AB1176 Ultrasound evaluation of adhesive capsulitis of the shoulder. description of a new and simple diagnostic sign
Authors: C. Moragues Pastor, X. Michelena, I. Morales, P. Juárez, J. Lluch, J.M. Nolla
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Adhesive capsulitis of the shoulder (ACS) is a common disease that is characterised by a global and progressive loss of mobility of the glenohumeral joint. It is the result of a capsular inflammation, thickening, and fibrosis with subsequent retraction of the joint capsule. Although it is a frequently self-limiting process, it may persist for years and be resolved with a permanent limitation of glenohumeral mobility. Its diagnosis is based on clinical presentation because the glenohumeral capsule is not visible in simple radiology and the MRI does not offer specific diagnostic findings for ACS. <h3>Objectives</h3> To evaluate the specific ultrasound signs to diagnose ACS in patients with clinical suspicion of ACS. <h3>Methods</h3> Prospective, non-interventional observational study in consecutive patients with clinical suspicion of ACS referred for an ultrasound evaluation. All patients signed an informed consent before the study. Adult patients with a painful shoulder less than 2 years of evolution with clinical suspicion of ACS were included. We excluded patients with surgery or severe articular trauma in the symptomatic shoulder and patients with ultrasound findings that could explain the painful symptoms of the shoulder due to other causes such as rotator cuff tendinopathy, synovitis or glenohumeral osteoarthritis. The ultrasound examination was systematically performed by an expert sonographer, using an Esaote MayLab 70 with a linear probe. In the ultrasound examination, the measurement of the joint capsule was performed in the axillary recess in the longitudinal plane (maximum passive abduction of the shoulder). The statistical analysis was carried out comparing the capsule means with the Mann-Whitney test (the variable did not follow a normal distribution verified with the Kolmogorov-Smirnov test). <h3>Results</h3> A total of 35 patients were included, with a mean age of 58.27 years,<sup>46–77</sup> 17 men and 18 women. Nine patients had both shoulders affected, so a total of 70 shoulders (44 affected shoulders and 26 control shoulders) were studied. The mean time of evolution of the ACS clinic was 5.6 months.<sup>1–18</sup> The 28.57% of the patients were diabetic and 14% had a history of severe cardiovascular disease before the onset of symptoms. The 44% of bilateral ACS cases were diabetic. The totality of the affected shoulders presented in the clinical exploration limitation of the degrees of mobility of the glenohumeral joint; on the other hand, all control shoulders had a preserved mobility. Regarding the sonographic findings, the mean axillary capsular measurement of the affected shoulders was 4,414 mm (SD 0.177) compared to a mean measurement of 2,203 mm (SD 0.165) in the controls with a statistically significant difference between both groups (p&lt;0.001). <h3>Conclusions</h3> The glenohumeral capsule is easily visible in the axillary approach by ultrasound and allows thickness measurement, being a feasible test for the diagnosis of ACS. <h3>Disclosure of Interest</h3> None declared