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Elasticity of the coracohumeral ligament in patients with frozen shoulder following rotator interval injection: a case series

David McKean
David McKean
, 
Siok Li Chung
Siok Li Chung
, 
Rebecca te Water Naudé
Rebecca te Water Naudé
, 
Bernard McElroy
Bernard McElroy
, 
Jonathan Baxter
Jonathan Baxter
, 
Aniruddha Pendse
Aniruddha Pendse
, 
Joseph Papanikitas
Joseph Papanikitas
, 
James Teh
James Teh
 oraz 
Richard Hughes
Richard Hughes
   | 18 gru 2020
Journal of Ultrasonography's Cover Image
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Article Category: research-article
Data publikacji: 18 gru 2020
Zakres stron: 300 - 306
Otrzymano: 11 maj 2020
Przyjęty: 05 wrz 2020
DOI: https://doi.org/10.15557/jou.2020.0052
Słowa kluczowe
© 2021 Polish Ultrasound Society. Published by Medical Communications Sp. z o.o.
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Fig. 1.

B-mode US scan shows measurement of coracohumeral ligament thickness in a patient with severe ACS. C – coracoid process, H – humeral head
B-mode US scan shows measurement of coracohumeral ligament thickness in a patient with severe ACS. C – coracoid process, H – humeral head

Fig. 2.

Measurement of the elastic modus of the coracohumeral ligament using shear wave elastography (SWE)
Measurement of the elastic modus of the coracohumeral ligament using shear wave elastography (SWE)

Fig. 3.

A transverse ultrasound image of the rotator interval with the long head of biceps tendon (BT) at the centre of the image. The superior glenohumeral ligament (SGHL) is anterior to the biceps tendon and the coracohumeral ligament (CHL) forms the roof of the interval superiorly. The supraspinatus tendon (SSp) lies laterally and subscapularis tendon (SSc) lies medially. The asterisk indicates the target point of the needle for targeted rotator interval injection
A transverse ultrasound image of the rotator interval with the long head of biceps tendon (BT) at the centre of the image. The superior glenohumeral ligament (SGHL) is anterior to the biceps tendon and the coracohumeral ligament (CHL) forms the roof of the interval superiorly. The supraspinatus tendon (SSp) lies laterally and subscapularis tendon (SSc) lies medially. The asterisk indicates the target point of the needle for targeted rotator interval injection

Fig. 4.

Transverse ultrasound image of the rotator interval with the biceps tendon at the centre of the image. Using a long axis needle approach, the needle tip lies between the coracohumeral ligament, as it forms the roof of the rotator interval, and the long head of biceps tendon sheath below
Transverse ultrasound image of the rotator interval with the biceps tendon at the centre of the image. Using a long axis needle approach, the needle tip lies between the coracohumeral ligament, as it forms the roof of the rotator interval, and the long head of biceps tendon sheath below

Fig. 5.

Shoulder manipulation technique. The patient is asked to demonstrate their range of motion before the injection is performed, and following the procedure is gently helped into elevation, external rotation and internal rotation using a gentle stretching motion
Shoulder manipulation technique. The patient is asked to demonstrate their range of motion before the injection is performed, and following the procedure is gently helped into elevation, external rotation and internal rotation using a gentle stretching motion

Coracohumeral ligament (CHL) thickness and elasticity on the symptomatic and asymptomatic sides in neutral and 30º external rotation (ER) position

  Asymptomatic Symptomatic
Age Symptomatic shoulder CHL (mm) CHL elastic modulus (kPa) – neutral position CHL elastic modulus (kPa) - 30° ER CHL (mm) CHL elastic modulus (kPa) – neutral position CHL elastic modulus (kPa) - 30° ER
Mean SD Median IQR IQR/Median Mean SD Median IQR IQR/Median Mean SD Median IQR IQR/Median Mean SD Median IQR IQR/Median
28 L 2.2 128.8 6.7 131.1 16 0.12 158.5 25.2 159.3 50.2 0.32 3.3 278.8 2.8 284.3 44.5 0.16 308.5 11.60 314.3 26.7 0.08
41 R (dominant) 2.2 198.5 23.6 213.6 51.5 0.24 235.2 15 235.4 36.8 0.16 3 280.4 12.3 278.8 30 0.11 303.7 10.20 305.7 6.8 0.02
42 L 2.7 183 12.3 187.8 28.9 0.15 198.2 2.2 199.5 5 0.03 3.7 202.8 4.5 200.6 6.1 0.03 210 8.00 210.5 19.5 0.09
50 L 1.2 159.4 51.2 164.4 36.8 0.22 166.5 18.5 165.7 41.5 0.25 3.8 194.7 17.7 202.3 23.6 0.12 224.3 15.6 217.8 36.5 0.17
52 L 2 131.3 5.3 134.3 11.8 0.09 143.9 8.7 146.2 21 0.14 3.7 307.2 54.9 309 6.6 0.02 340.9 55.50 343 7.8 0.02
53 L 2.1 116.4 18.4 123.9 23.2 0.19 138 5.9 135.7 14 0.10 3.7 338.4 4.7 340.2 12.3 0.04 339.6 4.50 345 8.9 0.03
55 R (dominant) 1.7 200.8 15.3 200.8 30.6 0.15 217.1 10.4 213.2 24.6 0.12 3 274.6 21.8 285.6 49.9 0.17 282.8 10.40 285.6 25.1 0.09
55 R (dominant) 1.8 189.8 19.2 187.9 25.6 0.14 216.8 24.3 223 38.1 0.17 2.4 278 31.9 273.9 30.7 0.11 287.5 33.60 284.7 43.9 0.15
56 L 1.3 228.1 6.9 225.9 16.5 0.07 246.5 1.8 246.3 4.4 0.02 3 292.4 4.5 290.6 10.6 0.04 292.4 4.5 290.6 10.6 0.04
58 L 1.9 215.7 25.1 210.5 60.9 0.29 225.1 0.44 229.6 27.2 0.12 3.1 274.2 28.8 261.3 67 0.26 303.6 8.40 306.3 20.5 0.07
63 L 2.6 173.2 1.5 172.3 3.4 0.02 179.4 5.1 176.4 11.4 0.06 3.9 208.9 8.1 210.3 19.6 0.09 221.4 2.40 220.8 4.3 0.02
72 R 1.1 169.4 29.8 182.1 42.6 0.23 195.6 8.2 190.1 17.8 0.09 3.3 306.03 28.8 310.6 54.6 0.18 342.2 15.10 349.9 34.6 0.10

Comparison of paired measurements of coracohumeral ligament (CHL) elasticity of the symptomatic shoulder pre- and post-treatment in the neutral and 30º ER position

Parameter Pre-injection (n = 8) Post-injection (n = 8) P value*
CHL thickness (mm) 3.2 (2.4–3.7)* 2.5 (1.9–3.2)* <0.05
CHL elastic modulus (kPa)
Neutral position 286.4 (208.9–338.4)* 226.5 (179.4–265.8)* <0.05
30°external rotation* 303 .7 (221.4–342.2)* 245.0 (197.7–273.2)* <0.05
OSS 13.5 (7–28)* 34 (22–46)* <0.05
VAS pain score 8.5 (6–10)* 3.5 (0–10)* at 24 hours <0.05
2 (0–5)* at 1 week <0.05
2.5 (1–6)* at 8 weeks <0.05

Cohort demographics

Parameter
Number of shoulders assessed 24
Gender 6 male; 6 female
Age (years) 54 (28–72)*
Duration of symptoms (months) 12 (3–36)*

Comparison of coracohumeral ligament (CHL) thickness and elasticity on the symptomatic and asymptomatic sides

Parameter Asymptomatic side (n = 12) Symptomatic side (n = 12) P value*
CHL thickness (mm) 1.95 (1.1–2.9)* 3.3 (2.4–3.7)* 0.00222
CHL elastic modulus (kPa)
Neutral position 178 (116.4–228.1)* 278 (194.7–338.4)* 0.00222
30°external rotation* 194 (138–246.5)* 298 (210–342.2)* 0.00222
OSS na 18 (7–39) na
VAS pain score na 8 (6–10) na

Coracohumeral ligament (CHL) thickness and elasticity of the symptomatic shoulder pre- and post-treatment in the neutral and 30° external rotation (ER) position

Pre-injection Post-injection 10 week follow up
Age Symptomatic shoulder CHL (mm) CHL elastic modulus (kPa) – neutral position CHL elastic modulus (kPa) - 30° ER CHL (mm) CHL elastic modulus (kPa) – neutral position CHL elastic modulus (kPa) - 30° ER
      Mean SD Median IQR IQR/Median Mean SD Median IQR IQR/Median   Mean SD Median IQR IQR/Median Mean SD Median IQR IQR/Median
41 R (dominant) 3 280.4 12.3 278.8 30 0.11 303.7 10.20 305.7 6.8 0.02 1.9 237 8.5 238.5 20.7 0.09 243.6 12.5 248.1 29.6 0.12
52 L 3.7 307.2 54.9 309 6.6 0.02 340.9 55.50 343 7.8 0.02 2.6 216 14.2 210.4 33.4 0.16 250.5 19.5 244.7 30.5 0.12
53 L 3.7 338.4 4.7 340.2 12.3 0.04 339.6 4.50 345 8.9 0.03 2.6 239.9 7.7 240.2 18.9 0.08 246.3 30 250.3 52.8 0.21
55 R (dominant) 3 274.6 21.8 285.6 49.9 0.17 282.8 10.40 285.6 25.1 0.09 3.2 265.8 12.4 267.2 30.2 0.11 273.2 2.6 273 6.4 0.02
56 L 3 292.4 4.5 290.6 10.6 0.04 292.4 4.5 290.6 10.6 0.04 3 264.5 9.2 268.8 21.3 0.08 266.1 19.4 274.3 45.4 0.17
58 L 3.1 274.2 28.8 261.3 67 0.26 303.6 8.40 306.3 20.5 0.07 2.3 189.2 13.7 191.9 21 0.11 198.9 4.8 197.3 11.4 0.06
63 L 3.9 208.9 8.1 210.3 19.6 0.09 221.4 2.40 220.8 4.3 0.02 2.1 210.5 22.2 198.4 50.1 0.25 217.2 15.7 218.6 33 0.15
72 R 3.3 306.03 28.8 310.6 54.6 0.18 342.2 15.10 349.9 34.6 0.10 1.95 179.4 5.7 182.2 13.2 0.07 197.7 15.3 188.4 33.8 0.18
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Język:
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