Department of Anesthesiology and Pain Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea.
Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Korea.
J Korean Med Sci. 2020 Apr 20;35(15):e99. doi: 10.3346/jkms.2020.35.e99.
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).
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.
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 ( < 0.01) and CHLT ( < 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.
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.
增厚的喙肱韧带（CHL）是冻结肩（FS）的重要形态学变化之一。先前的研究报告称，喙肱韧带厚度（CHLT）与盂肱前不稳定、旋转间隔有关，最终与 FS 有关。然而，厚度可能会因切割角度和测量点的不同而发生变化。为了减少测量错误，我们设计了一种新的成像标准，称为喙肱韧带面积（CHLA）。
收集并分析了 52 例 FS 患者和 51 例对照组（无 FS 证据）的 CHL 数据。所有受试者均进行肩部磁共振成像。我们使用图像存档和通信系统在 CHL 的最大增厚视图中研究 CHLT 和 CHLA。CHLA 作为包括斜矢状位 MR 图像上最肥大部分的 CHL 的整个区域进行测量。CHLT 在 CHL 的最厚点测量。
对照组的平均 CHLA 为 40.88±12.53mm²，FS 组为 67.47±19.88mm²。对照组的平均 CHLT 为 2.84±0.67mm，FS 组为 4.01±1.11mm。FS 患者的 CHLA（<0.01）和 CHLT（<0.01）明显高于对照组。受试者工作特征分析显示，CHLA 的最佳截断值为 50.01mm²，灵敏度为 76.9%，特异性为 76.5%，曲线下面积（AUC）为 0.87。CHLT 的最佳截断值为 3.30mm，灵敏度为 71.2%，特异性为 70.6%，AUC 为 0.81。
发现 CHLA、CHLT 与 FS 呈显著正相关。我们还证明 CHLA 与 CHLT 具有统计学等效的能力。因此，对于 FS 的诊断，治疗医生可以参考 CHLA 以及 CHLT。
