OBJECTIVE: To compare the elasticity of the supraspinatus tendon (SST) and infraspinatus tendon (IST) in patients with idiopathic adhesive capsulitis of the shoulder (ACS) with those in the control groups and to evaluate the relationship between age and tendon elasticity. MATERIALS AND METHODS: The Institutional Review Board approved this prospective, case-control study, which was conducted between November 2017 and March 2018, and informed consent was obtained from all participants. Control groups comprised healthy individuals or those with asymptomatic contralateral shoulders. Twenty-five shoulders in 20 participants in the ACS group (14 women; 53.5 ± 7.9 years) and 24 shoulders in 18 participants in the control group (6 women; 52.6 ± 10.5 years) were included. Elastography was performed in the oblique coronal plane at the neutral shoulder position. Mean/maximum/minimum velocity and stiffness from the shear-wave ultrasound elastography (SWE) and strain ratio (subcutaneous fat/target-tendon) from the strain ultrasound elastography (SE) of the SST and IST were evaluated. Statistical analyses were performed using the Mann-Whitney U test, receiver operating characteristic (ROC) curve, and Spearman correlation. RESULTS: Both velocity and stiffness in SWE were higher, and the strain ratio in SE was lower in participants with symptomatic shoulders than in those with normal shoulders (p < 0.001). SST- and IST-mean velocity, mean stiffness, and strain ratios showed excellent area under the ROC curve (> 0.970). The elastic modulus was little correlated with age (ρ = −0.340–0.239). CONCLUSION: SWE and SE indicated that SST and IST were stiffer in patients with ACS than in those with normal shoulders regardless of aging.
Adhesives ; Aging ; Bursitis ; Case-Control Studies ; Elastic Modulus ; Elasticity ; Elasticity Imaging Techniques ; Ethics Committees, Research ; Female ; Humans ; Informed Consent ; Prospective Studies ; ROC Curve ; Rotator Cuff ; 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

The shoulder is the third most common region in which musculoskeletal pain occurs, involving symptoms that cause a decrease in quality of life and a reduced ability to perform activities of daily life if untreated. Many lesions cause shoulder pain; therefore, we included those commonly encountered in primary care clinics. We aimed to describe the diagnosis and non-operative or conservative treatment modalities of rotator cuff tendinopathy, impingement syndrome, rotator cuff tear, adhesive capsulitis, biceps tendonitis, and acromioclavicular arthritis. Exercise has been reported to be effective for the treatment of impingement syndrome, and the effect of exercise has been shown to reduce pain. Both home-based self-exercise and exercise supervised by professionals are equally effective. Types of exercise should include stretching, active, active-assistive, and resistive exercise. Ten repetitions per set for 3 sets of each exercise should be prescribed initially post-injury. Repetition and resistance should be increased as strength grows. The use of ultrasonography for the diagnosis of shoulder pain has increased recently. Corticosteroid injection under ultrasonographic guidance is effective in reducing pain.
Arthritis ; Bursitis ; Diagnosis ; Muscle Stretching Exercises ; Musculoskeletal Pain ; Primary Health Care ; Quality of Life ; Rotator Cuff ; Shoulder Pain ; Shoulder ; Tears ; Tendinopathy ; Tendons ; Ultrasonography

Medial knee joint pain is a common problem in the field of orthopedics. In these patients, a high resolution ultrasound examination can reveal medial collateral ligament (MCL) bursitis, meniscal cyst, degeneration changes to the MCL and meniscal protrusion etc. Prolotherapy is effective in these patients. The author performed prolotherapy for MCL bursitis of the knee joint, and confirmed the disappearance of the bursitis using high resolution ultrasound.
Bursitis ; Collateral Ligaments ; Humans ; Knee Joint ; Knee ; Orthopedics ; Ultrasonography

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

OBJECTIVE: To investigate the shoulder disease patterns for the table-tennis (TT) and archery (AR) wheelchair athletes via ultrasonographic evaluations. METHODS: A total of 35 wheelchair athletes were enrolled, made up of groups of TT (n=19) and AR (n=16) athletes. They were all paraplegic patients and were investigated for their wheelchair usage duration, careers as sports players, weekly training times, the Wheelchair User's Shoulder Pain Index (WUSPI) scores and ultrasonographic evaluation. Shoulders were divided into playing arm of TT, non-playing arm of TT, bow-arm of AR, and draw arm of AR athletes. Shoulder diseases were classified into five entities of subscapularis tendinopathy, supraspinatus tendinopathy, infraspinatus tendinopathy, biceps long head tendinopathy, and subacromial-subdeltoid bursitis. The pattern of shoulder diseases were compared between the two groups using the Mann-Whitney and the chi-square tests RESULTS: WSUPI did not significantly correlate with age, wheelchair usage duration, career as players or weekly training times for all the wheelchair athletes. For the non-playing arm of TT athletes, there was a high percentage of subscapularis (45.5%) and supraspinatus (40.9%) tendinopathy. The percentage of subacromial-subdeltoid bursitis showed a tendency to be present in the playing arm of TT athletes (20.0%) compared with their non-playing arm (4.5%), even though this was not statistically significant. Biceps long head tendinopathy was the most common disease of the shoulder in the draw arm of AR athletes, and the difference was significant when compared to the non-playing arm of TT athletes (p<0.05). CONCLUSION: There was a high percentage of subscapularis and supraspinatus tendinopathy cases for the non-playing arm of TT wheelchair athletes, and a high percentage of biceps long head tendinopathy for the draw arm for the AR wheelchair athletes. Consideration of the biomechanical properties of each sport may be needed to tailor specific training for wheelchair athletes.
Arm ; Athletes* ; Bursitis ; Head ; Humans ; Pilot Projects* ; Shoulder Pain ; Shoulder* ; Sports ; Tendinopathy ; Ultrasonography ; Wheelchairs*

OBJECTIVE: To evaluate the feasibility of a new position (internal rotation in hanging) in ultrasonography, we compared the length of the glenohumeral joint space and the effectiveness of steroid injection with the hanging position and with the commonly used abdomen or cross position. METHODS: A prospective, randomized controlled trial was performed in 42 patients with adhesive capsulitis of shoulder. We used three arm positions for the posterior approach as follows: the patient's palm on thigh, other hand on abdomen (abdomen position); hand on patient's opposite shoulder (cross position); arm in hanging position with internal rotation of shoulder (hanging position). The order of shoulder position was randomized and blinded. Real-time ultrasonography-guided intra-articular steroid injection was performed by posterior approach at the first position in each patient. The Brief Pain Inventory (BPI), the Shoulder Pain and Disability Index (SPADI), and range of motion (ROM) were measured before steroid injection and 2 weeks after injection. RESULTS: The lengths of the joint space were 2.88±0.75, 2.93±0.89, and 2.82±0.79 mm in abdomen, cross, and hanging position respectively, with no significant difference among the three positions (p=0.429). Treatment efficacy was significantly improved in ROM, total BPI, and SPADI in all three positions (p<0.001). The changes in ROM for shoulder abduction were 23.6°±19.7°, 22.2°±20.9°, and 10.0°±7.8° in abdomen, cross, and hanging position, respectively. Changes in total BPI scores were 25.1±15.7, 23.6.±18.0, 11.6±6.1, and changes in total SPADI score were 35.0±14.2, 30.9±28.9, and 16.5±10.3 in abdomen, cross, and hanging position, respectively. There were no significant difference among the three positions for all parameters (p=0.194, p=0.121, and p=0.108, respectively. CONCLUSION: For patients with adhesive capsulitis who cannot achieve or maintain abdomen or cross position, scanning and injection with the shoulder in internal rotation with hanging position may be a useful alternative.
Abdomen ; Adhesives* ; Arm ; Bursitis* ; Hand ; Humans ; Injections, Intra-Articular ; Joints ; Posture ; Prospective Studies ; Range of Motion, Articular ; Shoulder Joint ; Shoulder Pain ; Shoulder* ; Thigh ; Treatment Outcome ; Ultrasonography

OBJECTIVE: To evaluate the feasibility of a new position (internal rotation in hanging) in ultrasonography, we compared the length of the glenohumeral joint space and the effectiveness of steroid injection with the hanging position and with the commonly used abdomen or cross position. METHODS: A prospective, randomized controlled trial was performed in 42 patients with adhesive capsulitis of shoulder. We used three arm positions for the posterior approach as follows: the patient's palm on thigh, other hand on abdomen (abdomen position); hand on patient's opposite shoulder (cross position); arm in hanging position with internal rotation of shoulder (hanging position). The order of shoulder position was randomized and blinded. Real-time ultrasonography-guided intra-articular steroid injection was performed by posterior approach at the first position in each patient. The Brief Pain Inventory (BPI), the Shoulder Pain and Disability Index (SPADI), and range of motion (ROM) were measured before steroid injection and 2 weeks after injection. RESULTS: The lengths of the joint space were 2.88±0.75, 2.93±0.89, and 2.82±0.79 mm in abdomen, cross, and hanging position respectively, with no significant difference among the three positions (p=0.429). Treatment efficacy was significantly improved in ROM, total BPI, and SPADI in all three positions (p<0.001). The changes in ROM for shoulder abduction were 23.6°±19.7°, 22.2°±20.9°, and 10.0°±7.8° in abdomen, cross, and hanging position, respectively. Changes in total BPI scores were 25.1±15.7, 23.6.±18.0, 11.6±6.1, and changes in total SPADI score were 35.0±14.2, 30.9±28.9, and 16.5±10.3 in abdomen, cross, and hanging position, respectively. There were no significant difference among the three positions for all parameters (p=0.194, p=0.121, and p=0.108, respectively. CONCLUSION: For patients with adhesive capsulitis who cannot achieve or maintain abdomen or cross position, scanning and injection with the shoulder in internal rotation with hanging position may be a useful alternative.
Abdomen ; Adhesives* ; Arm ; Bursitis* ; Hand ; Humans ; Injections, Intra-Articular ; Joints ; Posture ; Prospective Studies ; Range of Motion, Articular ; Shoulder Joint ; Shoulder Pain ; Shoulder* ; Thigh ; Treatment Outcome ; Ultrasonography

OBJECTIVE: To evaluate the feasibility and effect of ultrasound-guided ethyl alcohol injection on malleolar and olecranon synovial proliferative bursitis. METHODS: Twenty-four patients received ultrasound-guided 50% diluted ethyl alcohol injection at the site of synovial proliferative bursitis after aspiration of the free fluid. RESULTS: Swelling and symptoms significantly decreased in 13 of the 24 patients without any complications. Eleven patients had partial improvement in swelling and symptoms. CONCLUSION: Ultrasound-guided alcohol injection could be an alternative therapeutic option before surgery in patients with chronic intractable malleolar and olecranon synovial proliferative bursitis.
Bursitis* ; Ethanol* ; Humans ; Olecranon Process* ; Pilot Projects* ; Prospective Studies* ; Synovial Membrane ; Ultrasonography

Shoulder pain is a common problem in outpatient medical practice. Shoulder pain usually causes disability in activities of daily living, and therefore its proper diagnosis and management are essential. The prevalence of shoulder pain in Korea has been gradually increasing, and the differential diagnosis of shoulder pain has become more important. In Korea, the most common causes of shoulder pain are rotator cuff disease, including impingement syndrome (31%), adhesive capsulitis (35%), and calcific tendinitis (4%). This article presents the pathophysiology, clinical characteristics, typical physical examination findings and provocation tests, and radiologic findings of common shoulder diseases, including rotator cuff disease, adhesive capsulitis, and calcific tendinitis, to provide a guide to differential diagnosis. Common shoulder diseases can be easily diagnosed with careful history taking and precise physical examination; moreover, ultrasonography is a useful diagnostic tool for rotator cuff disease and can also assist with the differential diagnosis of shoulder diseases in the outpatient clinic.
Activities of Daily Living ; Ambulatory Care Facilities ; Bursitis ; Diagnosis ; Diagnosis, Differential* ; Humans ; Joint Capsule ; Korea ; Outpatients ; Physical Examination ; Prevalence ; Rotator Cuff ; Shoulder ; Shoulder Impingement Syndrome ; Shoulder Pain* ; Tendinopathy ; Ultrasonography