McKean David, Chung Siok Li, Naudé Rebecca Te Water, McElroy Bernard, Baxter Jonathan, Pendse Aniruddha, Papanikitas Joseph, Teh James, Hughes Richard
Radiology Department, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, UK.
Radiology Department, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, UK.
J Ultrason. 2021;20(83):e300-e306. doi: 10.15557/JoU.2020.0052. Epub 2020 Dec 18.
To evaluate changes in the elasticity of the coracohumeral ligament in patients with adhesive capsulitis of the shoulder treated with ultrasound-guided rotator interval injections. Shear wave elastography was used to evaluate elasticity of the coracohumeral ligament in symptomatic and asymptomatic shoulders in the shoulder-neutral position and 30° external rotation. A total of 24 shoulders were assessed. Symptomatic shoulders were treated with targeted steroid injection via the rotator interval and manipulation under local anaesthetic block. Follow-up assessment of the elasticity of the coracohumeral ligament was obtained at 10 weeks post-injection. In all subjects, the coracohumeral ligament elastic modulus was larger at 30° external rotation than in the neutral position. In patients with adhesive capsulitis, the coracohumeral ligament thickness and elastic modulus was significantly greater in the symptomatic shoulder in the neutral position and 30° ER. Treated patients had an excellent response with improved Oxford Shoulder Score and reduced visual analogue scale pain scores. Median Oxford Shoulder Score was 13.5 pre-injection and 34 at 10 weeks post-injection. Median visual analogue scale pain scores measured 8.5 pre-injection, 3.5 at 1 day, 2 at 1 week, and 2.5 at 10 weeks. Improved Oxford Shoulder Score and visual analogue scale pain score was associated with a trend to normalisation of the elastic modus of the coracohumeral ligament. In patients with adhesive capsulitis of the shoulder, shear wave elastography demonstrated the coracohumeral ligament is stiffer in the symptomatic shoulder than in the unaffected shoulder. Treatment with the ultrasound-guided rotator interval injection is associated with improved Oxford Shoulder Score, reduced visual analogue scale pain scores, and reduced stiffness in the coracohumeral ligament.
评估超声引导下肩袖间隙注射治疗肩周炎患者喙肱韧带弹性的变化。采用剪切波弹性成像技术评估在肩部中立位和外旋30°时，有症状和无症状肩部的喙肱韧带弹性。共评估了24个肩部。对有症状的肩部通过肩袖间隙进行靶向类固醇注射并在局部麻醉阻滞下进行手法治疗。在注射后10周对喙肱韧带弹性进行随访评估。在所有受试者中，喙肱韧带弹性模量在外旋30°时大于中立位。在肩周炎患者中，中立位和外旋30°时，有症状肩部的喙肱韧带厚度和弹性模量显著更大。接受治疗的患者反应良好，牛津肩部评分改善，视觉模拟评分疼痛评分降低。牛津肩部评分中位数在注射前为13.5，注射后10周为34。视觉模拟评分疼痛评分中位数在注射前为8.5，注射后1天为3.5，1周为2，10周为2.5。牛津肩部评分和视觉模拟评分疼痛评分的改善与喙肱韧带弹性模量趋于正常化有关。在肩周炎患者中，剪切波弹性成像显示有症状肩部的喙肱韧带比未受影响肩部更僵硬。超声引导下肩袖间隙注射治疗与牛津肩部评分改善、视觉模拟评分疼痛评分降低以及喙肱韧带僵硬程度降低相关。
