Do Jong Geol, Hwang Jin Tae, Yoon Kyung Jae, Lee Yong-Taek
Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Orthop J Sports Med. 2021 May 10;9(5):23259671211003675. doi: 10.1177/23259671211003675. eCollection 2021 May.
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.
To evaluate the ultrasound features of adhesive capsulitis and estimate the correlations between clinical impairment and ultrasound parameters.
Case series; Level of evidence, 4.
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.
The CHL, the RI, and the AR in affected shoulders were significantly thicker than in unaffected shoulders (05). CHL thickness in affected shoulders was significantly correlated with PROM limitation, which included forward elevation, abduction, external rotation (ER), and internal rotation (IR) (05). AR thickness correlated with passive forward elevation limitation and passive IR limitation (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).
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.
超声是诊断肩部疾病的重要工具。然而，超声在评估和诊断粘连性关节囊炎中的作用尚未得到充分研究。
评估粘连性关节囊炎的超声特征，并估计临床损伤与超声参数之间的相关性。
病例系列；证据等级，4级。
对61例临床诊断为单侧粘连性关节囊炎的患者进行回顾性研究，使用高分辨率超声。为了比较超声参数，我们对患侧和未患侧肩部均进行了超声检查。测量了超声参数，包括喙肱韧带（CHL）厚度、旋转间隙（RI）、腋窝隐窝（AR）、RI的血管增多情况以及肱二头肌长头腱鞘积液。采用被动活动范围（PROM）、疼痛视觉模拟评分以及肩痛和功能障碍指数进行临床评估。
患侧肩部的CHL、RI和AR明显比未患侧肩部厚（P<0.05）。患侧肩部的CHL厚度与PROM受限显著相关，PROM受限包括前屈、外展、外旋（ER）和内旋（IR）（P<0.05）。AR厚度与被动前屈受限和被动IR受限相关（P<0.05）。与1期相比，2期的CHL明显更厚，与3期相比，2期的RI更厚。粘连性关节囊炎的诊断临界值为CHL厚度2.2 mm（敏感性77%，特异性91.8%）和AR厚度4 mm（敏感性68.9%，特异性90.2%）。
与结构变化相关的超声参数与粘连性关节囊炎的临床特征相关。在患侧肩部观察到CHL、RI和AR增厚。CHL厚度2.2 mm和AR厚度4 mm的临界值可作为粘连性关节囊炎的诊断临界值。
