Comparison of Shoulder Ultrasonographic Assessments between Polymyalgia Rheumatica and Frozen Shoulder in Patients with Bilateral Shoulder Pain: A Comparative Retrospective Study

Abstract

This study aimed to assess and compare the ultrasonographic (US) pathologic findings in patients with polymyalgia rheumatica (PMR) and bilateral frozen shoulder (FS). We included 19 patients with clinically diagnosed PMR and 19 patients with stage II bilateral FS. The US evaluation included the assessment of subacromial-subdeltoid (SASD) bursitis, long head of biceps (LHB) tenosynovitis, and posterior and inferior glenohumeral (GH) synovitis. Unilateral SASD bursitis was noted significantly more frequently in PMR patients than in bilateral FS patients (p = 0.001). There were no significant differences in the incidence of unilateral LHB tenosynovitis and posterior GH synovitis between PMR and bilateral FS patients (p = 0.108 and p = 0.304, respectively). Unilateral inferior GH synovitis was more common among bilateral FS patients than among PMR patients (p < 0.001). Bilateral SASD bursitis and LHB tenosynovitis were noted significantly more frequently in PMR patients than in bilateral FS patients (p < 0.001 and 0.049, respectively). Significant differences were not observed in the incidence of bilateral posterior GH synovitis between PMR and bilateral FS patients (p = 0.426). Bilateral inferior GH synovitis was more common among bilateral FS patients than among PMR patients (p = 0.044). The US evidence for bilateral inferior GH synovitis without bilateral SASD showed high specificity (94.7%) with sensitivity (78.9%) for the diagnosis of bilateral FS. SASD bursitis, representing periarticular synovial inflammation, was more common among the patients with PMR than among the patients with bilateral FS. Inferior GH synovitis without SASD bursitis suggests FS rather than PMR in patients with bilateral shoulder pain.

Ultrasonic Identification of Polymyalgia Rheumatica and Frozen Shoulder

“…SASD bursitis, which represents periarticular synovial in ammation, is more common in patients with PMR than in those with FS. Inferior GH synovitis, representing intra-articular synovitis, is more common in patients with FS than in those with PMR [7]. These correspond to the pathological features of both diseases.…”

“…In terms of PMR, patients were included if they met the PMR classi cation criteria of 2012 EULAR/ACR [5], had a disease duration of less than 6 months; and used nonsteroidal anti-in ammatory drugs (NSAIDs) or disease-modifying anti-rheumatic drugs for less than one week. In terms of FS, patients were included if they had shoulder pain with limited passive movement, speci cally less than 30 degrees in two or more planes [7], were diagnosed as having stage II FS as de ned by Hanna n and Chiaia [8], had a disease duration of less than 6 months, and used NSAIDs. Patients were excluded if they took glucocorticoids within a week prior to the ultrasound; received a peripheral shoulder injection, sustained shoulder trauma, or underwent shoulder surgery within 3 months prior to the ultrasound; had a shoulder joint infectious disease, rheumatoid arthritis, giant cell arteritis or other rheumatic diseases; or had incomplete medical history information, including only unilateral shoulder ultrasound ndings.…”

“…In practice, it is more important to distinguish FS from PMR than to distinguish these diseases. Park et al [7] rst emphasized the importance of distinguishing between PMR and FS and proposed that SASD bursitis was more common in patients with PMR than in patients with bilateral FS. Inferior GH synovitis without SASD bursitis suggests FS rather than PMR in patients with bilateral shoulder pain.…”

Blood flow velocity in the anterior humeral circumflex artery and tear size can predict synovitis severity in patients with rotator cuff tears

“…PSV in the AHCA therefore is a stronger indicator of synovitis severity than Doppler activity. When applying Doppler activity to patients with RCTs, the following considerations should be kept in mind: (1) power Doppler may be less frequently observed in non-rheumatoid shoulder diseases [ 21 , 22 ], and it is a sensitive marker only during the active inflammatory phase [ 12 , 23 ]; (2) differences in measurement position can lead to errors in power Doppler findings [ 7 ]; and (3) PSV is quantitative, whereas Doppler activity is semiquantitative [ 6 ]. Nevertheless, the possibility that Doppler activity may be indicative of synovitis cannot be ruled out, and a system for assessing Doppler activity with high accuracy warrants future research.…”