The role of 18F-FDG PET/CT in the diagnosis of frozen shoulder

Abstract

PurposeFrozen shoulder is characterized by pain and reduced passive movement capability, and the diagnose is made clinically. However, pain is the major symptom in the first stage before stiffness occurs, and the condition can be mistaken for subacromial impingement. This study explored the possibility to use positron emission tomography/computed tomography (PET/CT) with a 18F Flour‐Deoxy‐Glucose (FDG) tracer in the diagnostic process. MethodsEleven patients with frozen shoulder and 9 patients with subacromial impingement received a 18F‐FDG PET/CT scan before being treated surgically. During arthroscopy, the diagnoses were confirmed. Images were blindly analyzed visually by two nuclear medicine physicians. Also, semi‐quantified analysis applying a set of standard regions was performed, and standard uptake value in both shoulder regions was recorded. ResultsBoth the visual description of the pictures and the semi‐quantified analysis generally showed increased FDG uptake in the affected shoulder regions of patients that had frozen shoulder and no uptake in patients with subacromial impingement. Kappa for interobserver agreement in the visual assessments was 0.74. Sensitivity was 92% and specificity 93% of the visual assessment, 77% and 93%, respectively, of the semi‐quantified analyses, and by combining the two types of analyses sensitivity was 100% and specificity was 93% for the distinction between frozen shoulders and subacromial impingement/unaffected shoulders. Conclusion18F‐FDG PET/CT seems to be a valid method to diagnose frozen shoulder. This is clinically relevant in diagnostically challenging cases, for instance in the first phase of frozen shoulder, which can be difficult to distinguish from subacromial impingement. Level of evidenceII.

Hydrodilatation with corticosteroids is the most effective conservative management for frozen shoulder

“…Frozen shoulder, sometimes known as idiopathic stiff shoulder or adhesive capsulitis [18], is an illness of uncertain aetiology and natural history [45]. It is identiiable by unexplained, sleep-disturbing pain and restricted shoulder 1 3 mobility despite essentially normal results when radiographically examined [1], although diagnosis remains challenging [8,48].…”