Value of Anterior Band of the Inferior Glenohumeral Ligament Area as a Morphological Parameter of Adhesive Capsulitis

Abstract

Objective. Thickened inferior glenohumeral ligament (IGHL) is considered as one of the major morphological parameters of adhesive capsulitis (AC). Previous studies reported that the anterior band of inferior glenohumeral ligament thickness (aIGHLT) is correlated with shoulder capsular contracture, luxatio erecta humeri, and AC. However, the thickness varies from the measured angle. To reduce this measurement error, we devised a new morphological parameter, called the anterior band of inferior glenohumeral ligament area (aIGHLA). Methods. The aIGHL samples were collected from 54 patients with AC and from 50 control subjects who underwent shoulder magnetic resonance imaging (MRI) without any evidence of AC. Coronal T2-weighted MRI images were obtained at the shoulder level from each patient. We measured the aIGHLA and aIGHLT at the maximal view of the IGHL in the coronal plane using our picture archiving and communication system. The aIGHLA was measured at the whole cross-sectional area of the IGHL in the most hypertrophied segment of the coronal MR images. The aIGHLT was measured at the thickest point of the IGHL. Results. The average aIGHLA was 55.58 ± 14.16 mm2 in the control group and 83.71 ± 28.45 mm2 in the AC group. The average aIGHLT was 3.47 ± 0.99 mm in the control group and 4.52 ± 1.02 mm in the AC group. AC patients showed significantly greater aIGHLA (p<0.001) and aIGHLT (p<0.001) than control subjects. Receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off score of the aIGHLA was 63.37 mm2, with 79.6% sensitivity, 80.0% specificity, and AUC of 0.84 (95% CI, 0.76–0.92). The optimal cut-off point of the IGHLT was 3.81 mm, with 74.1% sensitivity, 74.0% specificity, and AUC of 0.77 (95% CI, 0.68–0.86). Conclusions. Although the aIGHLA and aIGHLT were both significantly associated with AC, the aIGHLA was a more sensitive diagnostic parameter.

Evaluation of magnetic resonance imaging findings in adhesive capsulitis: which quantitative findings are most valuable?

“…Zappia et al 12 showed an increase in IGHL signal with high sensitivity and specificity in T2W sequences in patients diagnosed with AC. Bang et al 13 measured the mean IGHL anterior band thickness as 4.52±1.02 mm for the 54 AC patients and 3.47±0.99 mm for the control group. When the information obtained from this study and the information obtained from similar studies are evaluated together, an IGHL value of 4 mm and above can be considered as a favorable criterion for the diagnosis of AC.…”

Adhesive capsulitis; evaluation of a recently introduced MRI criterion

“…34438 we could say no definitive criteria exist for the diagnosis of adhesive capsulitis to date (8). As a consequence magnetic resonance imaging (MRI) -as the gold standard of shoulder imaging-plays a critical role in diagnosis of adhesive capsulitis, in the early stages (9). Studies on histological aspects of adhesive capsulitis suggest the predominance of abnormalities in the anterior joint capsule, which include accumulation of myofibroblasts and collagenous matrix, focal fibrosis, inflammatory cytokines, regenerative neural fibers and increased vascularity in this region, which is interestingly absent in the inferior portion (2).…”

Combined transcatheter arterial embolization and rehabilitative treatment for adhesive capsulitis refractory to conservative treatment

“…Plain-film X-rays of the shoulder should be done, but the findings are usually normal and other imaging studies are occasionally necessary for the differential diagnosis. Characteristic signs on ultrasonography and magnetic resonance imaging include thickening of the inferior glenohumeral ligament, coracohumeral ligaments, and axillary pouch as well as infiltration of the rotator interval, this thickening and contraction of the shoulder joint capsule and surrounding synovium is better defined by MRI [8][9][10][11][12][13] . Adhesive capsulitis is defined as a self-limiting condition, with different stages (painful, mobidity limitation and clinical recovery) and symptoms length between months to years.…”