Sonography in diagnosis of adhesive capsulitis of the shoulder: a case–control study

Abstract

Purpose

Adhesive capsulitis (AC) of the shoulder has been a diagnosis of exclusion on sonography due to lack of specific diagnostic criteria. This study prospectively assesses the efficacy of sonography using multiple static and dynamic parameters for diagnosis of AC.

Materials and methods

Shoulder sonography was performed independently by two musculoskeletal radiologists on 90 subjects (60 symptomatic and 30 controls). All symptomatic subjects were subjected to an MRI. Based on clinical and MRI diagnosis, three groups were made: AC (n = 30), painful shoulders (PS) (n = 30), and control group (CL) (n = 30). The sonographic parameters studied were: coracohumeral ligament (CHL) thickness, increased soft tissue in rotator interval (static parameters) and restriction of abduction and external rotation on dynamic scanning. These were compared within the three groups and the accuracy of each parameter in isolation and in combination for diagnosis of AC was calculated.

Results

Sonographic visualisation of CHL (96.7%) and its mean thickness (1.2 mm) were highest in the AC group (p < 0.01). A cut-off value of 0.7 mm was found to be accurate (sensitivity 93.1%, specificity 94.4%) for diagnosing AC. Increased soft tissue in the rotator interval was seen in the AC group and had a high sensitivity of 86.2% and specificity of 92.8%. On dynamic scanning, restriction of external rotation was specific (sensitivity 86.2%, specificity 92.8%), whereas restriction in abduction was non-specific (specificity 6.7%). Inter-observer agreement was substantial for CHL visualisation (kappa 0.66). Overall, sonography, using multiple parameters, revealed a high sensitivity and specificity (100 and 87%, respectively) for diagnosis of AC of the shoulder.

Conclusion

Sonography revealed a high accuracy for diagnosing AC of the shoulder and in differentiating it from other causes of painful shoulder. It, thus, has the potential to be adopted as a preferred imaging modality.

Sommario

Scopo

La capsulite adesiva (AC) della spalla è una diagnosi ecografica di esclusione, per la mancanza di criteri diagnostici specifici. Questo studio valuta prospetticamente l’efficacia dell’ecografia, utilizzando multipli parametri statici e dinamici, per la diagnosi di capsulite adesiva.

Materiale e metodi

L’ecografia della spalla é stata effettuata indipendentemente da due radiologi muscoloscheletrici su 90 soggetti (60 sintomatici e 30 di controllo). Tutti i soggetti sintomatici sono stati sottoposti a risonanza magnetica (RM). Sulla base della diagnosi clinica e RM sono stati suddivisi tre gruppi: pazienti con capsulite adesiva (AC) (n = 30), con spalla dolorosa (PS) (n = 30) e gruppo di controllo (CL) (n = 30). I parametri ecografici studiati sono stati: lo spessore del legamento coracoomerale (CHL), l’aumento di tessuto molle nell’intervallo dei rotatori (parametri statici) e la diminuzione di abduzione e rotazione esterna nelle scansioni dinamiche. I risultati sono stati confrontati all’interno dei tre gruppi ed è stata calcolata l’accuratezza di ogni parametro, singolarmente e in combinazione per la diagnosi di AC.

Risultati

La visualizzazione ecografica del CHL (96,7%) e il suo spessore medio (1,2 mm) erano più alti nel gruppo AC (P < 0.01). Il valore di cutoff di 0,7 millimetri è stato considerato accurato (sensibilità del 93,1% e specificità del 94.4%) per la diagnosi di AC. L’aumento del tessuto molle nell’intervallo dei rotatori é stato osservato nel gruppo AC e aveva elevata sensibilità (86,2%) e specificità (92,8%). Con scansioni dinamiche, la limitazione della rotazione esterna era significativa (sensibilità 86,2%, specificità 92,8%), mentre la limitazione dell’’abduzione non lo era (specificità 6,7%). L’accordo inter-osservatori, nella visualizzazione del CHL è stato notevole (kappa 0,66). Utilizzando più parametri, nel complesso, l’ecografia ha rivelato elevata sensibilità e specificità (100% e 87% rispettivamente) nella diagnosi di capsulite adesiva della spalla.

Conclusione

L’ecografia ha rivelato un’elevata precisione nella diagnosi di capsulite adesiva della spalla, nonché nel differenziarla dalle altre cause di spalla dolorosa, pertanto ha le potenzialità per essere adottata come modalità di scelta tra le metodiche di imaging.

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Correspondence to Anupama Tandon.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Written informed consent was obtained from patients for publication of this report and images.

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Tandon, A., Dewan, S., Bhatt, S. et al. Sonography in diagnosis of adhesive capsulitis of the shoulder: a case–control study. J Ultrasound 20, 227–236 (2017). https://doi.org/10.1007/s40477-017-0262-5

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Keywords

  • Shoulder sonography
  • Adhesive capsulitis
  • Frozen shoulder
  • Coracohumeral ligament
  • CHL
  • Rotator interval