Frozen shoulder is a disease characterized by shoulder pain and limited range of motion. Conservative treatment is preceded by surgical treatment to reduce pain and recover range of motion. Hydraulic distention is a procedure in which a sufficient amount of solution is injected into the shoulder joint to rupture the rigid joint capsule. Recently, the method of continuously maintaining the expanded capsular state after injection without the process of rupturing the rigid joint has also been used. However, in order to obtain the maximal stretching effect, we proposed a ‘pumping technique’ that inflates and shrinks the rigid joint capsule by repeating the process of infusion and regurgitation of the injection fluid into the capsule. Our proposed ‘pumping technique’ was shown to be more effective in increasing range of motion than the conventional hydraulic distension. This ‘pumping technique’ can be suggested as an effective therapeutic option for frozen shoulder.
Bursitis ; Humans ; Joint Capsule ; Joints ; Methods ; Range of Motion, Articular ; Rupture ; Shoulder Joint ; Shoulder Pain ; Ultrasonography

BACKGROUND: The aim of the present study was to determine the correlation between the amount of pain reduction after local anesthetic injection into the subacromial space preoperatively and clinical outcome after arthroscopic rotator cuff repair. METHODS: A total of 127 patients who underwent arthroscopic rotator cuff repair and followed up at least 1 year were analyzed retrospectively. Preoperatively, a visual analogue scale (VAS) for pain was measured in all patients before and after the ultrasound guided impingement test. The participants were divied into four groups according to pain reduntion ater impingement test (Group A: >75%, Group B: 50%–75%, Group C: 25%–50%, Group D: <25%). VAS for pain, shoulder range of motion, shoulder isometric strength, ASES score were evaluated preoperatively and at 3, 6, 9, and 12 months postoperatively. RESULTS: After surgery, the amount of pain reduction shows significantly at 3, 6 months in Groups A, B as compared to Groups C, D (p<0.05). Among the range of motion of shoulder joint, forward flexion was significantly improved in Group A at 3 months (p<0.05). The ASES score significantly improved at 3, 6 months in Groups A, B as compared to Group C, D (p<0.05). CONCLUSIONS: Preoperative degree of pain reduction after impingement test correlates with the improvement of pain after arthroscopic rotator cuff repair, especially in the early phase. Therefore, the impingement test could be effectively used.
Humans ; Range of Motion, Articular ; Retrospective Studies ; Rotator Cuff* ; Shoulder ; Shoulder Joint ; Shoulder Pain ; Ultrasonography

The shoulder pain is one of the most common problems to orthopaedic surgeons in clinic. Among therapeutic modality used to manage this pain, joint and periarticular injection, as well as suprascapular nerve block, show good clinical outcome. Ultrasound guidance is a safe technique, increasing the safety and accuracy of the procedure and reducing complications. An accurate understanding of the surface anatomy is important in performing the ultrasound-guided shoulder injections. This article aims to describe the surface anatomy and sono anatomy of both the shoulder and the surrounding structures and also summarize different infiltration techniques and peripheral nerve blocks.
Arthralgia ; Nerve Block ; Peripheral Nerves ; Shoulder Joint ; Shoulder Pain ; Shoulder ; Surgeons ; Ultrasonography

BACKGROUND: The aim of the present study was to determine the correlation between the amount of pain reduction after local anesthetic injection into the subacromial space preoperatively and clinical outcome after arthroscopic rotator cuff repair. METHODS: A total of 127 patients who underwent arthroscopic rotator cuff repair and followed up at least 1 year were analyzed retrospectively. Preoperatively, a visual analogue scale (VAS) for pain was measured in all patients before and after the ultrasound guided impingement test. The participants were divied into four groups according to pain reduntion ater impingement test (Group A: >75%, Group B: 50%–75%, Group C: 25%–50%, Group D: <25%). VAS for pain, shoulder range of motion, shoulder isometric strength, ASES score were evaluated preoperatively and at 3, 6, 9, and 12 months postoperatively. RESULTS: After surgery, the amount of pain reduction shows significantly at 3, 6 months in Groups A, B as compared to Groups C, D (p<0.05). Among the range of motion of shoulder joint, forward flexion was significantly improved in Group A at 3 months (p<0.05). The ASES score significantly improved at 3, 6 months in Groups A, B as compared to Group C, D (p<0.05). CONCLUSIONS: Preoperative degree of pain reduction after impingement test correlates with the improvement of pain after arthroscopic rotator cuff repair, especially in the early phase. Therefore, the impingement test could be effectively used.
Humans ; Range of Motion, Articular ; Retrospective Studies ; Rotator Cuff ; Shoulder ; Shoulder Joint ; Shoulder Pain ; Ultrasonography

OBJECTIVE: To identify the etiology of hemiplegic shoulder pain by ultrasonographic and clinical examinations and to determine the correlation between ultrasonographic findings and clinical factors in patients with hemiplegic shoulder. METHOD: Seventy hemiplegic patients with shoulder pain or without shoulder pain were enrolled. All of patients were evaluated by ultrasonography. We analyzed clinical factors including visual analogue scale (VAS) of hemiplegic shoulder pain, shoulder subluxation measured by plain X-ray, shoulder manual muscle test (MMT), passive range of motion (PROM) of the shoulder joint and complex regional pain syndrome (CRPS). RESULTS: 51.0% of patients with shoulder pain showed abnormal ultrasonographic findings, while 9.5% of patients without shoulder pain. Those with abnormal ultrasonographic findings had significantly decreased shoulder PROM in flexion, abduction, external rotation and internal rotation and more severe subluxation of hemiplegic shoulder (p<0.05). CONCLUSION: After investigating the hemiplegic shoulder through ultrasonography, painful hemiplegic shouder had high incidence of abnormal ultrasonographic characteristics. Ultrasonography is more worthwhile and useful as an primary diagnostic method, especially when there is severe shoulder subluxation and the limitation of PROM of shoulder in hemiplegic patients.
Hemiplegia ; Humans ; Incidence ; Range of Motion, Articular ; Shoulder Joint ; Shoulder Pain ; Shoulder* ; Ultrasonography

OBJECTIVE: The aim of this study is to know the usefulness of ultrasonographic evaluation of hemiplegic shoulder pain. METHOD: For 20 hemiplegic patients with shoulder pain, the shoulder was evaluated by simple radiographic findings, physical examinations, visual analogue scale (VAS), manual muscle test (MMT), and finally the ultrasonographic examination to define shoulder pain nature. The ultrasonographic results were compared to the simple radiography, physical examination, VAS, and MMT. RESULTS: The ultrasonographic findings were variable. The positive ultrasonographic findings were 10 joint fluid collections, 3 tendinous thickenings, 4 high echogenic findings, 4 tendon surface defects, 2 tendinous gracilings, and 1 joint surface irregularity. The ultrasonographic interpretative conclusion included 6 tendon (or muscle) tears, 2 degenerative changes, 5 nonspecific simple joint fluid collections, and 7 normal shoulder joints. In comparison of ultrasonographic findings and subluxation, VAS, and fluid collection, VAS showed relatively higher correlation. CONCLUSION: The ultrasonography is very useful as a non-invasive, inexpensive, painless, and rapid screening diagnostic method for the evaluation of painful hemiplegic shoulder.
Humans ; Joints ; Mass Screening ; Physical Examination ; Radiography ; Shoulder Joint ; Shoulder Pain ; Shoulder* ; Tendons ; Ultrasonography

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

OBJECTIVE: To evaluate the accuracy of ultrasonography (US) guided intraarticular injection technique comparing to blind technique of the shoulder joint. METHOD: Thirty patients with hemiplegia clinically diagnosed as adhesive capsulitis of the shoulder joint were included. Each patient was treated with serial intraarticular injections with both blind and US guided technique, and then was confirmed by X-ray. We analyzed possible factor including range of motion of the shoulder joint, degree of shoulder subluxation, and clinical stage by Cyriax contributing to failure of intraarticular injection with blind technique. RESULTS: The accuracy of intraarticular injection using blind technique were 46.7% and 33.3% in each physician without significant interpersonal difference. However, US guided intraarticular injection showed the accuracy of 93.3%, significantly higher than blind technique (p<0.05). We could not find significant differences in clinical stage by Cyriax, degree of subluxation between success and failure group by blind technique. However, the range of external and internal rotation of the shoulder joint was more limited in failure group by blind technique (p<0.05). CONCLUSION: Ultrasonography guided injection into the shoulder joint improved the accuracy of injection without exposure to radiation and could be used as one of the promising treatment for patients with adhesive capsulitis of the shoulder.
Bursitis ; Hemiplegia ; Humans ; Injections, Intra-Articular* ; Range of Motion, Articular ; Shoulder Joint ; Shoulder* ; Ultrasonography*

Although several histopathological changes have been developed in frozen shoulder, frozen shoulder is mostly accompanied by the changes of the rotator cuff which has the most important function in movement and has a role in stabilizing the shoulder joint. The changes of the rotator cuff in frozen shoulder have not been reported in Korea yet, but Simon reported that there was an attenuation of the rotator cuff in frozn shoulder. Accordingly, we observed the changes of the rotator cuff in frozen shoulder by ultrasonography, which has no rsdiation exposure and is non-invasive. The authors practiced the shoulder ultrasonography on 36 patients with a pain and limitation of motion in shoulder at the Dept. of Orthopedic Surgery, Hangang Sacred Heart Hospital, Hallym University, from March in 1988 to August in 1988. The results are as follows ;1) Ultrasonography is thought to contribute a great deal in detection of the changes of the rotator cuff, especially of the thickness of the rotstor cuff. 2) Among 36 patients, the thickness of the rotator cuff of 35 patients was 6.494+1.008 mm (M+SD) in the affected shoulder and 6.475+1.052 mm(M+SD) in the unaffected shoulder. In only one pstient, the thickness of the rotator cuff was 1.68+0.58 mm(M+SD) in the affected shoulder and 553+1.16mm(M+SD) in the unaffected shoulder. Theres no significant change in the thickness of the rotator cuff measured by ultrasonography in frozen shoulder. 3) Ultrasonography is an excellent diagnostic method in detecting the rupture of the rotator cuff in frozen shoulder.
Bursitis ; Heart ; Humans ; Korea ; Methods ; Orthopedics ; Rotator Cuff ; Rupture ; Shoulder ; Shoulder Joint ; Ultrasonography

BACKGROUND: This study was designed to evaluate the validity of the Cyriax's selective tension examination as a diagnostic tool in young male with shoulder pain compared to ultrasonographic findings. METHODS: Twenty young male patients with 26 shoulder pain cases were prospectively included in this study. All had a physical examination performed by Cyriax's selective tension method. As a diagnostic gold standard, ultrasonographic examination was carried out within one week of the physical examination by two specialists. RESULTS: The most common findings by sonographic evaluation were sub-deltoid bursitis (65.4%). Sub-deltoid bursal effusion without rotator cuff injury were 10 cases (58.8%) and 17 cases (41.2%) showed combined rotator cuff lesion. The most common diagnoses by physical examination were sub-deltoid bursitis (46.2%) followed by supraspinatus tendon lesion (19.2%). Clinical assessment by physical examination showed low sensitivity in the diagnosis of rotator cuff lesion (42.9%) and sub-deltoid bursitis (70.6%) but high sensitivity and specificity in the diagnosis of shoulder joint instability (sensitivity 100%, specificity 91.7%). CONCLUSION: This study suggest that the validity of Cyriax's selective tension test for the diagnosis of shoulder pain are questionable.
Bursitis ; Diagnosis ; Humans ; Male* ; Physical Examination ; Prospective Studies ; Rotator Cuff ; Sensitivity and Specificity ; Shoulder Joint ; Shoulder Pain* ; Shoulder* ; Specialization ; Tendons ; Ultrasonography