Correlation of Ultrasound Findings With Clinical Stages and Impairment in Adhesive Capsulitis of the Shoulder

Abstract

Background: Ultrasound is an essential tool for diagnosing shoulder disorders. However, the role of ultrasound in assessing and diagnosing adhesive capsulitis has not been fully studied. Purpose: To evaluate the ultrasound features of adhesive capsulitis and estimate the correlations between clinical impairment and ultrasound parameters. Study Design: Case series; Level of evidence, 4. Methods: A total of 61 patients with clinically diagnosed unilateral adhesive capsulitis were retrospectively reviewed using high-resolution ultrasound. To compare ultrasound parameters, we performed ultrasound examinations on both affected and unaffected shoulders. Ultrasound parameters, including thickness of the coracohumeral ligament (CHL), rotator interval (RI), axillary recess (AR), hypervascularity of the RI, and effusion of the long head of the biceps tendon sheath, were measured. Passive range of motion (PROM), visual analog scale for pain, and the Shoulder Pain and Disability Index were used for clinical assessment. Results: The CHL, the RI, and the AR in affected shoulders were significantly thicker than in unaffected shoulders ( P < .05). CHL thickness in affected shoulders was significantly correlated with PROM limitation, which included forward elevation, abduction, external rotation (ER), and internal rotation (IR) ( P < .05). AR thickness correlated with passive forward elevation limitation and passive IR limitation ( P < .05). The CHL was significantly thicker in stage 2 compared with stage 1, and the RI was thicker in stage 2 compared with stage 3. The diagnostic cutoff values for adhesive capsulitis were 2.2 mm for CHL thickness (77% sensitivity, 91.8% specificity) and 4 mm for AR thickness (68.9% sensitivity, 90.2% specificity). Conclusion: The ultrasound parameters associated with structural changes were correlated with clinical characteristics of adhesive capsulitis. Thickened CHL, RI, and AR were observed in affected shoulders. The cutoff values of 2.2 mm for CHL thickness and 4 mm for AR thickness can be used as cutoff diagnostic values for adhesive capsulitis.

Evaluation of the tissue thickness of the supraspinatus and biceps long head tendons using ultrasound among elderly patients with unilateral adhesive capsulitis in the freezing phase

“…Patients with AC underwent ultrasonography. Compared with unaffected shoulders, the frequency of increased tissue thickness at the rotator interval and BT effusion in the affected shoulders was found to be higher in the freezing phase than in the frozen and thawing phases 18 ) . An MRI study showed that the shoulder joint capsule thickness in the humeral portion of axillary recess was positively correlated with the intensity of pain 23 ) .…”

“…Arthroscopy provides an accurate assessment of the joint capsule; however, because of its invasive nature, its use is limited for diagnostic purposes. Further, high-resolution ultrasound has been widely used as a suitable imaging option for musculoskeletal problems, as it is noninvasive, inexpensive, and easy to perform bilaterally in specific positions 18 ) . Several orthopedic tests are available to detect abnormalities in the soft tissue surrounding the shoulder joint.…”

“…In the freezing phase of AC, if the tissue causing severe pain can be detected by ultrasonography, it is possible to select the treatment target for pain relief and objectively judge the treatment effect on the tissue. Ultrasonography of patients with AC has shown changes in tissue thickness of the coracohumeral ligament, inferior capsule, inferior glenohumeral ligament, and rotator interval 18 , 24 , 25 , 26 ) . These reports do not presuppose selection of treatment targets or judge treatment effect.…”

Frozen Shoulder: Symptoms, Causes, Diagnosis, and Treatment

“…Several studies have shown that the CHL is thickened and stiffened in adhesive capsulitis on ultrasound [29][30][31] .Other researches correlate AR thickening as a key diagnostic finding of adhesive capsulitis [32] and approximately the AR cutoff value for adhesive capsulitis diagnosis was 4 mm [28].…”

“…However, the role of ultrasound in assessing and diagnosing adhesive capsulitis has not been fully studied. Sonography had high diagnostic accuracy for the diagnosis of adhesive capsulitis using a combination of parameters, such as coracohumeral ligament (CHL) thickness, rotator interval (RI) thickness, and hypervascularity, axillary recess (AR) thickness [27,28].…”