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      Anterior capsular abnormality: another important MRI finding for the diagnosis of adhesive capsulitis of the shoulder

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          Abstract

          <p class="first" id="d17661312e125">To evaluate the usefulness of anterior capsular abnormality, thickening, and abnormal signal intensity on MRI for the diagnosis of adhesive capsulitis of the shoulder. </p>

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          Most cited references28

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          Intraarticular corticosteroids, supervised physiotherapy, or a combination of the two in the treatment of adhesive capsulitis of the shoulder: a placebo-controlled trial.

          To compare the efficacy of a single intraarticular corticosteroid injection, a supervised physiotherapy program, a combination of the two, and placebo in the treatment of adhesive capsulitis of the shoulder. Ninety-three subjects with adhesive capsulitis of <1 year's duration were randomized to 1 of 4 treatment groups: group 1, corticosteroid injection (triamcinolone hexacetonide 40 mg) performed under fluoroscopic guidance followed by 12 sessions of supervised physiotherapy; group 2, corticosteroid injection alone; group 3, saline injection followed by supervised physiotherapy; or group 4, saline injection alone (placebo group). All subjects were taught a simple home exercise program. Subjects were reassessed after 6 weeks, 3 months, 6 months, and 1 year. The primary outcome measure was improvement in the Shoulder Pain and Disability Index (SPADI) score. At 6 weeks, the total SPADI scores had improved significantly more in groups 1 and 2 compared with groups 3 and 4 (P = 0.0004). The total range of active and passive motion increased in all groups, with group 1 having significantly greater improvement than the other 3 groups. At 3 months, groups 1 and 2 still showed significantly greater improvement in SPADI scores than group 4. There was no difference between groups 3 and 4 at any of the followup assessments except for greater improvement in the range of shoulder flexion in group 3 at 3 months. At 12 months, all groups had improved to a similar degree with respect to all outcome measures. A single intraarticular injection of corticosteroid administered under fluoroscopy combined with a simple home exercise program is effective in improving shoulder pain and disability in patients with adhesive capsulitis. Adding supervised physiotherapy provides faster improvement in shoulder range of motion. When used alone, supervised physiotherapy is of limited efficacy in the management of adhesive capsulitis.
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            Frozen shoulder: MR arthrographic findings.

            To evaluate the magnetic resonance (MR) arthrographic findings in patients with frozen shoulder. Preoperative MR arthrograms of 22 patients (six women, 16 men; mean age, 54.7 years) with frozen shoulder treated with arthroscopic capsulotomy were compared with arthrograms of 22 age- and sex-matched control subjects without frozen shoulder. The thickness of the coracohumeral ligament (CHL) and the joint capsule, as well as the volume of the axillary recess, were measured (Mann-Whitney test). Abnormalities in the CHL, subcoracoid fat, superior glenohumeral ligament, superior border of the subscapularis tendon, long biceps tendon, and subscapularis recess were analyzed in consensus by two blinded radiologists (chi(2) test). Patients with frozen shoulder had a significantly thickened CHL (4.1 mm vs 2.7 mm in controls) and a thickened joint capsule in the rotator cuff interval (7.1 mm vs 4.5 mm; P < .001 for both comparisons, Mann-Whitney test) but not in the axillary recess. The volume of the axillary recess was significantly smaller in patients with frozen shoulder than in control subjects (P = .03, Mann-Whitney test). Thickening of the CHL to 4 mm or more had a specificity of 95% and a sensitivity of 59% for diagnosis of frozen shoulder. Thickening of the capsule in the rotator cuff interval to 7 mm or more had a specificity of 86% and a sensitivity of 64%. Synovitis-like abnormalities at the superior border of the subscapularis tendon were significantly more common in patients with frozen shoulder than in control subjects (P = .014, chi(2) test). Complete obliteration of the fat triangle between the CHL and the coracoid process (subcoracoid triangle sign) was specific (100%) but not sensitive (32%). Thickening of the CHL and the joint capsule in the rotator cuff interval, as well as the subcoracoid triangle sign, are characteristic MR arthrographic findings in frozen shoulder.
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              Inflammatory cytokines are overexpressed in the subacromial bursa of frozen shoulder.

              Frozen shoulder is a debilitating condition characterized by gradual loss of glenohumeral motion with chronic inflammation and capsular fibrosis. Yet its pathogenesis remains largely unknown. We hypothesized that the subacromial bursa may be responsible for the pathogenesis of frozen shoulder by producing inflammatory cytokines.
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                Author and article information

                Journal
                Skeletal Radiology
                Skeletal Radiol
                Springer Science and Business Media LLC
                0364-2348
                1432-2161
                April 2019
                September 11 2018
                April 2019
                : 48
                : 4
                : 543-552
                Article
                10.1007/s00256-018-3064-8
                30206678
                a7d47efb-115e-4629-8c1c-a6546913d682
                © 2019

                http://www.springer.com/tdm

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