Prevalence and Correlation between MRI Findings and Outcome of Conservative Treatment in Primary Idiopathic Frozen Shoulder

Document Type : RESEARCH PAPER

Authors

1 Tehran University of Medical Sciences · Department of Orthopedics, Tehran, Iran

2 Department of Radiology, Medical Imaging Center, Tehran University of Medical Sciences, Tehran, Iran

3 Department of Radiology, Imam hossein Hospital, Shahroud University of Medical Sciences, Shahroud, Iran

4 Department of Radiology, Shariati Hospital, MIRC(Musculoskeletal Imaging Research Center) Tehran University of Medical Sciences, Tehran, Iran

Abstract

Objectives: Primary idiopathic frozen shoulder (FS) causes pain and stiffness in the shoulder joint. Over 
time, this disease causes restriction of shoulder motion. We undertook this study to evaluate possible 
correlation of MRI findings with outcome of conservative management in FS.
Methods: A total of 65 cases participated in prospective cohort study. The correlation of MRI findings obtained 
before commencing the treatment with outcome of non-operative management (Mean of ROM, VAS, SST and OSS) 
was evaluated.
Results: Anterior extracapsular edema significantly correlated with FF, EXR, VAS (a) and OSS. The effusion in 
humeral side of axillary recess significantly correlated with ROM restriction in ABD, EXR. Capsular thickness of 
glenoid portion showed good significance with FF, ABD, VAS (a) and OSS. Increased thickness of CHL showed 
negative correlation with improvement of EXR (P=0.049) (r=-0.617). Thickening of IGHL showed negative 
correlation with improvement of ABD (p=0.005 r=-0.862) and FF (p=0.007 r=-0.831). Mean Height of Axillary recess 
(HAR) was 7.2mm (3.5-11mm). HAR showed negative correlation with VAS pain scale (P=0.036) (r=-0.682) and 
OSS (P=0.038) (r=-0.668)
Conclusion: Thickness of the joint capsule and effusion at the axillary fold are important factors for refractory frozen 
shoulder. We can recommend MRI for refractive cases and low threshold of expectation can be set for conservative 
management in patients with above findings.
 Level of evidence: III

Keywords

Main Subjects

References

  1. Warner JJP. Frozen Shoulder: Diagnosis and Management. J Am Acad Orthop Surg. 1997; 5(3):130-140. doi:10.5435/00124635-199705000-00002.
  2. Harryman DT. Shoulders: frozen and stiff. Instr Course Lect. 1993; 42:247-257.
  3. Frederick A. Matsen, Frank A. Cordasco, John W Sperling, Steven B. Lippitt,eds. Rockwood and Matsen's The Shoulder. 6st ed. Elsevier, Saunders; 2021.
  4. Bunker TD. Frozen shoulder: unravelling the enigma. Ann R Coll Surg Engl. 1997; 79(3):210-213.
  5. Binder AI, Bulgen DY, Hazleman BL, Tudor J, Wraight P. Frozen shoulder: an arthrographic and radionuclear scan assessment. Ann Rheum Dis. 1984; 43(3):365-369. doi:10.1136/ard.43.3.365.
  6. Lee JC, Guy S, Connell D, Saifuddin A, Lambert S. MRI of the rotator interval of the shoulder. Clin Radiol. 2007; 62(5):416-423. doi: 10.1016/j.crad.2006.11.017.
  7. Ahn KS, Kang CH, Oh YW, Jeong WK. Correlation between magnetic resonance imaging and clinical impairment in patients with adhesive capsulitis. Skeletal Radiol. 2012; 41(10):1301-1308. doi:10.1007/s00256-012-1391-8.
  8. Sofka CM, Ciavarra GA, Hannafin JA, Cordasco FA, Potter HG. Magnetic Resonance Imaging of Adhesive Capsulitis: Correlation with Clinical Staging. HSS J. 2008; 4(2):164-169. doi:10.1007/s11420-008-9088-1.
  9. Emig EW, Schweitzer ME, Karasick D, Lubowitz J. Adhesive capsulitis of the shoulder: MR diagnosis. American Journal of Roentgenology. 1995; 164(6):1457-1459. doi:10.2214/ajr.164.6.7754892.
  10. Kanazawa K, Hagiwara Y, Sekiguchi T, et al. Correlations between Capsular Changes and ROM Restriction in Frozen Shoulder Evaluated by Plain MRI and MR Arthrography. Open Orthop J. 2018; 12(1):396-404. doi:10.2174/1874325001812010396.
  11. Hannafin JA, Chiaia TA. Adhesive capsulitis. A treatment approach. Clin Orthop Relat Res. 2000 ;( 372):95-109.
  12. Neviaser RJ, Neviaser TJ. The frozen shoulder. Diagnosis and management. Clin Orthop Relat Res. 1987 ;( 223):59-64.
  13. Robinson CM, Seah KTM, Chee YH, Hindle P, Murray IR. Frozen shoulder. J Bone Joint Surg Br. 2012; 94-B (1):1-9. doi:10.1302/0301-620X.94B1.27093.
  14. Watson L, Dalziel R, Story I. Frozen shoulder: A 12-month clinical outcome trial. J Shoulder Elbow Surg. 2000; 9(1):16-22. doi:10.1016/S1058-2746(00)90004-1.
  15. Hand C, Clipsham K, Rees JL, Carr AJ. Long-term outcome of frozen shoulder. J Shoulder Elbow Surg. 2008; 17(2):231-236. doi:10.1016/j.jse.2007.05.009.
  16. Shaffer B, Tibone JE, Kerlan RK. Frozen shoulder. A long-term follow-up. J Bone Joint Surg Am. 1992; 74(5):738-746.
  17. Li J qing, Tang K lai, Wang J, et al. MRI Findings for Frozen Shoulder Evaluation: Is the Thickness of the Coracohumeral Ligament a Valuable Diagnostic Tool? PLoS One. 2011; 6(12):e28704. doi:10.1371/journal.pone.0028704.
  18. Chellathurai A, Subbiah K, Elangovan A, Kannappan S. Adhesive capsulitis: MRI correlation with clinical stages and proposal of MRI staging. Indian Journal of Radiology and Imaging. 2019; 29(01):19-24. doi:10.4103/ijri.IJRI_116_18.
  19. Park S, Lee DH, Yoon SH, Lee HY, Kwack KS. Evaluation of Adhesive Capsulitis of the Shoulder with Fat-Suppressed T2-Weighted MRI: Association between Clinical Features and MRI Findings. American Journal of Roentgenology. 2016; 207(1):135-141. doi:10.2214/AJR.15.15200.
  20. Neer CS, Satterlee CC, Dalsey RM, Flatow EL. The anatomy and potential effects of contracture of the coracohumeral ligament. Clin Orthop Relat Res. 1992 ;( 280):182-185.
  21. Kanazawa K, Hagiwara Y, Kawai N, et al. Correlations of coracohumeral ligament and range of motion restriction in patients with recurrent anterior glenohumeral instability evaluated by magnetic resonance arthrography. J Shoulder Elbow Surg. 2017; 26(2):233-240. doi:10.1016/j.jse.2016.09.016.
  22. Zuckerman JD, Rokito A. Frozen shoulder: a consensus definition. J Shoulder Elbow Surg. 2011; 20(2):322-325. doi:10.1016/j.jse.2010.07.008.
  23. Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: Spectrum of pathology part I: Pathoanatomy and biomechanics. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2003; 19(4):404-420. doi:10.1053/jars.2003.50128.
  24. Hannafin JA, Chiaia TA. Adhesive capsulitis. A treatment approach. Clin Orthop Relat Res. 2000 ;( 372):95-109.
  25. Teixeira PAG, Balaj C, Chanson A, Lecocq S, Louis M, Blum A. Adhesive Capsulitis of the Shoulder: Value of Inferior Glenohumeral Ligament Signal Changes on T2-Weighted Fat-Saturated Images. AJR Am J Roentgenol. 2012; 198(6):W589-W596. doi:10.2214/AJR.11.7453.
  26. Koh KH. Corticosteroid injection for adhesive capsulitis in primary care: a systematic review of randomised clinical trials. Singapore Med J. 2016; 57(12):646-657. doi:10.11622/smedj.2016146.

 

  1. Green S, Buchbinder R, Hetrick SE. Physiotherapy interventions for shoulder pain. Cochrane Database of Systematic Reviews. 2003; 2013(3). doi:10.1002/14651858.CD004258.
  2. Hasegawa A, Mihata T, Fukunishi K, Neo M. Does the timing of surgical intervention impact the clinical outcomes and overall duration of symptoms in frozen shoulder? J Shoulder Elbow Surg. 2021; 30(4):836-843. doi:10.1016/j.jse.2020.07.023.
  3. Chellathurai A, Subbiah K, Elangovan A, Kannappan S. Adhesive capsulitis: MRI correlation with clinical stages and proposal of MRI staging. Indian J Radiol Imaging. 2019; 29(1):19-24. doi:10.4103/ijri.IJRI_116_18.
  4. Park S, Lee DH, Yoon SH, Lee HY, Kwack KS. Evaluation of Adhesive Capsulitis of the Shoulder with Fat-Suppressed T2-Weighted MRI: Association between Clinical Features and MRI Findings. American Journal of Roentgenology. 2016; 207(1):135-141. doi:10.2214/AJR.15.15200.
  5. Choi ES, Lee YS, Yang JH, et al. MRI Findings of Adhesive Capsulitis of Shoulder. Journal of the Korean Academy of Rehabilitation Medicine. 2002; 26(2):177-181.
  6. Jung JY, Jee WH, Chun HJ, Kim YS, Chung YG, Kim JM. Adhesive capsulitis of the shoulder: evaluation with MR arthrography. Eur Radiol. 2006; 16(4):791-796. doi:10.1007/s00330-005-0020-5.
  7. Codman EA. The Shoulder; Rupture of the Supraspinatus Tendon and Other Lesions in or About the Subacromial Bursa. T. Todd Company printers; 1934.

 

 

 

 

The Archives of Bone and Joint Surgery
Volume 12, Issue 4
April 2024
Pages 275-282

Files

History

  • Receive Date: 24 July 2023
  • Revise Date: 15 January 2024
  • Accept Date: 13 December 2023

Share

How to cite

Statistics