The Thickness Of Coracohumeral Ligament In The Diagnosis And Prognosis Of Adhesive Capsulitis Of The Shoulder

Background: Adhesive capsulitis of the shoulder,also know as frozen shoulder or scapulohumeral periarthritis,is first described by Codman in 1934.It’s a poorly understood condition that characterized by shoulder pain and stiffness,especially restriction of external rotation.Accurate findings of the etiology and pathophysiology of adhesive capsulitis of the shoulder is an inflammatory thickening and contract of the rotato interval,where the coracohumeral ligament crosses.The prevalence of adhesive capsulitis of the shoulder in the total population is 2%-5%,but as high as 30% in patients diagnosed with non-insulin dependent diabetes metilus.Adhesive capsulitis of the shoulder is named the fifty year old shoulder,which commonly affects women aged 40 to 60 years.Adhesive capsulitis of the shoulder is usually diagnosed on the basis of medical history and physical exam,not radiographic findings.Other causes of shoulder pain and stiffness must be excluded,including bicipital tenosynovitis,glenohumeral and acromioclavicular arthritis,tears of rotato cuff,fracture malunion,cervical radiculopathy,shoulder tumors.Imaging can be helpful to rule out other causes with similar syndromes to adhesive capsulitis of the shoulder.Invasive arthroscopic findings as the consensus “gold standard” for the diagnosis of adhesive capsulitis of the shoulder is not a common practice,and needed professional technical and equipment.Some attempts have made to assist accurately diagnosis adhesive capsulitis of the shoulder through imaging,such as Magnetic resonance imaging(MRI),Magnetic resonance angiography(MRA),ultrasound.Dynamic sonography can document thickening of primarily the rotato interval and the coracohumeral ligament.These findings can provide early and accurate diagnosis of adhesive capsulitis of the shoulder.Objective:To investigate the thickness of the coracohumeral ligament in adhesive capsulitis of the shoulder and asymptomatic individuals.Observe the relationship between the coracohumeral ligament thickenness and adhesive capsulitis of the shoulder.The objective of present study was also to evaluate the changes in the thickness of coracohumeral ligament through ultrasound-guided corticosteroid injection via rotato interval.Methods:The study was conducted at the inheritance of the First Affiliated Hospital of Soocow University during the period from October 2017 to February 2018.1.Exam 36 adhesive capsulitis patients shoulders with high-frequency ultrasound,and measure the thickness of coracohumeral ligament.All sufffered shoulders underwent ultrasound-guided corticosteroid injection via rotato interval weekly,three times as a course.All cases were followed up for three months.2.Measure 66 asymptomatic individual shoulders with high-frequency ultrasound for thickness of coracohumeral ligament of the dominant side and nondominant side.Compare the thickness of coracohumeral ligament between different gender group、different age group、different body weight index group and different shoulder side.Clinical examination,ROM,the thickness of coracohumeral ligament,Constant-Murley score,NRS score were performed and compared at 0,1week,1 and 3 months.The thickness of coracohumeral ligament of affected shoulders were compared with unaffected shoulders and asymptomatic shoulders.Results: The thickness of coracohumeral ligament was significantly greater in adhesive capsulitis shoulders than in the asymptomatic shoulders(3.09±0.45 mm vs1.52±0.39mm).The outcome measures showed significant differences between baseline and after the treatment in NRS,ROM,Constant-Murley score,the thickness of coracohumeral ligament(P<0.05).Conclusion:Ultrasound is a satisfactory method for coracohumeral ligament depiction and a thickened coracohumeral ligament is highly suggestive of adhesive capsulitis of the shoulder.The changes in thickness of coracohumeral ligament may be a reference for the therapeutic efficacy of adhesive capsulitis of the shoulder.