Correlations between Clinical Examination, Ultrasonography and MRI Findings in Different Causes of Painful or Limited Range of Movement in the Shoulder Joint
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- Category: Vol. 92, December 2024
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Correlations between Clinical Examination, Ultrasonography and MRI Findings in Different Causes of Painful or Limited Range of Movement in the Shoulder Joint, RANIA ZEITOUN, AZZA I. GALAL, NEHAL H. ELGHOBASHY and NOUR M.M. KANDIL
Abstract Background: In clinical practice, reduced shoulder move-ment with an unclear cause continues to be a significant issue. This condition is known as adhesive capsulitis when the range of motion is completely limited. Other conditions such as ro-tator cuff tendinopathy or tears, with or without impingement, should be taken into consideration. Aim of Study: To assess the contribution of magnetic reso-nance imaging (MRI) and ultrasound in the diagnosis of various shoulder joint range of motion restrictions to clinical examina-tion. Material and Methods: There were 100 patients in the study, a total of 102 shoulders with painful and restricted shoul-der movements. There were 56 male cases (56%) and 44 fe-male cases (44%). Every patient had a clinical examination, a B-mode dynamic ultrasound and an MRI. For each patient, a provisional diagnosis was reported clinically, by ultrasound (US) and by MRI. Results: Most patients (78.4%) had painful limited range of motion (ROM), 21.6% had painful non-limited active ROM, 58.8% had painful non-limited passive ROM and none had lim-ited passive range. There were different etiologies for restricted ROM: Rotator cuff tendinopathy, tear, shoulder impingement syndrome and adhesive capsulitis. Diagnostics for rotator cuff tears and tendinopathy showed moderate and high agreement, respectively, between MRI and ultrasound. However, in terms of adhesive capsulitis, there was little agreement between, clini-cal, MRI and ultrasound. In addition. The diagnosis of shoulder impingement syndrome by MRI, clinical and ultrasonography evaluations agreed fairly well. The diagnostic accuracy of US was higher than clinical examination in rotator cuff tendinopa-thy and tear being 78.4% and 88.2% respectively. Patients with painful passive range had statistically significant thicker rotator interval and axillary recess thickness by US and statistically significant thicker coracohumeral ligament (CHL) and axillary capsule by MRI as well as rotator interval and subcoracoid fat infiltration (p-values <0.05). Conclusion: We came to the conclusion that even though the patients’ range of motion was restricted, the US can still be used to diagnose a variety of shoulder conditions with the highest performance in rotator cuff tendinopathy and tear. Since MRI showed a strong correlation with the clinical assessment of painful passive ROM, we also concluded that MRI is su-perior to other methods for diagnosing adhesive capsulitis in its early stages before passive movement becomes limited. The entire care process is positively impacted by this advancement in patient assessment and management.