J Rheum Dis.  2019 Jul;26(3):149-155. 10.4078/jrd.2019.26.3.149.

Role of Ultrasonography in Diagnosis and Treatment of Frozen Shoulder

• Park GY

• KMID: 2451506
• DOI: http://doi.org/10.4078/jrd.2019.26.3.149

Abstract

Frozen shoulder (FS) is a common, painful and disabling condition of the shoulder. Patients usually present with an insidious onset of symptoms with gradual restriction and loss of shoulder mobility. FS can be categorized into primary and secondary types. The natural course of FS is characterized by the following 3 stages: the painful, the freezing/frozen, and the thawing phase based on the duration of symptoms, as well as pain and limitation of motion observed on physical examination. Diagnosis of FS is based on careful and accurate history taking and physical examination. Imaging modalities including arthrography, ultrasonography, and magnetic resonance imaging are useful in excluding concomitant painful conditions of the shoulder and in confirming FS. Ultrasonography is recommended as the first-line imaging modality to diagnose FS because it is noninvasive, it provides an easy comparison of ultrasonography parameters between the affected and unaffected sides, and it reflects the clinical characteristics of FS. The goal of treatment in patients with FS is pain reduction and restoration of normal function and mobility of the shoulder. Ultrasonography-guided glenohumeral joint injection, suprascapular nerve block, and distention arthrography achieve favorable therapeutic outcomes by virtue of greater accuracy. Ultrasonography and ultrasonography guided injections can accurately diagnose and effectively treat patients with FS.

Keyword

Frozen shoulder; Ultrasonography; Diagnosis; Treatment

MeSH Terms

Arthrography
Bursitis*
Diagnosis*
Humans
Magnetic Resonance Imaging
Nerve Block
Physical Examination
Shoulder
Shoulder Joint
Ultrasonography*
Virtues

Figure

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  Figure 1 Ultrasonography measurement of coracohumeral ligament thickness. Longitudinal ultrasonography scan shows that the coracohumeral ligament thickness of the affected shoulder is thicker than that of the unaffected shoulder in the patient with frozen stage frozen shoulder.

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  Figure 2 Transverse power Doppler ultrasonography scan shows hypervascularity in rotator cuff interval.

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  Figure 3 Ultrasonography measurement of axillary recess thickness. Longitudinal ultrasonography scan shows that the axillary recess thickness of the affected shoulder is thicker than that of the unaffected shoulder in the patient with frozen stage frozen shoulder. Axillary recess ratio is 2.34 (6.14/2.62 mm).

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  Figure 4 Ultrasonography guided glenohumeral joint injection using posterior approach in seated (A) and prone (B) position. D: deltoid, ISP: infraspinatus muscle, G: glenoid, HH: humeral head.

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  Figure 5 Ultrasonography guided glenohumeral joint injection using posterior approach in prone position. The needle tip is targeted at the point between the posterior labrum and posterior humeral head cartilage. The hyperechoic triamcinolone crystal (arrow) is detected in posterior glenohumeral joint after injection.

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  Figure 6 Distal (classic) suprascapular nerve block under ul- and serratus anterior muscle (SA). trasonography guidance. Needle is (arrow heads) approaching on the suprascapular nerve and artery (arrow) in suprascapular notch (open arrow head).

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  Figure 7 Proximal suprascapular nerve block under ultrasonography guidance, Needle tip (arrow) is located beneath proximal suprascapular nerve between omohyoid muscle (OM) and serratus anterior muscle (SA).

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  Figure 8 Glenohumeral distension arthrography under ultrasonography guidance. Capsular distension of posterior glenohumeral joint (arrow) is noted during and after distension arthrography.

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