title: Magnetic resonance imaging and short-term clinical results of severe frozen shoulder treated with manipulation under ultrasound-guided cervical nerve root block.
abstract: BACKGROUND
  We evaluated the magnetic resonance (MR) imaging findings and short-term clinical outcomes of severe idiopathic frozen shoulder treated with manipulation under ultrasound-guided cervical nerve root block (MUC).
  
  
  METHODS
  The subjects were 30 patients (average age, 55.2 years; 12 men, 18 women) with severe frozen shoulder. Severe idiopathic frozen shoulder was defined as follows: a range of motion (ROM) of ≤ 100° in forward flexion, ≤ 10° in external rotation, and at or below the fifth lumbar vertebral level in internal rotation. Before the manipulation, all patients had continued global ROM loss for at least 6 months. Before and after manipulation, they underwent MR imaging. MR images and clinical results were evaluated 1 month after the procedure.
  
  
  RESULTS
  In terms of the capsule tear pattern, MR imaging showed 14 midsubstance tears and 15 humeral avulsions of glenohumeral ligament-like lesions. An anterior labrum tear occurred in 4 shoulders, whereas 15 shoulders showed a bone bruise in the posterosuperior and anteromedial portions of the humeral head despite no humeral shaft fracture. There were significant improvements in the ROM, Constant-Murley score, American Shoulder and Elbow Surgeons score, and Numeric Rating Scale score from before treatment to 1 month after the procedure.
  
  
  CONCLUSIONS
  MR imaging of patients with severe frozen shoulder after MUC showed 29 capsule tears, 4 labrum tears, and 15 bone bruises of the humeral head. Approximately 50% of patients are likely to experience bone bruising after MUC. Long-term follow-up of these patients should be performed carefully.
authors.affiliation: Department of Orthopaedic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan. Electronic address: sasakou@jichi.ac.jp.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Sasanuma
authors.affiliation: Department of Radiology, Jichi Medical University, Shimotsuke, Tochigi, Japan.
authors.forename: Hideharu
authors.initials: H
authors.lastname: Sugimoto
authors.affiliation: Department of Orthopaedic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kanaya
authors.affiliation: Department of Orthopaedic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Iijima
authors.affiliation: Department of Orthopaedic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Saito
authors.affiliation: Department of Orthopaedic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Saito
authors.affiliation: Department of Orthopaedic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan.
authors.forename: Katsushi
authors.initials: K
authors.lastname: Takeshita
mesh_terms: D000328:Adult; D000368:Aged; D002062:Bursitis / Q000503:physiopathology / Q000628:therapy*; D003288:Contusions / Q000503:physiopathology; D005260:Female; D006801:Humans; D058430:Humeral Head / Q000293:injuries; D017746:Joint Capsule / Q000293:injuries*; D008023:Ligaments, Articular / Q000293:injuries; D008279:Magnetic Resonance Imaging; D008297:Male; D008349:Manipulation, Orthopedic; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods; D016059:Range of Motion, Articular; D012399:Rotation; D012422:Rupture, Spontaneous / Q000503:physiopathology; D012785:Shoulder Joint / Q000503:physiopathology; D013126:Spinal Nerve Roots; D018084:Ultrasonography, Interventional
keywords: Frozen shoulder; bone bruise; capsule tear; magnetic resonance imaging; manipulation