Abstract
This study aimed to assess and compare the ultrasonographic (US) pathologic findings in patients with polymyalgia rheumatica (PMR) and bilateral frozen shoulder (FS). We included 19 patients with clinically diagnosed PMR and 19 patients with stage II bilateral FS. The US evaluation included the assessment of subacromial-subdeltoid (SASD) bursitis, long head of biceps (LHB) tenosynovitis, and posterior and inferior glenohumeral (GH) synovitis. Unilateral SASD bursitis was noted significantly more frequently in PMR patients than in bilateral FS patients (p = 0.001). There were no significant differences in the incidence of unilateral LHB tenosynovitis and posterior GH synovitis between PMR and bilateral FS patients (p = 0.108 and p = 0.304, respectively). Unilateral inferior GH synovitis was more common among bilateral FS patients than among PMR patients (p < 0.001). Bilateral SASD bursitis and LHB tenosynovitis were noted significantly more frequently in PMR patients than in bilateral FS patients (p < 0.001 and 0.049, respectively). Significant differences were not observed in the incidence of bilateral posterior GH synovitis between PMR and bilateral FS patients (p = 0.426). Bilateral inferior GH synovitis was more common among bilateral FS patients than among PMR patients (p = 0.044). The US evidence for bilateral inferior GH synovitis without bilateral SASD showed high specificity (94.7%) with sensitivity (78.9%) for the diagnosis of bilateral FS. SASD bursitis, representing periarticular synovial inflammation, was more common among the patients with PMR than among the patients with bilateral FS. Inferior GH synovitis without SASD bursitis suggests FS rather than PMR in patients with bilateral shoulder pain.
Highlights
Frozen shoulder (FS) is a common pathologic condition of the shoulder joint capsule, which is characterized by progressive shoulder pain and the restriction of range of motion [1,2]
Seven patients were positive for anti-nuclear antibody (ANA) and none had an anti-CCP antibody
The analysis revealed that the power Doppler grades of all three kinds of synovial pathologies in polymyalgia rheumatica (PMR) patients were significantly greater than those in bilateral FS patients (p < 0.001, 0.007, and 0.015, respectively)
Summary
Frozen shoulder (FS) is a common pathologic condition of the shoulder joint capsule, which is characterized by progressive shoulder pain and the restriction of range of motion [1,2]. 20–30% of the patients affected develop the condition in the opposite shoulder [3,4]. It is difficult to differentiate idiopathic FS from other stiff shoulder conditions such as rotator cuff tear, calcific tendinitis, or inflammatory arthropathy [2,3,4]. In the case of bilateral shoulder involvement, it is important to differentiate between bilateral FS and polymyalgia rheumatica (PMR), as PMR is characterized by bilateral shoulder aching, stiffness, and is known to be associated with an inflammatory disease of the large blood vessels, i.e., giant cell arteritis [6,7,8]. 20% of patients with PMR have normal levels of inflammatory markers, whereas 30% of patients with idiopathic FS have elevated levels of high-sensitivity C-reactive protein (CRP) [11,12]
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