J Korean Med Sci.  2020 Apr;35(15):e99. 10.3346/jkms.2020.35.e99.

Optimal Cut-Off Value of the Coracohumeral Ligament Area as a Morphological Parameter to Confirm Frozen Shoulder

• Cho HR
• Cho BH
• Kang KN
• Kim YU

• KMID: 2500187
• DOI: http://doi.org/10.3346/jkms.2020.35.e99

Abstract

Background
Thickened coracohumeral ligament (CHL) is one of the important morphological changes of frozen shoulder (FS). Previous research reported that coracohumeral ligament thickness (CHLT) is correlated with anterior glenohumeral instability, rotator interval and eventually FS. However, thickness may change depending on the cutting angle, and measurement point. To reduce measurement mistakes, we devised a new imaging criteria, called the coracohumeral ligament area (CHLA).
Methods
CHL data were collected and analyzed from 52 patients with FS, and from 51 control subjects (no evidence of FS). Shoulder magnetic resonance imaging was performed in all subjects. We investigated the CHLT and CHLA at the maximal thickened view of the CHL using our picture archiving and communications system. The CHLA was measured as the whole area of the CHL including the most hypertrophied part of the MR images on the oblique sagittal plane. The CHLT was measured at the thickest point of the CHL.
Results
The average CHLA was 40.88 ± 12.53 mm2 in the control group and 67.47 ± 19.88 mm2 in the FS group. The mean CHLT was 2.84 ± 0.67 mm in the control group and 4.01 ± 1.11 mm in the FS group. FS patients had significantly higher CHLA (P < 0.01) and CHLT (P < 0.01) than the control group. The receiver operator characteristic analysis showed that the most suitable cut-off score of the CHLA was 50.01 mm2, with 76.9% sensitivity, 76.5% specificity, and area under the curve (AUC) of 0.87. The most suitable cut-off value of the CHLT was 3.30 mm, with 71.2% sensitivity, 70.6% specificity, and AUC of 0.81.
Conclusion
The significantly positive correlation between the CHLA, CHLT and FS was found. We also demonstrate that the CHLA has statistically equivalent power to CHLT. Thus, for diagnosis of FS, the treating physician can refer to CHLA as well as CHLT.

Keyword

Adhesive Capsulitis; Area Under Curve; Frozen Shoulder; Ligaments; ROC Curve

Figure

• 

  Fig. 1 T2-weighted TSE oblique sagittal shoulder magnetic resonance images: (A) CHLT in the FS, (B) CHLA in the FS.TSE = turbo-spin-echo, CHLT = coracohumeral ligament thickness, CHLA = coracohumeral ligament area, FS = frozen shoulder, C = coracoid process, H = humerus.

• 

  Fig. 2 ROC curve of CHLT and CHLA for confirmation of FS. The best-cut-off-point of CHLA was 50.01 mm2 vs. 3.30 mm of CHLT, with sensitivity 76.9% vs. 71.2%, specificity 76.5% vs. 70.6%.ROC = receiver operating characteristic, CHLT = coracohumeral ligament thickness, CHLA = coracohumeral ligament area, FS = frozen shoulder.

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