a particular effort was put into the development of novel minimal-invasive techniques capable of pain relief and functional range improvement of the glenohumeral joint. The purpose of this literature review is to report the main updates on diagnosis and treatment for adhesive capsulitis with a focus on imaging diagnosis techniques and novel minimally invasive ultrasound-guided treatments. Results showed that ultrasound-guided procedures come with a high success rate in terms of pain reduction and improved range of motion, thus making the ultrasound a unique tool capable of giving the operator real-time diagnostic information confirming the clinical suspicion, and subsequently performing an interventional procedure.

Ultrasound-guided hydrodilatation of glenohumeral joint combined with acupotomy for treatment of frozen shoulder

BACKGROUND

Frozen shoulder (FS), also known as shoulder adhesive capsulitis, is a musculoskeletal disorder associated with pain and functional disability. There is a lack of evidence on the optimal treatment strategy for FS.

OBJECTIVE

The present study aimed to evaluate the effectiveness and safety of ultrasound-guided hydrodilatation of glenohumeral joint combined with acupotomy for treatment of FS.

METHODS

In this prospective randomized, double-blind, controlled study, 63 FS patients were recruited, and equally allocated to treatment group and control group. The treatment group was treated with ultrasound-guided hydrodilatation of glenohumeral joint combined with acupotomy, while the control group was only treated with ultrasound-guided hydrodilatation of glenohumeral joint. The pain and mobility of shoulder, overall efficacy and adverse reactions were evaluated 3 months after treatment.

RESULTS

At baseline, no significant difference in all characteristic value was found between the treatment group (n= 33) and control group (n= 30). Three months after operation, the joint's Active Range of Motion (AROM) and Constant-Murley Scale (CMS) scores in the experimental group were higher than those in the control group, and the coracohumeral ligament (CHL) thickness and the rate of hypoechoic thickening in rotator cuff space in the experimental group were lower than those in the control group (all P< 0.05). The amount of injection volume at the third hydrodilatation was significantly higher in the experimental group than that in the control group (15.8 ± 4.7 vs 12.2 ± 5.2, P= 0.03). After 2 times of treatment, the volume increment of glenohumeral joint Δ2 in the experimental group was greater than that in the control group (3.5 ± 1.8 vs 1.2 ± 1.6, P< 0.001). There were significant differences in the effective rate between the two groups (93.94% vs. 76.67%, P= 0.04).

CONCLUSION

The ultrasound-guided hydrodilatation of glenohumeral joint combined with acupotomy may benefit FS patients.