Frequency of pulley lesions in patients with frozen shoulder

Abstract

Background. Analyzing the results of studies conduc­ted at various MRI centers in different cities of our country, demonstrates that the diagnosis of pulley lesion was only established in a few of them, while the diagnosis of adhesive capsulitis was established in every third examination. This fact leads to the disregard of the primary cause of the disease, diagnostic errors, and consequently, treatment mistakes. The purpose was to investigate the frequency of different types of pulley lesions involving the ligaments that maintain the integrity of the long head of the biceps (pulley lesion injuries) in patients with adhesive capsulitis of the shoulder joint (frozen shoulder). Materials and methods. We performed 310 ope­rations on patients with adhesive capsulitis of the shoulder. The patients’ ages ranged from 30 to 90 years. The average duration from the onset of the disease to surgical intervention was 189 ± 104 days. All patients were examined clinically and radiologically and all patients underwent MRI study of anatomical structures and shoulder joint arthroscopy. Results. Pulley lesion injuries of the shoulder joint were detected in 84 (27.1 %) of the patients who underwent surgery for a frozen shoulder. This allows us to assert that in this particular patient group, secondary adhesive capsulitis with the development of shoulder joint contracture was predominant. The third (16.5 %) and fourth (12.4 %) types of pulley lesion injuries were the most prevalent. These particular types of pulley lesion injuries exhibit the most contracture-inducing properties, with the third type predominating over the fourth type. А change in the type of pulley lesion damage (an increase in the number of damaged structures of the shoulder), the average indicators of the mobility of the shoulder decreased. Conclusions. In 27.1% of patients who were opera­ted on for idiopathic adhesive capsulitis was detected pulley lesion, which gives us to reconsider treatment approaches and expand the indications for diagnostic and therapeutic shoulder arthroscopy in the earlier stages of the disease.