Gwark, Ji-Yong
(Department of Orthopaedic Surgery, Gyeongsang National University Changwon Hospital)
,
Gahlot, Nitesh
(Department of Orthopedic Surgery, All India Institute of Medical Science)
,
Kam, Mincheol
(Department of Orthopaedic Surgery, Gyeongsang National University Changwon Hospital)
,
Park, Hyung Bin
(Department of Orthopaedic Surgery, Gyeongsang National University Changwon Hospital)
Background: Although a common shoulder disease, there are no accepted classification criteria for frozen shoulder (FS). This study therefore aimed to evaluate the accuracy of the conventionally used FS classification system. Methods: Primary FS patients (n=168) who visited our clinic from January 20...
Background: Although a common shoulder disease, there are no accepted classification criteria for frozen shoulder (FS). This study therefore aimed to evaluate the accuracy of the conventionally used FS classification system. Methods: Primary FS patients (n=168) who visited our clinic from January 2010 to July 2015 were included in the study. After confirming restrictions of the glenohumeral joint motion and absence of history of systemic disease, trauma, shoulder surgery, shoulder muscle weakness, or specific x-ray abnormalities, the Zuckerman and Rokito's classification was employed for diagnosing primary FS. Following clinical diagnosis, each patient underwent a shoulder magnetic resonance imaging (MRI) and blood tests (lipid profile, glucose, hemoglobin A1c, and thyroid function). Based on the results of the blood tests and MRIs, the patients were reclassified, using the criteria proposed by Zuckerman and Rokito. Results: New diagnoses were ascertained including blood test results (16 patients with diabetes, 43 with thyroid abnormalities, and 149 with dyslipidemia), and MRI revealed intra-articular lesions in 81 patients (48.2%). After re-categorization based on the above findings, only 5 patients (3.0%) were classified having primary FS. The remaining 163 patients (97.0%) had either undiagnosed systemic or intrinsic abnormalities (89 patients), whereas 74 patients had both. Conclusions: These findings demonstrate that most patients clinically diagnosed with primary FS had undiagnosed systemic abnormalities and/or intra-articular pathologies. Therefore, a modification of the Zuckerman and Rokito's classification system for FS may be required to include the frequent combinations, rather than having a separate representation of systemic abnormalities and intrinsic causes.
Background: Although a common shoulder disease, there are no accepted classification criteria for frozen shoulder (FS). This study therefore aimed to evaluate the accuracy of the conventionally used FS classification system. Methods: Primary FS patients (n=168) who visited our clinic from January 2010 to July 2015 were included in the study. After confirming restrictions of the glenohumeral joint motion and absence of history of systemic disease, trauma, shoulder surgery, shoulder muscle weakness, or specific x-ray abnormalities, the Zuckerman and Rokito's classification was employed for diagnosing primary FS. Following clinical diagnosis, each patient underwent a shoulder magnetic resonance imaging (MRI) and blood tests (lipid profile, glucose, hemoglobin A1c, and thyroid function). Based on the results of the blood tests and MRIs, the patients were reclassified, using the criteria proposed by Zuckerman and Rokito. Results: New diagnoses were ascertained including blood test results (16 patients with diabetes, 43 with thyroid abnormalities, and 149 with dyslipidemia), and MRI revealed intra-articular lesions in 81 patients (48.2%). After re-categorization based on the above findings, only 5 patients (3.0%) were classified having primary FS. The remaining 163 patients (97.0%) had either undiagnosed systemic or intrinsic abnormalities (89 patients), whereas 74 patients had both. Conclusions: These findings demonstrate that most patients clinically diagnosed with primary FS had undiagnosed systemic abnormalities and/or intra-articular pathologies. Therefore, a modification of the Zuckerman and Rokito's classification system for FS may be required to include the frequent combinations, rather than having a separate representation of systemic abnormalities and intrinsic causes.
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가설 설정
We hypothesized that most primary FS, as classified by Zuckerman and Rokito’s FS criteria, are actually secondary FS, but cannot be identified with the traditional diagnostic methods of clinical examination.
제안 방법
The initial diagnosis of primary FS was based on observations of the clinical examination which showed restriction in both the active and passive glenohumeral movements during flexion, abduction, and internal rotation (associated with >50% decrease in external rotation with arm at side), and on the basis of normal radiographic findings of the affected shoulders in true anteroposterior, outlet, and axillary lateral views.
Therefore, the current study was undertaken to determine the accuracy of Zuckerman and Rokito’s FS classification using blood tests and shoulder magnetic resonance imaging (MRI).
Of the 465 patients reviewed, we excluded 70 patients who did not have the result of shoulder MRI, 62 patients who did not have laboratory results, 53 patients who did not have results of the physical examination, and 112 patients who had previous history of shoulder surgery, trauma, and systemic disease. The remaining 168 patients included in the study underwent blood tests (lipid profile, glucose level, glycosylated hemoglobin A1c [HbA1c], and thyroid function tests) and a shoulder MRI.
The initial diagnosis of primary FS was based on observations of the clinical examination which showed restriction in both the active and passive glenohumeral movements during flexion, abduction, and internal rotation (associated with >50% decrease in external rotation with arm at side), and on the basis of normal radiographic findings of the affected shoulders in true anteroposterior, outlet, and axillary lateral views. Additionally, the diagnosis was based on a medical history of no underlying disease, systemic abnormality, shoulder surgery, or shoulder trauma. All the clinical assessments were carried out by the senior author (HBP).
This study was undertaken to determine the accuracy of the Zuckerman and Rokito’s FS classification,3) after confirming blood tests and shoulder MRI outcomes.
This study has several limitations. First, the evaluation was confined to three systemic disease entities and did not include other systemic factors which are known to be associated with FS, for example, adrenocorticotropic hormone deficiency. Second, this is a cross-sectional observation study; hence, it was not possible to identify the causative relationships between various factors and FS, particularly whether FS is merely age-related or whether MRI-detected intrinsic lesions trigger FS.
대상 데이터
Most patients (142/168, 84.5%) underwent MRIs at our institute, with a 1.5 T scanner (Siemens Medical Systems, Erlangen, Germany); the remaining 26 patients performed MRIs outside our institute. All the MRI images included in this study, whether performed at our institute or elsewhere, were interpreted by a single experienced musculoskeletal radiologist who was blind to the clinical findings.
A total of 168 patients, who were initially diagnosed with primary FS and who met the aforementioned inclusion criteria, were enrolled in this study. These included 66 males (39.
성능/효과
Based on the analyses of the blood tests, the newly diagnosed afflictions were 16 cases of diabetes (9.5%), 43 cases of thyroid abnormalities (25.6%) (4 hyper-thyroidism and 39 hypothyroidism), and 149 cases of dyslipidemia (88.7%). A total of 156 patients (92.
after confirming blood tests and shoulder MRI outcomes. In accordance with our hypothesis, the results revealed that most of the primary FS were reclassified as secondary FS, having intrinsic lesions and/or systemic disease.
후속연구
First, the evaluation was confined to three systemic disease entities and did not include other systemic factors which are known to be associated with FS, for example, adrenocorticotropic hormone deficiency. Second, this is a cross-sectional observation study; hence, it was not possible to identify the causative relationships between various factors and FS, particularly whether FS is merely age-related or whether MRI-detected intrinsic lesions trigger FS. Third, because we only included patients initially diagnosed with primary FS based on clinical findings, we were unable to evaluate any associations between systemic causes and extrinsic causes.
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