Correlation between musculoskeletal ultrasound findings and clinical staging and symptoms of frozen shoulder

doi:10.3877/cma.j.issn.2096-0263.2025.03.004

Abstract

Abstract:

Objective

By observing the musculoskeletal ultrasonographic findings of frozen shoulder in different clinical stages，to explore the correlation between musculoskeletal ultrasonographic findings and frozen shoulder clinical stages， and to explore the correlation between musculoskeletal ultrasonographic findings and frozen shoulder symptoms.

Methods

60 frozen shoulder patients who met the exclusion criteria were divided into three groups according to clinical stages. The glenohumeral distance （GHD）， posterior shoulder capsule thickness （PCT）， coracobrachial ligament thickness （CHL）， joint capsuleand supraspinatus muscleshear wave elastography （SWE）， blood flow in rotator interval （RI）of the affected shouder were measured by musculoskeletal ultrasound.The differences of shoulder ultrasonographic findings among the three groups were compared，and the correlation between ultrasonic findings and symptoms was observed.

Results

GHD， PCTand the positive ratio of RI blood flowwas significantly different in different stages， in which the GHD of stage 1 was the highest，and the PCT of stage 2 was the highest.There was a significant difference in the positive ratio of RI blood flow between stage 1 and stage 2，stage 1 and stage 3，but there was no significant difference between stage 2 and period 3.GHD and PCT on different stages were statistically significant.The larger the GHD value，the more inclined to clinical stage 1.The larger the PCT value，the more inclined to clinical stage 2.There was a positive correlation between flexion，abduction activity and GHD，and a negative correlation with PCT.There were significant differences in VAS activity and VAS sleep among different RI blood flow groups， and the scores of VAS activity and VAS sleep in RI bloodflow positive group were higher than those in negative group.

Conclusions

（1）Musculoskeletal ultrasound scan of RI blood flow，glenohumeral distance， posterior shoulder joint capsule thickness is helpful to judge the clinical stage of frozen shoulder.（2）The blood flow of RI，glenohumeral distance and the thickness of posterior articular capsule under musculoskeletal ultrasound are related to the clinical symptoms of frozen shoulder，which may be used as an intervention point to relieve the symptoms.

Key words: Frozen shoulder, Musculoskeletal ultrasound, Clinical staging

Yani Zhao, Pingzhi Wang, Qiang Liu, Yiting Du, Lixia Qiu, Min Gao, Yingchun Li, Xiangping Li, Tao Zhang, Yinlian Liu, Ying Liang. Correlation between musculoskeletal ultrasound findings and clinical staging and symptoms of frozen shoulder[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2025, 11(03): 153-160.

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Figures/Tables 8

一般资料		1期	2 期	3 期	F/χ ²值	P值
年龄（岁， $\overset{ˉ}{x}$ ± s ）		53.2±7.53	56.00±7.02	52.95±6.06	1.206	0.307
BMI（kg/m²， $\overset{ˉ}{x}$ ± s ）		23.81±2.24	24.00±1.09	23.92±1.65	0.062	0.94
病程（月， $\overset{ˉ}{x}$ ± s ）		4.25±2.45	11.18±13.03	32.45±33.27	10.106	＜0.001
性别	男[例（%）]	6（30）	6（30）	4（20）	0.682	0.711
	女[例（%）]	14（70）	14（70）	16（80）
受累侧	左[例（%）]	14（70）	8（40）	10（50）	3.75	0.153
	右[例（%）]	6（30）	12（60）	10（50）

一般资料		1期	2 期	3 期	F/χ ²值	P值
年龄（岁， $\overset{ˉ}{x}$ ± s ）		53.2±7.53	56.00±7.02	52.95±6.06	1.206	0.307
BMI（kg/m²， $\overset{ˉ}{x}$ ± s ）		23.81±2.24	24.00±1.09	23.92±1.65	0.062	0.94
病程（月， $\overset{ˉ}{x}$ ± s ）		4.25±2.45	11.18±13.03	32.45±33.27	10.106	＜0.001
性别	男[例（%）]	6（30）	6（30）	4（20）	0.682	0.711
	女[例（%）]	14（70）	14（70）	16（80）
受累侧	左[例（%）]	14（70）	8（40）	10（50）	3.75	0.153
	右[例（%）]	6（30）	12（60）	10（50）

分组	样本量	子集1	子集2
1期	20	4.250
2期	20	11.175
3期	20		32.450

症状指标	1期	2 期	3 期	F值	P值
VAS休息（分）	1.85±1.76	1.55±1.4	0.95±1.28	1.893	0.16
VAS活动（分）	7.1±1.92	5.15±1.27	2.8±1.64	34.872	＜0.001
VAS睡眠（分）	5.5±2.01	3.7±1.59	1.15±1.14	36.37	＜0.001
前屈（分）	6.9±2	4.1±1.37	8.7±1.34	42.014	＜0.001
外展（分）	6±2.51	3±1.52	8.6±1.85	39.129	＜0.001
外旋（分）	6.4±3.22	2.3±2.08	9.3±1.63	42.837	＜0.001
内旋（分）	5.4±2.16	3.8±1.7	8.6±1.6	35.32	＜0.001
CMS（分）	72.7±14.52	47.05±11.11	91.05±9.33	69.567	＜0.001

超声表现		1 期	2 期	3 期	F/χ ²值	P值
GHD（cm， $\overset{ˉ}{x}$ ± s ）		0.21±0.02	0.16±0.02	0.19±0.02	35.409	＜0.001
PCT（cm， $\overset{ˉ}{x}$ ± s ）		0.07±0.02	0.17±0.02	0.11±0.02	201.812	＜0.001
CHL（cm， $\overset{ˉ}{x}$ ± s ）		0.09±0.02	0.1±0.03	0.1±0.03	0.242	0.786
冈上肌SWE（m/s， $\overset{ˉ}{x}$ ± s ）		7±1.59	8.02±2.56	8.94±3.12	3.006	0.057
关节囊SWE（m/s， $\overset{ˉ}{x}$ ± s ）		5.2±1.86	5.8±1.65	5.42±2.83	0.381	0.685
RI 血流	阳性[例（%）]	16（80）	7（35）	8（40）	9.744	＜0.008
	阴性[例（%）]	4（20）	13（65）	12（60）

超声表现		1 期	2 期	3 期	F/χ ²值	P值
GHD（cm， $\overset{ˉ}{x}$ ± s ）		0.21±0.02	0.16±0.02	0.19±0.02	35.409	＜0.001
PCT（cm， $\overset{ˉ}{x}$ ± s ）		0.07±0.02	0.17±0.02	0.11±0.02	201.812	＜0.001
CHL（cm， $\overset{ˉ}{x}$ ± s ）		0.09±0.02	0.1±0.03	0.1±0.03	0.242	0.786
冈上肌SWE（m/s， $\overset{ˉ}{x}$ ± s ）		7±1.59	8.02±2.56	8.94±3.12	3.006	0.057
关节囊SWE（m/s， $\overset{ˉ}{x}$ ± s ）		5.2±1.86	5.8±1.65	5.42±2.83	0.381	0.685
RI 血流	阳性[例（%）]	16（80）	7（35）	8（40）	9.744	＜0.008
	阴性[例（%）]	4（20）	13（65）	12（60）

指标	估算	标准误差	瓦尔德	显著性	95% 置信区间
指标	估算	标准误差	瓦尔德	显著性	下限	上限
[临床分期= 1]	-2.122	5.470	0.151	0.698	-12.844	8.599
[临床分期= 2]	2.974	5.671	0.275	0.600	-8.141	14.090
冈上肌SWE（m/s）	0.079	0.072	1.121	0.298	-0.072	0.233
GHD（cm）	-49.373	24.902	3.931	0.047	-98.179	-0.567
PCT（cm）	55.598	19.570	8.071	0.004	17.242	93.955
RI 血流阳性比	1.544	1.089	2.012	0.156	-0.590	3.678

症状指标	盂肱距离	后方关节囊厚度	喙肱韧带	冈上肌弹性	关节囊弹性
VAS休息	0.031	-0.061	-0.022	-0.101	-0.202
VAS活动	0.167	-0.221	-0.04	-0.176	-0.037
VAS睡眠	0.228	-0.186	0.007	0.031	-0.015
前屈	0.341**	-0.530**	0.121	0.014	-0.106
外展	0.343**	-0.453**	0.047	0.07	-0.049

症状指标	阳性	阴性	t 值	P值
VAS休息	1.71±1.64	1.17±1.34	1.386	0.171
VAS活动	5.81±2.5	4.17±1.98	2.795	0.007
VAS睡眠	4.52±2.41	2.31±1.83	3.972	＜0.001
前屈	6.71±2.16	6.41±2.8	0.456	0.65
外展	5.94±2.56	5.79±3.52	0.178	0.859

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