Coracohumeral Ligament Research Articles

The role of grey-scale ultrasound in the diagnosis of adhesive capsulitis of the shoulder: a systematic review and meta-analysis.

In this systematic review and meta-analysis, we discuss the value of grey-scale ultrasonography (US) in diagnosing adhesive capsulitis of the shoulder (ACS). We retrieved relevant studies from PubMed, Cochrane Library, and Embase before 8 April 2019. We selected 7 studies concerning 446 patients (490 shoulders) that used grey-scale US to diagnose ACS and magnetic resonance imaging (MRI) or arthroscopy as the reference standard. We assessed the diagnostic accuracy of US on the basis of combined sensitivity, specificity, likelihood ratio (LR), and the area under the summary receiver operating characteristic (SROC) curve (AUC). The combined sensitivity, specificity, positive LR and negative LR were found to be 88% (95%CI: 74-95), 96% (95%CI: 88-99), 23.89 (95%CI: 6.31-90.51) and 0.12 (95%CI: 0.05-0.29), respectively. The AUC was 0.97 (95%CI: 0.96-0.98). ACS was diagnosed on the basis of four US features: coracohumeral ligament thickening, inferior capsule/axillary recess capsule thickening, rotator interval abnormality, and restriction of the range of motion. The corresponding sensitivities were 64.4 (95%CI: 48.8-78.1), 82.1 (95%CI: 73.8-88.7), 82.6 (95%CI: 74.1-89.2) and 94.3 (95%CI: 84.3-98.8), respectively, and specificities were 88.9 (95%CI: 76.0-96.3), 95.7 (95%CI: 90.3-98.6), 93.9 (95%CI: 89.8-96.7), and 90.9 (95%CI: 75.7-98.1), respectively. Our meta-analysis showed that grey-scale US plays a significant role in the diagnosis of ACS. Because of its high sensitivity and specificity, US can be added to the existing clinical diagnosis program.

Sonographically Guided Percutaneous Sectioning of the Coracohumeral Ligament for the Treatment of Refractory Adhesive Capsulitis: Proof of Concept.

Treatment options are limited for nonsurgical chronic refractory cases of adhesive capsulitis. We describe a novel percutaneous tenotomy technique for coracohumeral ligament interruption with cadaveric validation. The objective of this study was to describe and validate a novel technique for percutaneous interruption of the coracohumeral ligament. Cadaveric study. Academic tertiary care center. Eight cadavers underwent ultrasound (US)-guided percutaneous incision of the coracohumeral (CHL) ligament. Performance of the procedure requires that the practitioner make oscillatory motions with a needle that uses ultrasound energy to cut through tissue. Each pass removes a pinhead-sized amount of tissue. The number of passes and the cutting time are recorded during the procedure. As a standard for this procedure does not exist, the authors created their own based on the preclinical information presented here. Postprocedure dissection was performed to assess the extent of CHL interruption and injury to surrounding tissue. The average resection time was seven minutes, requiring 500 passes. The technique described in this paper completely interrupted the CHL in all subjects. Cadaveric analysis demonstrated interruption of the CHL with respect to control shoulders requiring an average of seven minutes of cutting time and ∼500 micro-perforations. US-guided percutaneous CHL ligament sectioning is possible with a commercially available ultrasonic probe.

Evaluating Correlations of Coracohumeral Ligament Thickness with Restricted Shoulder Range of Motion and Clinical Duration of Adhesive Capsulitis with Ultrasound Measurements

The primary objective of this study is to evaluate, using ultrasound measurements, the correlation between coracohumeral ligament (CHL) thickness and restricted shoulder range of motion (ROM) in patients with adhesive capsulitis (AC). The secondary objective is to investigate the correlation between CHL thickness and disease duration. Prospective cross-sectional survey. Clinical research of a tertiary care hospital. Overall, 65 patients with clinically diagnosed AC were enrolled. Ultrasound measurements of CHL thickness in the axial oblique plane were obtained under maximal external rotation of the glenohumeral joint. Both Shoulder Pain and Disability Index (SPADI) and shoulder ROM were prospectively evaluated by an experienced investigator. CHL thickness was compared with shoulder ROM and SPADI. The association between CHL thickness and disease duration was also investigated. Simple linear regression analysis showed significant inverse correlation between CHL thickness and shoulder ROM including external rotation (ER) (r = -0.335, P = .006) and internal rotation (IR) (r = -0.409, P = .001). CHL thickness also correlated with disease duration (r = -0.352, P = .004). Multiple linear regression analysis demonstrated that CHL thickness was significantly associated with restricted ER (r = -0.293, P = .02) and IR (r = -0.363, P = .003) after adjusting for age and disease duration. On the other hand, CHL thickness showed no significant correlation with abduction (r = -0.210, P = .09), flexion (r = -0.170, P = .176), or total SPADI score (r = 0.176, P = .16). Moreover, CHL was significantly thicker in patients with disease duration >6 months (P = .004, difference in means: 0.55 mm, 95% confidence interval: -0.922, -0.183). CHL was significantly thicker in later-stage AC. CHL thickness correlated negatively with ER and IR of the shoulder. Furthermore, CHL thickening could be observed in the early stage of the disease course. These imaging findings may assist in confirming the diagnosis of AC, leading to early intervention and treatment options.

Correlations between clinical features and MRI findings in early adhesive capsulitis of the shoulder: a retrospective observational study

BackgroundThis retrospective study investigated the association between clinical features and MRI findings in patients with early adhesive capsulitis of the shoulder.MethodsThe study included 29 patients with early adhesive capsulitis of the shoulder. The clinical diagnostic criteria were significantly restricted passive range of motion (ROM) and a symptom duration of up to 9 months. Various measurements related to adhesive capsulitis, including humeral and glenoid capsular thickness in the axillary recess, maximal axillary capsular thickness, coracohumeral ligament thickness, and anterior capsular thickness were measured on MRI. Abnormal humeral and glenoid capsular hyperintensity in the axillary recess, abnormal hyperintensity in the rotator interval, and obliteration of the subcoracoid fat triangle were also evaluated. Correlations between MRI findings and clinical features, including limited ROM, pain, and symptom duration were sought.ResultsMaximal axillary and humeral capsular thickness measured on MRI were negatively correlated with ROM for internal rotation. Also, hyperintensity in axillary recess and glenoid capule were correlated with ROM for abduction. Humeral capsular hyperintensity was correlated with ROM for forward flexion. There were no MRI findings that showed correlations with ROM for external rotation and severity of pain. The hyperintensity in the humeral capsule among MRI findings was only correlated with duration of symptoms.ConclusionsMRI can be useful for assessment of several measures of clinical impairment in patients with adhesive capsulitis. Thickening and hyperintensity of the joint capsule in the axillary recess on MRI is associated with limited ROM and duration of symptoms.

Biceps Pulley: Normal Anatomy and Associated Lesions at MR Arthrography

The biceps pulley or "sling" is a capsuloligamentous complex that acts to stabilize the long head of the biceps tendon in the bicipital groove. The pulley complex is composed of the superior glenohumeral ligament, the coracohumeral ligament, and the distal attachment of the subscapularis tendon, and is located within the rotator interval between the anterior edge of the supraspinatus tendon and the superior edge of the subscapularis tendon. Because of its superior depiction of the capsular components, direct magnetic resonance arthrography is the imaging modality of choice for demonstrating both the normal anatomy and associated lesions of the biceps pulley. Oblique sagittal images and axial images obtained with a high image matrix are valuable for identifying individual components of the pulley system. Various pathologic processes occur in the biceps pulley as well as the rotator interval. These processes can be traumatic, degenerative, congenital, or secondary to injuries to the surrounding structures. The term hidden lesion refers to an injury of the biceps pulley mechanism and is derived from the difficulty in making clinical and arthroscopic identification. Pathologic conditions associated with pulley lesions include anterosuperior impingement, instability of the biceps tendon, biceps tendinopathy or tendinosis, superior labrum anterior and posterior lesions, and adhesive capsulitis. It is important to be familiar with the normal appearance of the biceps pulley so that abnormalities can be correctly assessed and effectively managed.

Visualization of Shoulder Ligaments Motion by Ultrasound Speckle Tracking Method.

There is no unified consensus on the pathophysiology of adhesive capsulitis which is also called as frozen shoulder. Some studies have suggested that coracohumeral ligament (CHL) played an important role in adhesive capsulitis. These studies showed relation between disease prevalence and CHL thickness by means of ultrasound or MRI. Other possible etiology of the disease is the adhesion of shoulder ligament with each other. In the present study, shoulder ligaments motion is visualized with velocity vector by speckle tracking and temporal outlier removal algorithm to process ultrasound movie during forced movement of shoulder joint. The measurement with a typical subject has demonstrated an improvement of velocity vector deviation of up to 43% by the proposed outlier removal technique.

Usefulness of intravenous contrast-enhanced MRI for diagnosis of adhesive capsulitis

We aimed to compare the reliability and performance of MRI measures enhanced with intravenous (IV) injection of gadolinium contrast versus non-enhanced MRI measures for the diagnosis of adhesive capsulitis (AC). We also aimed to examine the association between MRI findings and clinical features in patients with AC. MRI of 42 patients with a clinical diagnosis of AC confirmed by arthrography and that of 42 patients in a control group were retrospectively studied by 2 blinded readers. Reliability and performance of MRI findings were compared between IV contrast-enhanced measures and non-enhanced MRI measures in T2-weighted fat-saturated and T1-weighted images. MRI findings were correlated with clinical stage, etiology, and pain. Sensitivity (97.6%) and specificity (97.6%) of axillary-recess capsule signal enhancement for AC diagnosis were significantly superior (p= 0.02) to hyperintense signals on T2-weighted fat-suppressed images (sensitivity 90.5%, specificity 92.7%). Measures of the intensity signal in the area of the rotator interval were less performant for AC diagnosis but could be improved with joint capsule enhancement. Moreover, we found very high specificity (100%) of enhancement of the coracohumeral ligament signal for AC diagnosis. The early stage of adhesive capsulitis was positively correlated with joint capsule enhancement in the rotator interval. Secondary etiology of capsulitis was correlated with joint capsule hyperintensity signals of the rotator interval on T2-weighted fat-suppressed images. IV contrast injection with MRI can be helpful for AC diagnosis in difficult cases. The stage of AC seems related to joint capsule enhancement in the rotator interval. • IV gadolinium-enhanced MRI can improve the analysis of signal changes in the shoulder synovium and capsule of the shoulder that are related to adhesive capsulitis. • As an original finding, we observed that coracohumeral ligament enhancement had a 100% specificity for the diagnosis of adhesive capsulitis. • The intensity of enhanced signals in the rotator interval seems to be related to the early stage of frozen shoulder.

Editorial Commentary for In Throwers with Posterior Instability, Rotator Cuff Tears are Common but Do Not Affect Surgical Outcomes

Superior labral pathology is an exceedingly common entity among throwers, and in recent years, a number of reports have elucidated the prevalence of posterior glenohumeral instability among overhead athletes (baseball, softball, volleyball.) However, within this unique patient population, these conditions should not be viewed as separate clinical entities, but, rather as findings that exist on a single pathomechanic spectrum. In 2020, we now know that the complexity of the symptomatic thrower’s shoulder is a consequence of the complex anatomic relationships between the biceps tendon, capsulolabral tissues, posterosuperior rotator cuff, and the glenoid. In 2003, Burkhart et al. noted that diminished glenohumeral range of motion (i.e. glenohumeral internal rotation deficit “GIRD”) was common among throwers with painful shoulders. These authors further described a posterior-inferior capsular contracture as the “essential lesion” in the development of diminished range of motion in conjunction with impingement of the supraspinatus tendon between the greater tuberosity and the posterior-superior labrum (“pathologic internal impingement”) [1,2]. It is this internal impingement that so often manifests as partial thickness, articular sided supraspinatus tears in the throwing athlete. But these findings are now perhaps better understood as sequelae of a number of anatomic factors, including humeral retrotorsion, contractures of the coracohumeral ligament, pectoralis, and anterior deltoid, as well as dynamic muscle stiffness that can occur in response to the repetitive strains involved in overhead throwing.

Contrast-enhanced Magnetic Resonance Imaging Revealing the Joint Capsule Pathology of a Refractory Frozen Shoulder

Background: Frozen shoulder (FS) is clinically diagnosed on the basis of patients’ medical history and physical examination. Its confirmation is based on joint capsule and coracohumeral ligament thickening, subcoracoid fat obliteration, and joint capsule contrast enhancement on magnetic resonance imaging (MRI). We performed bilateral contrast-enhanced MRI (CE-MRI) in FS patients to compare the outcomes with those of their unaffected contralateral counterparts. Methods: Ten patients (3 men, 7 women, median age: 54.5 years) with unilateral FS, requiring arthroscopic capsular release after failed conservative treatment, were included. The median forward elevation, abduction, external rotation, and internal rotation of the 10 patients were 100°, 60°, 7.5°, and the buttock, respectively. The median visual analog scale score was 5.3, and American Shoulder and Elbow Surgeons (ASES) score was 42. Bilateral CE-MRI was simultaneously performed on the day before surgery, and MRI findings were compared between FS and contralateral healthy shoulders (controls). Results: Significant axillary pouch enhancement and rotator interval were observed in all FS, but not in the unaffected comparable sides (p=0.002, respectively). The thickness of the axillary pouch (FS: 4.8 mm, C: 4.4 mm, p=0.58), coracohumeral ligament (FS: 3.9 mm, C: 4.1 mm, p=0.33), and subcoracoid fat obliteration (p=1.00) were not significantly different between FS and controls. Conclusion: CE-MRI aids in the clinical diagnosis of FS. However, axillary pouch joint capsule and coracohumeral ligament thickening or subcoracoid fat obliteration differences were not characteristic findings when contralateral shoulders were compared.

Quantitative and Qualitative Analyses of the Glenohumeral Ligaments: An Anatomic Study

Background: While several studies have qualitatively described the anatomy of the glenohumeral ligaments, there remains a lack of consensus regarding their quantitative humeral and glenoid attachment sites. Purpose: To quantitatively and qualitatively describe the anatomic humeral and glenoid attachment sites of the glenohumeral ligaments and their relationship to well-established anatomic landmarks. Study Design: Descriptive laboratory study. Methods: A total of 10 nonpaired, fresh-frozen human cadaveric shoulders were included in this study. A 3-dimensional coordinate measuring device was used to quantify the location of pertinent bony landmarks and soft tissue attachment areas. All subcutaneous tissues and musculature were removed, with the exception of the rotator cuff (respective muscle bellies cut at their musculotendinous junctions) and the long head of the biceps tendon. The superior glenohumeral ligament (SGHL), middle glenohumeral ligament (MGHL), anteroinferior glenohumeral ligament (AIGHL), posteroinferior glenohumeral ligament (PIGHL), and coracohumeral ligament (CHL) were then transected. Coordinates of points along the perimeters of attachment sites were used to calculate areas, while coordinates of center points were used to determine distances between surgically relevant attachment sites and pertinent bony landmarks. Results: The mean length of the SGHL humeral attachment along the intra-articular cartilage margin was 9.5 ± 3.2 mm, spanning from 12:55 to 1:40, while the SGHL glenoid attachment to the labrum was 1.9 ± 1.2 mm medial to the most lateral extent of the labral rim, spanning from 12:30 to 12:45. The mean length of the MGHL attachment along the intra-articular cartilage margin was 16.4 ± 3.0 mm, equating to 2:10 to 3:35 on the humeral head clockface, and the glenoid attachment was confluent with the labrum, attaching 1.5 ± 1.0 mm medial to the most lateral extent of the labral rim and thus extending from 1:50 to 2:35 on the glenoid clockface. The mean length of the AIGHL attachment along the intra-articular cartilage margin was 12.0 ± 3.0 mm, spanning from 4:05 to 5:10 on the humeral head clockface. The AIGHL bony footprint on the glenoid neck was 48.4 ± 24.5 mm2. The confluent attachment of the AIGHL to the labrum was 1.2 ± 0.9 mm medial to the most lateral extent of the labral rim, corresponding to 3:30 to 4:05 on the glenoid clockface. The mean length of the PIGHL attachment along the intra-articular cartilage margin was 12.0 ± 1.4 mm, spanning from 7:40 to 8:50 on the humeral head clockface. The PIGHL attachment to the labrum was 1.2 ± 0.5 mm medial to the most lateral extent of the labral rim. This attachment to the labrum was calculated to span from 7:35 to 8:50 on the glenoid clockface. The mean length of the CHL origin from the coracoid was 12.9 mm, with its most anterior point located a mean of 14.1 mm from the tip of the coracoid. The mean length of the CHL attachment along the intra-articular cartilage margin was 10.0 ± 4.0 mm, spanning from 11:55 to 12:40 on the humeral head clockface. Conclusion: Glenohumeral ligaments were consistently identified in all specimens with minor anatomic variability for the SGHL, MGHL, AIGHL, and PIGHL. Important landmarks including the cartilage surface of the humerus, the bicipital groove, and the clockface can be utilized intraoperatively when attempting anatomic repair of these structures. Clinical Relevance: There are multiple open and arthroscopic shoulder procedures that rely on anatomic restoration of these static stabilizers to provide optimal shoulder function and prevent recurrent instability. The qualitative descriptions are comparable with current literature; however, this study is the first to quantify the glenohumeral capsular and ligamentous attachments. The data provided allow for reliable landmarks to be established from known bony and soft tissue structures.

Effects of joint capsular release on range of motion in patients with frozen shoulder

A thickened joint capsule is believed to be one of the most specific manifestations of and the primary restraint against range of motion (ROM) in frozen shoulders. The purpose of this study was to evaluate the relationship among ROMs under general anesthesia before surgery and the effects of each joint capsular release on ROM. ROM was measured using a goniometer with scapular fixation. Arthroscopic pan-capsular release was performed with the patient in the beach-chair position in the following order: (1) rotator interval, (2) coracohumeral ligament, (3) superior capsule, (4) middle glenohumeral ligament, (5) anterior inferior glenohumeral ligament, and (6) posterior inferior glenohumeral ligament. ROMs in forward flexion (FF), lateral elevation (LE), external rotation with the arm at the side (ER1), external rotation at 90° of LE (ER2), internal rotation at 90° of LE (IR2), horizontal flexion, external rotation at 90° of FF (ER3), and internal rotation at 90° of FF (IR3) were evaluated before and after each release. A total of 32 consecutive shoulders were included. After each capsular release, the ROM recovered; the final ROM was significantly greater on the affected side than on the unaffected side. Significant correlations were found between FF and LE, FF and ER1, ER1 and ER2, ER1 and ER3, ER2 and ER3, and IR2 and IR3 on both sides, regardless of surgery. Each segment of the joint capsule affected ROM in all directions, supporting the need for whole-joint capsular release; ROM was significantly greater on the affected side than on the unaffected side after surgery.

Lesions of the biceps pulley: a prospective study and classification update

HypothesisThe purpose of the study was to investigate which anatomic structures are affected in a series of patients with pulley lesions and whether all lesions can be classified according to the Habermeyer classification.MethodsOne hundred consecutive patients with pulley lesions were prospectively studied. During arthroscopy, lesions of the superior glenohumeral ligament (SGHL), medial coracohumeral ligament (MCHL) and/or lateral coracohumeral ligament (LCHL), adjacent rotator cuff, and biceps (long head of the biceps) were recorded. All lesions were then classified according to the Habermeyer classification. The χ2 test was used for statistical analysis.ResultsThere were 3 lesions in group 1, 20 in group 2, 6 in group 3, and 35 in group 4 according to the Habermeyer classification. Thirty-six lesions were not classifiable because of an intact SGHL. A lateral pulley sling (LCHL) lesion was found in 95% of the patients, and a medial pulley sling (MCHL-SGHL) lesion was noted 64%. An isolated lesion of the MCHL and/or SGHL was present in 5%, and an isolated lesion of the LCHL was found in 36%. Combined medial-lateral sling lesions were correlated with complete subscapularis tears and biceps fraying.ConclusionThe lateral pulley sling is more often affected than the medial sling. The SGHL is not always affected, and isolated lesions of the medial sling are rare. Lesions of both slings correlated with complete subscapularis tears and fraying of the long head of the biceps. An updated classification of direct pulley lesions is proposed: type 1, lesion of the medial pulley (MCHL and/or SGHL); type 2, lesion of the lateral pulley (LCHL); and type 3, lesion of the medial and lateral pulley slings. Concomitant lesions of the indirect pulley stabilizers can be mentioned additionally according to the well-known classifications.

Effects of positional coracohumeral ligament stretching on the size of calcium deposits in adhesive capsulitis

Adhesive capsulitis is a painful condition of unknown etiology with restriction of active and passive movements of the glenohumeral joint. The condition is a result of inflammation, adherence, and swelling in the lining of the shoulder joint capsule and its associated ligaments, causing resultant contracture of the capsule. We describe a patient with calcified and thickened coracohumeral ligament with adhesive capsulitis and diabetes mellitus.

RAGE-dependent NF-kB inflammation processes in the capsule of frozen shoulders

The etiology of frozen shoulder (FS) remains uncertain. Advanced glycation end-products (AGEs) cause the cross-linking and stabilization of collagen and are increased in FS. The purpose of this study was to elucidate the pathogenesis of FS by evaluating the receptor of AGE (RAGE)-dependent pathways. Tissue samples of the coracohumeral ligament (CHL) and anterior inferior glenohumeral ligament (IGHL) were collected from 33 patients with FS, with severe stiffness, and 25 with rotator cuff tears (RCTs) as controls. Gene expression levels of RAGE, high-mobility group box 1 (HMGB1), Toll-like receptor 2 (TLR2), TLR4, nuclear factor-kappa B (NF-kB), and cytokines were evaluated using a quantitative real-time polymerase chain reaction. The immunoreactivities of carboxymethyllysine (CML), pentosidine, and RAGE were also evaluated. CML and pentosidine were further evaluated using high-performance liquid chromatography. Gene expression levels of RAGE, HMGB1, TLR2, TLR4, and NF-kB were significantly greater in the CHLs and IGHLs from the FS group than in those from the RCT group. Immunoreactivities of RAGE and CML were stronger in the CHLs and IGHLs from the FS group than in those from the RCT group. Pentosidine was weakly immunostained in the CHLs and IGHLs from the FS group. CML using high-performance liquid chromatography was significantly greater in the CHLs and IGHLs from the FS group than in those from the RCT group. AGEs and HMGB1 might play important roles in the pathogenesis of FS by binding to RAGE and activating NF-kB signaling pathways. Suppression of these pathways could be a treatment option for FS.

Non-contrast MRI Findings of Adhesive Capsulitis: A review

Adhesive Capsulitis (AC) is a self-limiting disease of the shoulder joint characterized by progressive painful restriction of theshoulder’s motion. This study aimed to search the findings on AC in non-contrast MRI. Although AC is a clinical diagnosis,imaging can provide helpful data for earlier diagnosis and treatment. It seems that some findings are specific and sensitive foraccurate diagnosis and staging of AC such as coracohumeral ligament thickening, joint capsule edema, and rotator intervalinfiltration. Non-contrast MRI can provide an abundance of information on AC and help clinicians make a more definitivediagnosis, stage the disease, and choose better treatment plans.

Accuracy of unguided and ultrasound guided Coracohumeral ligament infiltrations \u2013 a feasibility cadaveric case series

BackgroundCoracohumeral ligament (CHL) thickening, contracture, and fibroplasia have been identified in glenohumeral idiopathic adhesive capsulitis (GHIAC). The CHL is the main structure responsible for the range of motion limitations. Favorable outcomes have been reported with CHL surgical release. Intra-articular glenohumeral joint corticosteroid infiltrations are utilized to disrupt the inflammatory process and reduce pain in GHIAC. The aim of this study was to investigate whether the CHL could be accurately targeted with a periligamentous infiltration.MethodsA convenience sample of 12 unembalmed cadaver shoulders (mean age: 74.5 years, range 66–87 years) without evidence of previous injury or surgery were utilized in this exploratory double factor feasibility cadaveric (unguided and ultrasound (US) guided) case series. Two clinicians trained in musculoskeletal infiltration techniques carried out the infiltrations on each shoulder with colored latex. One clinician infiltrated without guidance, the other with US-guidance. The injecting clinicians were blinded to the others infiltration procedure and the order was randomized. An anatomist blinded to the infiltration order performed a shoulder dissection and recorded the infiltrate location. Percentage calculation for accuracy of infiltration and a chi-square evaluation of the difference between unguided and US-guided infiltrations was applied.ResultsAn accuracy of 75% was achieved for unguided infiltration and 80% for US-guided infiltration techniques. Chi-squared indicated there was no significant difference (p = 0.82) between the unguided and US-guided techniques.ConclusionUS-guided and unguided infiltrations achieved good accuracy targeting the CHL, suggesting infiltrations can specifically and accurately target the CHL. In vivo investigation using such infiltration techniques are warranted.

Short-Term Outcome Predictors in Patients With Primary Adhesive Capsulitis Treated With Ultrasound-Guided Hydrodilatation With Corticosteroids.

Glenohumeral joint hydrodilatation with corticosteroids has been proposed as an effective secondary therapeutic procedure for primary adhesive capsulitis. However, little is known about which subgroup of patients would benefit from this procedure. This study aimed to identify covariates associated with improved prognosis in patients receiving ultrasound-guided hydrodilatation with corticosteroid injection. This was a cohort study. Data on baseline demographic characteristics, disease status, past medical conditions, and initial ultrasonographic findings were collected. Linear and logistic regression analyses were performed to determine the prognostic factors associated with better clinical outcomes. Fifty-three patients (54 shoulders) were included. Linear regression analysis showed that coracohumeral ligament thickness of less than 3 mm, use of analgesics before hydrodilatation, and female sex were associated with good improvement in the Shoulder Pain and Disability Index score. Multivariate logistic regression analysis showed that coracohumeral ligament thickness of less than 3 mm on ultrasound was associated with a strong tendency (P = 0.054) of reaching the minimal detectable change. In addition, capsule rupture did not play a role in determining the clinical efficacy of hydrodilatation. In patients with primary adhesive capsulitis, coracohumeral ligament thickness of less than 3 mm is correlated with greater short-term improvement in the Shoulder Pain and Disability Index score after ultrasound-guided hydrodilatation with steroid injection is performed.

Correlations Between Range of Motion and Elasticity of the Coracohumeral Ligament Evaluated With Shear-Wave Elastography.

Range of motion (ROM) in the glenohumeral joint decreases with age in healthy subjects; however, the underlying mechanism remains unclear. The process of aging of the joint capsule, including the coracohumeral ligament (CHL), could affect ROM limitation. This study investigated correlations between elasticity of the CHL, evaluated by means of shear-wave elastography, and age, side dominance, and ROM in healthy individuals. Experimental study. Laboratory. Eighty-four healthy volunteers (39 men and 45 women, mean age: 42.6y) were included. Subjects were divided into 3 age groups: younger (20-39y), middle (40-59y), and older (≥60y) age groups. With participants in the supine position, CHL elasticity in both shoulders was evaluated in both neutral and 30° external rotation, with arms at the sides. ROM, including forward flexion, lateral elevation, external rotation, 90° abduction with external rotation, and hand behind the back were measured with participants in the standing position. The CHL elastic modulus was higher in the older group than in the younger group in the neutral (78.4kPa [SD: 37.1] and 56.6kPa [SD: 31.7], respectively) and 30° external rotation positions (135.5kPa [SD: 63.5] and 71.4kPa [SD: 32.2], respectively). Negative correlations were found between the CHL elastic modulus and ROM in terms of 30° external rotation and both external rotation (R = -.59, P = .02) and 90° abduction with external rotation (R = -.71, P = .003) in the older group, with correlation coefficients increasing with age. Significant correlations were identified between CHL elasticity and ROM in both external rotation and 90° abduction with external rotation with increasing age. Decreased CHL elasticity was strongly associated with decreased shoulder ROM in middle-aged and older individuals.

Optimal Cut-Off Value of the Coracohumeral Ligament Area as a Morphological Parameter to Confirm Frozen Shoulder.

BackgroundThickened 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).MethodsCHL 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.ResultsThe 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 (P < 0.01) and CHLT (P < 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.ConclusionThe 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.

Assessment Of Active Shoulder Rotation After Tendon Transfer Around The Shoulder In Cases Of Residual Brachial Plexus Injury

Background: Active range of motion were analyzed as the outcomes of tendon transfer around the shoulder in children who had internal rotation contracture deformities secondary to obstetric brachial plexus palsy (OBPP) to improve the shoulder external rotation. Regarding to importance of external rotation there was some limitation of internal rotation which can affect patient’s daily activities. Methods: 50 patients with brachial plexus injury who underwent tendon transfer (teres major or latissimus dorsi) with or without anterior shoulder release in two separate incisions. Coracohumeral ligament release and Subscapularis release were done for all patients through anterior incision. A separate second incision in the posterior axillary fold was carried out to perform rerouting of the teres major or latissimus dorsi tendon. Results: The average active external rotation in abduction increased from 23.5o preoperatively to 76.4o postoperatively. The average active external rotation in adduction increased from 9.6o to 77.5o. The average shoulder abduction increased from 74.5o to 142.6o. Active internal rotation was analyzed just after operation, 6 month after and one year after. There was limited active IR in adduction from 10o to 50o with mean average 28.21o and improvement gradually with physiotherapy. Conclusions: Anterior shoulder release combined with latissimus dorsi or teres major rerouting significantly improved global shoulder function, but with limitations of active internal rotation which improving significally with physiotherapy.