Coracohumeral Ligament Research Articles

Dynamic Analysis of the Coracohumeral Ligament Using Ultra-Sonography in Shoulder Contracture.

The coracohumeral ligament (CHL) is related to the range of motion of the shoulder joint. The evaluation of the CHL using ultrasonography (US) has been reported on the elastic modulus and thickness of the CHL, but no dynamic evaluation method has been established. We aimed to quantify the movement of the CHL by applying Particle Image Velocimetry (PIV), a technique used in the field of fluid engineering, to cases of shoulder contracture using the US. The subjects were eight patients, with 16 shoulders. The coracoid process was identified from the body surface, and a long-axis US image of the CHL parallel to the subscapularis tendon was drawn. The shoulder joint was moved from 0 degrees of internal/external rotation to 60 degrees of internal rotation at a rhythm of one reciprocation every 2 s. The velocity of the CHL movement was quantified by the PIV method. The mean magnitude velocity of CHL was significantly faster on the healthy side. The maximum magnitude velocity was significantly faster on the healthy side. The results suggest that the PIV method is helpful as a dynamic evaluation method, and in patients with shoulder contracture, the CHL velocity was significantly decreased.

Arthroscopic coracohumeral ligament release for patients with frozen shoulder

Background Frozen shoulder (FS) is one of the most common musculoskeletal problems and has an incidence of 3–5% in the general population. Aim This study aimed to assess the effects and outcomes of arthroscopic coracohumeral ligament (CHL) release and L-shaped incision of the rotator interval (RI) for patients with FS. Patients and methods Arthroscopic CHL release and L-shaped incision of RI and subacromial decompression (SAD) were done. Assessment of pain, shoulder function, and range of motion scores were measured according to the The University of California - Los Angeles (UCLA) shoulder score. Results Arthroscopic CHL release and L-shaped incision of RI and SAD showed a significant improvement in pain, shoulder function, motion, and UCLA score. Conclusion Arthroscopic CHL release and L-shaped incision of RI and SAD is a good choice for FS treatment.

Comprehensive Review of Multidirectional Instability of the Shoulder.

Multidirectional instability of the shoulder can result from underlying atraumatic laxity, from repetitive microtrauma, or from a traumatic injury and often occurs in association with generalized ligamentous laxity or underlying connective tissue disorders. It is critical to differentiate multidirectional instability from unidirectional instability with or without generalized laxity to maximize treatment success. Although rehabilitation is still considered the primary treatment method for this condition, surgical treatment in the form of open inferior capsular shift or arthroscopic pancapsulolabral plication is indicated if conservative treatment fails. Recent biomechanical and clinical research has shown that there is still room for improvement in the treatment methods offered to this specific patient cohort. Potential treatment options, such as various methods to improve cross-linking of native collagen tissue, electric muscle stimulation to retrain the abnormally functioning dynamic stabilizers of the shoulder, and alternative surgical techniques such as coracohumeral ligament reconstruction and bone-based augmentation procedures, are brought forth in this article as potential avenues to explore in the future.

The AIUM Practice Parameter for the Performance of the Musculoskeletal Ultrasound Examination.

The AIUM Practice Parameter for the Performance of the Musculoskeletal Ultrasound Examination.

Alteration in coracohumeral ligament and distance in people with symptoms of subcoracoid impingement

BackgroundDifferentiation between subacromial impingement versus subcoracoid impingement are important for the treatment target. We evaluated the correlations between coracohumeral ligament (CHL) thickness and distance (CHD) and characterized the CHL and subscapularis (SSC) in subcoracoid impingement subjects.MethodsAn observational, cross-sectional study was carried out. Twenty subcoracoid impingement subjects and age/gender matched controls were assessed in 4 different shoulder positions by ultrasonography.ResultsModerate correlations between CHL thickness with CHD (r = 0.455 in neutral rotation, p = 0.044; r = 0.483 in interior rotation, p = 0.031) were found in subacromial subjects. Subcoracoid impingement subjects had greater CHL thickness (difference = 0.3 mm, effect size = 0.85, p = 0.006), SSC tendon thickness (difference = 0.7 mm, effect size = 0.92, p = 0.01) and SSC/CHD occupation ratio (difference = 8%, effect size = 0.95, p = 0.005) compared with the control.ConclusionsCoracohumeral distance is related to ligament thickness, especially in subacromial impingement subjects. Increased coracohumeral ligament and subscapularis thickness as well as decreased subscapularis/coracohumeral distance occupation ratio are characterized in subcoracoid impingement subjects. These quantitative measurements can be useful in identifying patients at risk of subcoracoid impingement from subacromial impingement.

Adhesive capsulitis after COVID-19 vaccine injection: a peculiar case treated with combined bursa distention and glenohumeral capsular hydrodilatation

Frozen shoulder is a common and self-limiting condition affecting the soft tissues of the shoulders, characterized by severe pain, impaired range of motion (ROM) and limitation of daily activities. Its prevalence is 5% and it occurs most commonly in the fifth and sixth decades of life; women are more affected [DePalma in Clin Orthop Relat Res 466:552–560, 2008]. It can be idiopathic or associated with other conditions such as metabolic disorders, diabetes, thyroid diseases, prolonged immobilization, trauma [DePalma in Clin Orthop Relat Res 466:552–560, 2008], or complications after vaccine administration known as SIRVA (Shoulder injury related to vaccine administration). SIRVA is not caused by the vaccine itself but by inappropriate vaccination techniques [Martín Arias et al. in Vaccine 35:4870–4876, 2017]. The natural history of the frozen shoulder is a progression through three stages based on clinical and arthroscopic presentations: freezing, frozen and thawing [DePalma in Clin Orthop Relat Res 466:552–560, 2008; Do et al. in Orthop J Sport Med 9:232596712110036, 2021]. The onset is characterized by disabling pain, that worsens at night; it is induced by inflammation and hypervascularity and lasts from 10 to 36 weeks [Do et al. in Orthop J Sport Med 9:232596712110036, 2021]. The second stage is predominated by stiffness and severe reduction of ROM. This phase typically lasts from 9 to 12 months [Do et al. in Orthop J Sport Med 9:232596712110036, 2021]. Eventually, a recovery phase occurs, with a gradual recovery of the ROM that can last between 12 and 42 months. Ultrasound is an emerging diagnostic tool that contributes to differential diagnosis and treatment [Zappia et al. in Insights Imaging 7:365–371, 2016; Ricci et al. in J Ultrasound Med 39:633–635, 2020]: signs of adhesive capsulitis consist of thickening of the inferior recess of the glenohumeral joint capsule, thickening of the coracohumeral ligament and soft tissue structures in the rotator cuff interval, with hypervascularity. An unspecific sign is increased fluid in the tendon sheath of the long head of the biceps [Martín Arias et al. in Vaccine 35:4870–4876, 2017; Tandon et al. in J Ultrasound 20:227–236, 2017].

Evaluation of muscle stiffness in adhesive capsulitis with Myoton PRO.

Adhesive capsulitis (AC) is characterized by pain and limited range of motion, caused by stiffness of the joint capsule and coracohumeral ligament. On the other hand, there have been few reports on muscle stiffness in AC. The purpose of this study was to assess muscle stiffness in patients of AC with a portable and noninvasive device, Myoton PRO. We hypothesized that muscle stiffness around shoulder joint increases in AC. At first, we surveyed correlation between Myoton PRO and shear wave elastography with phantoms. Second, reproducibility and repeatability of healthy volunteers with Myoton PRO were evaluated. Finally, muscle stiffness was measured in 40 patients who were diagnosed with AC. Muscle stiffness was quantitatively measured with Myoton PRO. We compared the stiffness of the anterior deltoid (AD), pectoralis major, and latissimus dorsi (LD) in AC patients on both the affected and nonaffected sides. Correlation coefficient in shear wave elastography and Myoton PRO was 0.99(P=.001). Reliability of intraoperator and interoperator with Myoton PRO was 0.9 or higher. Muscle stiffness values (N/m) of the AD, pectoralis major, and LD were 355±61, 252±54, 207±51 in the affected sides and 328±50, 252±41, 186±37 in the nonaffected sides, and the differences were significant in the AD and LD (P=.005, P=.002, respectively). We used Myoton PRO to evaluate muscle stiffness in AC. The AD and LD muscles of AC patients were significantly stiffer on the affected side compared to the nonaffected side.

Comparison of the spread pattern of medial-to-lateral and lateral-to-medial rotator interval injections: A cadaveric study

ObjectiveRotator interval (RI) corticosteroid injections are used to alleviate pain associated with adhesive capsulitis, though the pattern of injectate spread remains unclear. The purpose of this anatomical study was to assess the staining patterns of intra-articular, intracapsular/extrasynovial, and pericapsular structures of the glenohumeral joint following medial-to-lateral and lateral-to-medial RI injections. DesignTen cadaveric specimens were injected with a methylene blue dye injectate: five using a medial-to-lateral RI injection technique and five using a lateral-to-medial RI injection technique. Serial dissection was performed to assess the staining of intra-articular, intracapsular/extrasynovial, and pericapsular structures. The frequency of capture and degree of staining were compared between injection groups. ResultsThe lateral-to-medial injection resulted in the capture of all intra-articular; intracapsular/extrasynovial; and pericapsular structures, whereas the medial-to-lateral injection did not consistently stain all structures. Intracapsular/extrasynovial structures (superior glenohumeral ligament and the long head of biceps tendon) were more darkly stained in the lateral-to-medial group, and pericapsular structures (supraspinatus tendon and coracohumeral ligament) were more darkly stained in the medial-to-lateral group. ConclusionThe frequency of capture and degree of staining of intra-articular, intracapsular/extrasynovial, and pericapsular structures of the glenohumeral joint differed between medial-to-lateral and lateral-to-medial RI injection techniques, which may influence outcomes in pain management for adhesive capsulitis.

Effectiveness of ultrasound-guided fascia hydrorelease on the coracohumeral ligament in patients with global limitation of the shoulder range of motion: a pilot study

We conducted a prospective single-arm interventional study of the treatment efficacy of ultrasound-guided fascia hydrorelease (US-FHR) on the coracohumeral ligament (CHL) of patients with global limitation of shoulder range of motion (ROM) without local inflammation. The primary outcome was the change in passive ROM (pROM) of external rotation (ER) after first US-FHR. Secondary outcomes included the change in pROM of other directions from baseline, the pain visual analogue scale (pVAS) at the timepoints after each procedure (first, second US-FHR and rehabilitation) as well as the change in the Shoulder Pain and Disability Index (SPADI) from the first to the second visit. Eleven patients underwent US-FHR. The pROM of ER after the 1st US-FHR changed by a median of 7.1° (p < 0.01). There was a statistically significant improvement in the pROM of flexion, extension, abduction, external rotation, and internal rotation from baseline to each timepoints. The pVAS at rest showed no significant improvement, although the pVAS at maximal ER showed a trend towards improvement. The SPADI score decreased by a median of 13.4 (p < 0.01). No adverse events were observed. US-FHR on the CHL with or without rehabilitation might be an effective, less invasive treatment for patients with global limitation of shoulder ROM.

The Effect of Arthroscopic Extra-Articular Entire Coracohumeral Ligament Release for Patients with Recalcitrant Frozen Shoulder.

The thickened coracohumeral ligament (CHL) is an important part of the typical manifestations and magnetic resonance imaging of frozen shoulder. However, only a few clinical studies with limited cases on arthroscopic extra-articular entire CHL release exist in the literature. This study was to evaluate the effect of arthroscopic extra-articular entire CHL release for patients with recalcitrant frozen shoulder. From February 2014 to February 2020, 81 cases of recalcitrant frozen shoulder patients treated with surgery in a single-center shoulder department and followed for more than 2 years were analyzed. Arthroscopic 360° capsular release was performed with intra-articular partial release (IPR group) or additional extra-articular entire release (IPR + EER group) of CHL. The same rehabilitation program was performed after surgery in both groups. Visual analogue scale (VAS) for pain, range of motion (ROM), and the Constant-Murley scoring system was evaluated before operation, at 3 months after operation, 6 months after operation, and the final follow-up. T-test, Mann-Whitney U-test and chi-squared test were used to compared data. There were 39 patients in the IPR group, with an average follow-up of 29.2 months. A total of Forty-two patients in the IPR + EER group completed a mean follow-up of 25.7 months. All incisions healed in stages. There were significant differences in Constant-Murley shoulder score, VAS score, and ROM before operation and at the final follow-up in both groups (both P < 0.001). The VAS score of the IPR + EER group was lower than that of the IPR group at 3 months after surgery (P <0.05), and 6 months after operation (P <0.05). External rotation, internal rotation, and abduction of ROMs and Constant-Murley shoulder score were significantly greater in the IPR + EER group at 3 months (P < 0.001, P <0.05, P < 0.001, P <0.05, respectively) and 6 months after operation (P < 0.001, P <0.05, P < 0.001, P <0.05, respectively). At the last follow-up, there was no significant difference in forward flexion, internal rotation, and abduction of ROMs, VAS, and the Constant-Murley shoulder score between the IPR and IPR + EER groups. The external rotation of the IPR + EER group was still greater than that of the IPR group at the last follow-up (P < 0.001). Arthroscopic extra-articular entire coracohumeral ligament release could solve early pain of shoulder joint, recover shoulder joint functions effectively, and achieve a satisfactory efficacy in the treatment of recalcitrant frozen shoulder.

MR imaging biomarkers for evaluation of adhesive capsulitis of the shoulder. Additive value of anterior capsule abnormality as a reliable criterion for diagnosis of adhesive capsulitis: a cross sectional analytic study

BackgroundAdhesive capsulitis of the shoulder is a pain syndrome of progressive nature, associated with reduced active and passive range of motion of the gleno-humeral joint. Previous studies suggested an underlying synovial inflammatory process, followed by capsular hypertrophy and reactive fibrosis. The aim of our study was to investigate the influence of anterior shoulder joint capsule abnormal thickening and abnormal signal intensity on MRI, as important imaging biomarkers, for the diagnosis of as adhesive capsulitis.ResultsThis cross sectional analytic study involved 28 patients with adhesive capsulitis ((17 males, 11 females, age range:23–65 years, mean age: 45.61 years ± 11.95) and 28 controls (14 males, 14 females; age range, 39 to 61 years; mean age 52.82 years ± 6.45;). The patients and the controls were reviewed by two radiologists with experience of more than 10 years, blinded to each other's results. Adhesive capsulitis was diagnosed based on clinical criteria of significant restricted passive motion of shoulder joint. The thickness and abnormal signal intensity of anterior glenohumeral joint capsule were evaluated at its thickest portion, positioned underneath the subscapularis muscle. Additionally, the formerly known MR characteristics of adhesive capsulitis, involving the thickness of humeral and glenoid portions of axillary recess, maximal thickness of axillary capsule, and thickness of coracohumeral ligament, were assessed. The estimation of abnormal hyperintensity of humeral and glenoid capsule in axillary recess, subcoracoid fat triangle obliteration and abnormal hyperintensity were also included in our study. All magnetic resonance imaging (MRI) quantitative values showed significant difference between adhesive capsulitis group and control group. Regarding qualitative values, only abnormal high signal intensity of the anterior portion of joint capsule, of the axillary portion of joint capsule and of glenoid portion of axillary capsule showed statisticaly significant difference between cases and controls. In receiver operating characteristic (ROC) curve study, the anterior capsule thickness revealed a high diagnostic value with an area under the curve (AUC) of 1.0. An anterior capsule thickness cut off value of at 2.45 mm showed a very high diagnostic performance, revealing a sensitivity of and specificity of 100%.ConclusionsThe anterior glenohumeral joint capsule abnormal thickening, and abnormal hyperintensity have a high diagnostic performance, in addition to the previously known abnormal MRI findings, in the evaluation of adhesive capsulitis.

Adhesive capsulitis and ultrasound diagnosis, an inseparable pair: a novel review.

Adhesive Capsulitis (AC) is a musculoskeletal disorder initially described by Codman in 1934. The disease is characterized by pain-limited restriction in active and passive glenohumeral range of motion (ROM) despite the lack of a structural deficit. In the last decades, arthroscopy and magnetic resonance imaging (MRI) has been the only diagnostic tools able to highlight the characteristic alterations of the glenohumeral capsular-ligament apparatus in AC; nevertheless, both arthroscopy and MRI are burdened by intrinsic limitations. The aim of this narrative review is to summarize the most significant evidence supporting the use of ultrasound (US) for the diagnosis of AC. We extensively searched via PubMed library the terms "frozen-shoulder" and "adhesive capsulitis" each combined with "ultrasound". We found 3723 papers on PubMed and selected those inherent to AC diagnosis, US imaging, correlation with arthroscopic and MRI findings. Forty papers which were strictly related to the topic of this narrative review were initially chosen, then 20 studies which described and exploited US for AC diagnosis were finally included. Coracohumeral ligament (2.65 ± 0.4mm) and axillary pouch thickening (3.34 ± 0.8mm), as well as an increase in vascularity at rotator interval (78/214, 36.44%), represented the commonest US signs useful for AC diagnosis and for which the most significant cut-off values were reported. The evidence collected in this review testify that musculoskeletal US is as reliable as MRI for AC diagnosis, therefore we believe that in this context US should be considered a first-line imaging technique.

Ultrasound Guıded Multisıte Injectıon Technıque in the Treatment of Frozen Shoulder

Frozen shoulder (FS) is an elusive condition that affects patients’ mental and emotional quality of their lives. Corticosteroid injection technique is one of the first-line treatment methods in the treatment of FS. Ultrasound (USG) guidance allows visualization of the shoulder anatomy and improves the accuracy of the injection site. This study describes an USG-guided injection technique for FS treatment. The aim of this technique was to affect glenohumeral joint and capsule, subacromial space, the long head of biceps tendon sheath, and the coracohumeral ligament. For this purpose, four different sites were injected by USG guidance. Patients with FS can be effectively treated through this technique that is detailed in this article.

Pooled prevalence estimation of anomalous insertion of pectoralis minor in cadaveric studies

Introduction: The pectoralis minor muscle originates in the chest wall's third to fifth ribs and inserts on the medial side of the Scapula's coracoid process. It aids in scapulothoracic joint abduction and shoulder downward movement. Since the 19th century, the aberrant insertion of the pectoralis minor beyond the coracoid process has been known. Aim of the study: To measure its pooled prevalence in different populations. Methods: The keywords were generated from MeSH term database. The keywords were combined with the operator to form search strategies. Three significant databases PubMed, Embase, and Google Scholar were used. The data extraction was done from cadaveric studies. Results: The prevalence of anomalous insertion of pectoralis minor was reported to be 1.5-34% (per hundred shoulders in cadaveric dissection in exiting literatures, but its pooled prevalence was 22% (16-31%) (Per hundred shoulders). According to Le Double's classification, there were three sorts of variations of aberrant tendon insertion. In the literature, the Coracohumeral ligament and the Supraspinatus are two more common locations for the implantation of aberrant tendons. Conclusion: During rotator cuff surgeries, surgeons should be cautious about the pectoralis minor tendon in the rotator interval.

THICKNESS OF THE CORACOHUMERAL LIGAMENT IN CASES OF RECURRENT SHOULDER DISLOCATION

Enhancement of the joint capsule, fibrovascular tissue, and synovial membrane in the rotator cuff interval using MRI can aid the identification of adhesive capsulitis following intravenous gadolinium injection. This study assesses the thickness of the coracohumeral ligament (CHL) in the cases of recurrent shoulder dislocation and identifies the status of the CHL in these cases. A 3T MRI machine was used to perform the imaging. Patients were included with a history of at least two episodes of shoulder dislocation at the radiology department of King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia, from January 2017 to May 2020. A total of 177 patients were diagnosed with recurrent shoulder dislocation through its associated symptoms, out of which 107 had a history of shoulder dislocation. A mean CHL thickness was reported in the control group as 1.6 (± 0.49) mm, while in patients with shoulder dislocation it was reported as 2.84 (± 0.91) mm. A statistically significant relationship was observed between CHL thickness and the presence of Hill-Sachs and Bankart lesions. The study concluded that increased CHL thickness is strongly correlated with shoulder dislocation: there is a good predictability of shoulder dislocation based on the presence of thickened CHL.

Ultrasound-guided hydrodilatation of glenohumeral joint combined with acupotomy for treatment of frozen shoulder.

Frozen shoulder (FS), also known as shoulder adhesive capsulitis, is a musculoskeletal disorder associated with pain and functional disability. There is a lack of evidence on the optimal treatment strategy for FS. The present study aimed to evaluate the effectiveness and safety of ultrasound-guided hydrodilatation of glenohumeral joint combined with acupotomy for treatment of FS. In this prospective randomized, double-blind, controlled study, 63 FS patients were recruited, and equally allocated to treatment group and control group. The treatment group was treated with ultrasound-guided hydrodilatation of glenohumeral joint combined with acupotomy, while the control group was only treated with ultrasound-guided hydrodilatation of glenohumeral joint. The pain and mobility of shoulder, overall efficacy and adverse reactions were evaluated 3 months after treatment. At baseline, no significant difference in all characteristic value was found between the treatment group (n= 33) and control group (n= 30). Three months after operation, the joint's Active Range of Motion (AROM) and Constant-Murley Scale (CMS) scores in the experimental group were higher than those in the control group, and the coracohumeral ligament (CHL) thickness and the rate of hypoechoic thickening in rotator cuff space in the experimental group were lower than those in the control group (all P< 0.05). The amount of injection volume at the third hydrodilatation was significantly higher in the experimental group than that in the control group (15.8 ± 4.7 vs 12.2 ± 5.2, P= 0.03). After 2 times of treatment, the volume increment of glenohumeral joint Δ2 in the experimental group was greater than that in the control group (3.5 ± 1.8 vs 1.2 ± 1.6, P< 0.001). There were significant differences in the effective rate between the two groups (93.94% vs. 76.67%, P= 0.04). The ultrasound-guided hydrodilatation of glenohumeral joint combined with acupotomy may benefit FS patients.

Clinical Significance of Shear Wave Ultrasound Elastography in Patients With Idiopathic Adhesive Capsulitis: Can It Be Used Instead of Magnetic Resonance Imaging as an Early Indicator?

The aim of this study was to evaluate the elasticity of the supraspinatus (SSp) and infraspinatus (ISp) tendons and coracohumeral ligament (CHL), as well as the thickness of CHL in patients diagnosed with adhesive capsulitis (AC) using ultrasound (US) and 2D shear wave elastography (2D-SWE), determining their contributions to diagnosis and stage differentiation.This prospective case-control study was conducted between January 2020 and May 2021. In all cases, the ultrasound examinations were performed using the virtual touch quantification and expressed as shear wave velocity (SWV) in meters per second. After US examinations, magnetic resonance imaging (MRI) was planned for all cases.The measurements made in US and MRI revealed that CHL thicknesses and SWV values of CHL and SSp and ISp tendons were statistically substantially higher in the patient group. The diagnostic performance of 2D-SWE in predicting AC was evaluated using receiver operating characteristics curve analysis. When the cutoff value of the mean SWE for CHL was taken as 4.67 m/s, the sensitivity of SWE was found to be 90.2% and the specificity 85.7%.Our study results suggest that CHL thickness on B-mode US, as well as SWV values of CHL and SSp and ISp tendons in 2D-SWE examination, can be used as a useful tool for AC diagnosis without the need for MRI, a costly and time-consuming examination.

Evaluation of stiffness of rotator cuff tendons, coracohumeral ligament, tendon of long head of biceps and posterior capsule by strain and shear wave elastography in frozen shoulder vs normal shoulder

Background: Frozen shoulder is an idiopathic condition which presents with the loss of both active and passive movement at the shoulder joint over a period of time, associated with pain on movement. The wide range of clinical conditions with similar symptoms make the diagnosis difficult, hence making imaging studies mandatory. An increase in stiffness is noted by shear wave and strain ultrasound elastography of rotator cuff tendons, coracohumeral ligament, tendon of long head of biceps, posteriorcapsuleina patient affected with frozen shoulder. Objectives: To evaluate the stiffness of rotator cuff tendons, coracohumeral ligament, tendon of long head of biceps and posterior capsule in frozen shoulder by strain elastography and shear wave elastography and compare it with normal shoulder. Materials and Methods: The study was conducted with twenty-nine patients with frozen shoulder. Limited and painful motion without tendinitis or tendon tears were considered. in inclusion criteria. Strain and shear wave lastography were performed on rotator cuff tendons, coracohumer alligament, tendon of long head of biceps and posterior capsule on affected side and normal side to assess and compare the strain ratios and stiffness values on both sides. Receiveroperatingcharacteristiccurvaturewasplottedfortheobtainedvalues.

IMPACT OF MULLIGAN’S MOBILIZATION TECHNIQUE ON CORACOHUMERAL LIGAMENT THICKNESS IN PATIENTS WITH ADHESIVE CAPSULITIS

Background: Mulligan’s Mobilization with movement is one of the important physical therapy interventions in the management of adhesive capsulitis of shoulder. Increased coracohumeral thickness is a grave factor in the reduction of shoulder Range of motion and functional limitation in adhesive capsulitis. Very limited literatures are available in this regard. Aim: To identify the effectiveness of Mulligan’s Mobilization with movement on coracohumeral thickness in patients with adhesive capsulitis of shoulder. Study Design: Randomized controlled trial. Methods: One hundred and fifty patients with adhesive capsulitis were randomly divided into two groups, viz., group ‘A’ and group ‘B’. In group A, Mulligan’s mobilization with movement was administered for three weeks whereas in group ‘B’. Conventional physical therapy program was administered for a period of 3 weeks. Outcome measures: Coracohumeral thickness was evaluated by ‘B’ mode ultrasound scanning before and after therapy. The differences in the CHL thickness between groups was evaluated statistically by independent sample‘t’ test. Results: The mean improvement in the CHL thickness was significantly higher in Mulligan’s mobilization, mean diff. = 0.63, t = 50.05, p = 0.001 than in conventional treatment. Conclusion: It is concluded that Mulligan’s Mobilization with Movement is effective in reducing coracohumeral ligament thickness in patients with adhesive capsulitis. Keywords: Adhesive Capsulitis, Coracohumeral Thickness, Shoulder Abduction and External Rotation ROM, Mulligan’s Mobilization with Movement.

Effect of proprioceptive neuromuscular facilitation technique on the treatment of frozen shoulder: a pilot randomized controlled trial

Background and objectivesFrozen shoulder is a common painful disease of the shoulder joint characterized by structural changes in the shoulder joint, restricting both active and passive shoulder joint activities. Proprioceptive neuromuscular facilitation (PNF) effectively improved and maintained the range of motion; however, it is not clear whether it can improve the shoulder joint structure in patients with frozen shoulder. This pilot study used magnetic resonance imaging (MRI) observation to assess the improvement of the local structure of the shoulder joint upon PNF treatment to elucidate a target based on structure for the treatment of frozen shoulder.Materials and methodsForty-eight patients with frozen shoulder were randomly divided into the traditional manual therapy group and the PNF technique group. Changes in the thicknesses of the coracohumeral ligament (CHL) and capsule in axillary recess (CAR) of the shoulder joint were observed via MRI upon admission and at 4 weeks after treatment. A visual analog scale (VAS) and passive shoulder range of motion (ROM) at abduction, anteflexion and external rotation position were used to evaluate the improvement of shoulder joint pain and function in the initial, mid-term, and discharge of the two groups of patients.ResultsThe primary outcome results shown that the PNF joint mobilization significantly reduced the thickness of the CHL (p = 0.0217) and CAR (p = 0.0133). Compared with simple joint mobilization, The mid-term and discharge rehabilitation assessment results showed that PNF has a better effect on shoulder pain. At the mid-term evaluation, the ROM of the PNF group was significantly better than that of the Control group in the three directions (p < 0.05).ConclusionAs an adjunctive therapy, PNF can improve the shoulder joint structure of patients with frozen shoulder and is an effective treatment strategy for frozen shoulder.