Department of Rheumatology, Lariboisière-Fernand Widal Hospital, AP-HP, Paris 7 University, Paris, France -
Department of Physical and Rehabilitation Medicine, Lariboisière-Fernand Widal Hospital, AP-HP, Paris 7 University, Paris, France -
Eur J Phys Rehabil Med. 2020 Aug;56(4):438-443. doi: 10.23736/S1973-9087.19.05890-8. Epub 2019 Nov 18.
The diagnosis of adhesive capsulitis is currently based on restricted range of motion (ROM) but its diagnostic value has only been rarely investigated.
The aim of this study is to assess the diagnostic value of active global and passive gleno-humeral ROM to diagnose shoulder adhesive capsulitis.
Cross-sectional descriptive study.
One French center for Rehabilitation Medicine.
Patients referred for treatment of shoulder adhesive capsulitis in our center were included. Inclusion criteria were: shoulder pain; limitation of active global ROM (abduction or flexion <180°); limitation of passive gleno-humeral ROM (abduction or flexion <90° or 25% reduction at less of lateral rotation versus the opposite shoulder); no gleno-humeral arthropathy on radiography.
The volume of the gleno-humeral capsule was assessed during a procedure of arthro-distension. The reference criterion for adhesive capsulitis was a volume <12 mL. We analyzed the correlation between the parameters of mobility and the volume of the gleno-humeral capsule; and the positive predictive value (PPV) of inclusion criteria, with the reference criterion for the diagnosis of adhesive capsulitis.
We included 38 patients. Passive gleno-humeral ROM in abduction only was correlated with volume of the gleno-humeral capsule: r=0.33, P=0.043. The PPV of inclusion criteria was 82% for the diagnosis of shoulder adhesive capsulitis. Rather than 90°, when we considered 80°, 60° and 40° as the threshold of passive gleno-humeral ROM in abduction, the PPV increased from 83% to 100%.
Passive gleno-humeral ROM in abduction is correlated with volume of the gleno-humeral capsule. The PPV is high for active global and passive gleno-humeral ROM for diagnosis of shoulder adhesive capsulitis.
Limitation of active and passive shoulder ROM, especially passive abduction gleno-humeral, is a good criterion to diagnose shoulder adhesive capsulitis, in patients with shoulder pain and no gleno-humeral arthropathy on radiography.
目前，粘连性肩关节囊炎的诊断基于活动范围受限（ROM），但其诊断价值很少被研究。
本研究旨在评估主动整体和被动盂肱关节 ROM 对诊断肩部粘连性关节囊炎的诊断价值。
横断面描述性研究。
法国康复医学中心。
在我们中心接受肩部粘连性关节囊炎治疗的患者被纳入研究。纳入标准为：肩部疼痛；主动整体 ROM 受限（外展或前屈＜180°）；被动盂肱关节 ROM 受限（外展或前屈＜90°或与对侧肩部相比侧方旋转减少 25%）；影像学未见肩关节炎。
在关节扩张过程中评估盂肱关节囊的容积。粘连性关节囊炎的参考标准为容积＜12mL。我们分析了活动度参数与盂肱关节囊容积之间的相关性；以及纳入标准的阳性预测值（PPV）与粘连性关节囊炎的诊断参考标准之间的关系。
共纳入 38 例患者。仅在外展时的被动盂肱关节 ROM 与盂肱关节囊容积相关：r=0.33，P=0.043。纳入标准的 PPV 为诊断肩部粘连性关节囊炎的 82%。当我们将被动盂肱关节 ROM 外展的阈值设定为 80°、60°和 40°时，而不是 90°，PPV 从 83%增加到 100%。
在外展时，被动盂肱关节 ROM 与盂肱关节囊容积相关。主动整体和被动盂肱关节 ROM 的 PPV 均较高，可用于诊断肩部粘连性关节囊炎。
在肩部疼痛且影像学未见肩关节炎的患者中，限制主动和被动肩部 ROM，特别是被动外展盂肱关节 ROM，是诊断肩部粘连性关节囊炎的一个很好的标准。
