Top

European Journal of Orthopaedic Surgery & Traumatology

Published in:

Open Access 28-09-2024 | Shoulder Stiffness | Technical Note

A comprehensive scoring system for the diagnosis and staging of adhesive capsulitis: development, application, and implications

Authors: Fabio Vita, Danilo Donati, Roberto Tedeschi, Marco Miceli, Paolo Spinnato, Flavio Origlio, Enrico Guerra, Marco Cavallo, Salvatore Massimo Stella, Luigi Tarallo, Giuseppe Porcellini, Stefano Galletti, Cesare Faldini

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 8/2024

Abstract

Introduction

Adhesive capsulitis (AC), often referred to as frozen shoulder, presents a diagnostic challenge due to its insidious onset and progressive nature. The condition is characterized by pain and restricted motion in the shoulder, with a predilection for individuals between 40 and 60 years of age. A novel scoring system was developed to enhance the accuracy of diagnosing AC and distinguishing between its stages, aiming to streamline clinical decision-making and treatment planning.

Methods

A cohort of patients with symptoms suggestive of AC was assessed using the new scoring system, which integrates clinical, radiological, and patient history factors. Parameters included comorbidities like diabetes mellitus, recent immobility, rotator cuff tears, and specific ultrasound findings. Patients were scored and categorized into definitive AC, uncertain diagnosis, or exclusion from AC, with scores > 7, 6–2, and < 2, respectively.

Results

The scoring system effectively categorized patients, with those scoring > 7 demonstrating pronounced symptoms and ultrasound changes consistent with Phase 2 AC. Patients with scores between 6 and 2 were classified into uncertain Phase 1 or Phase 3, necessitating further observation. Scores < 2 effectively excluded AC, indicating a need to explore alternative diagnoses.

Conclusion

The structured scoring system demonstrated potential as a comprehensive tool for diagnosing AC. By quantitatively assessing a range of contributory factors, it allowed for the stratification of the disease into distinct stages. This system is anticipated to improve early diagnosis and the precision of treatment interventions, although further validation in larger cohorts is warranted.

Level of evidence

II-III.

Al Khayyat SG, Falsetti P, Conticini E, Frediani B, Galletti S, Stella SM (2023) Adhesive capsulitis and ultrasound diagnosis, an inseparable pair: a novel review. J Ultrasound 26(2):369–384. https://doi.org/10.1007/s40477-022-00725-9CrossRefPubMed

Amaechi O, Human MM, Featherstone K (2021) Pharmacologic Therapy for Acute Pain. AFP 104(1):63–72

Ayan B, Abacıoğlu S, Basilio MP (2023) A comprehensive review of the novel weighting methods for multi-criteria decision-making. Information 14(5):285. https://doi.org/10.3390/info14050285CrossRef

Biglia A, Morandi V, Zanframundo G, Donati D, Maggiore F, Vita F et al (2023) Adhesive capsulitis after COVID-19 vaccine injection: a peculiar case treated with combined bursa distention and glenohumeral capsular hydrodilatation. J Ultrasound 26(4):909–911. https://doi.org/10.1007/s40477-022-00739-3CrossRefPubMedCentralPubMed

Chang K-V, Wu W-T, Hsu P-C, Lew HL, Özçakar L (2020) Clinical tests of the shoulder: accuracy and extension using dynamic ultrasound. Am J Phys Med Rehabil 99(2):161–169. https://doi.org/10.1097/PHM.0000000000001311CrossRefPubMed

Chou R, Wagner J, Ahmed AY, Blazina I, Brodt E, Buckley DI, et al. (2020) Introduction [Internet]. In: Treatments for acute pain: a systematic review [Internet]. Agency for healthcare research and quality (US); 2020 [cited 2024 Aug 31]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK566500/

Corazza A, Orlandi D, Fabbro E, Ferrero G, Messina C, Sartoris R et al (2015) Dynamic high-resolution ultrasound of the shoulder: how we do it. Eur J Radiol 84(2):266–277. https://doi.org/10.1016/j.ejrad.2014.11.007CrossRefPubMed

Do JG, Hwang JT, Yoon KJ, Lee Y-T (2021) Correlation of ultrasound findings with clinical stages and impairment in adhesive capsulitis of the shoulder. Orthop J Sports Med 9(5):23259671211003676. https://doi.org/10.1177/23259671211003675CrossRefPubMedCentralPubMed

Donati D, Tedeschi R, Spinnato P, Pederiva D, Pilla F, Faldini C et al (2024) Ultrasoundhydrodistention in adhesivecapsulitis: hospital versus home-based rehabilitation. Egypt Rheumatol 46(4):166–170. https://doi.org/10.1016/j.ejr.2024.06.003CrossRef

10.

Donati D, Vita F, Tedeschi R, Galletti S, Biglia A, Gistri T et al (2023) Ultrasound-guided infiltrative treatment associated with early rehabilitation in adhesive capsulitis developed in post-COVID-19 syndrome. Medicina 59(7):1211. https://doi.org/10.3390/medicina59071211CrossRefPubMedCentralPubMed

11.

Elnady B, Rageh EM, Hussein MS, Abu-Zaid MH, Desouky DE-S, Ekhouly T et al (2020) In shoulder adhesive capsulitis, ultrasound-guided anterior hydrodilatation in rotator interval is more effective than posterior approach: a randomized controlled study. Clin Rheumatol 39(12):3805–3814. https://doi.org/10.1007/s10067-020-05131-2CrossRefPubMedCentralPubMed

12.

Ezell B, Lynch CJ, Hester PT (2021) Methods for weighting decisions to assist modelers and decision analysts: a review of ratio assignment and approximate techniques. Appl Sci 11(21):10397. https://doi.org/10.3390/app112110397CrossRef

13.

Gimber LH, Melville DM, Klauser AS, Witte RS, Arif-Tiwari H, Taljanovic MS (2016) Artifacts at musculoskeletal US: resident and fellow education feature. Radiographics 36(2):479–480. https://doi.org/10.1148/rg.2016150200CrossRefPubMed

14.

Homsi C, Bordalo-Rodrigues M, da Silva JJ, Stump XMGRG. Ultrasound in adhesive capsulitis of the shoulder: is assessment of the coracohumeral ligament a valuable diagnostic tool? Skeletal Radiol. 2006 Sep;35(9):673–678. https://doi.org/10.1007/s00256-006-0136-y

15.

Kim J-H, Kim B-S, Han K, Kwon H-S (2023) The risk of shoulder adhesive capsulitis in individuals with prediabetes and type 2 diabetes mellitus: a longitudinal nationwide population-based study. Diabetes Metab J 47(6):869–878. https://doi.org/10.4093/dmj.2022.0275CrossRefPubMedCentralPubMed

16.

King W (2007) Acute pain, subacute pain and chronic pain. In: Schmidt RF, Willis WD (eds) Encyclopedia of pain. Springer, Berlin, Heidelberg, pp 35–36CrossRef

17.

Lanfranchi E, Fairplay T, Tedeschi R (2023) A case report: pain in the hand and tingling of the upper limb may be a symptom of a schwannoma in the supraclavicular region. Int J Surg Case Rep 110:108664. https://doi.org/10.1016/j.ijscr.2023.108664CrossRefPubMedCentralPubMed

18.

Mertens MG, Meert L, Struyf F, Schwank A, Meeus M (2022) Exercise therapy is effective for improvement in range of motion, function, and pain in patients with frozen shoulder: a systematic review and meta-analysis. Arch Phys Med Rehabil 103(5):998-1012.e14. https://doi.org/10.1016/j.apmr.2021.07.806CrossRefPubMed

19.

Nakandala P, Nanayakkara I, Wadugodapitiya S, Gawarammana I (2021) The efficacy of physiotherapy interventions in the treatment of adhesive capsulitis: a systematic review. J Back Musculoskelet Rehabil 34(2):195–205. https://doi.org/10.3233/BMR-200186CrossRefPubMed

20.

Neviaser AS, Hannafin JA (2010) Adhesive capsulitis: a review of current treatment. Am J Sports Med 38(11):2346–2356. https://doi.org/10.1177/0363546509348048CrossRefPubMed

21.

Pandey V, Madi S (2021) Clinical guidelines in the management of frozen shoulder: an update! Indian J Orthop 55(2):299–309. https://doi.org/10.1007/s43465-021-00351-3CrossRefPubMedCentralPubMed

22.

Ricci V, Chang K-V, Özçakar L (2020) Ultrasound-guided hydrodilatation of the shoulder capsule at the rotator interval: technical tips and tricks. Pain Pract 20(8):948–949. https://doi.org/10.1111/papr.12920CrossRefPubMed

23.

Ricci V, Özçakar L (2019) Looking into the joint when it is frozen: a report on dynamic shoulder ultrasound. J Back Musculoskelet Rehabil 32(4):663–665. https://doi.org/10.3233/BMR-181448CrossRefPubMed

24.

Roedl JB, Gonzalez FM, Zoga AC, Morrison WB, Nevalainen MT, Ciccotti MG et al (2016) Potential utility of a combined approach with US and MR arthrography to image medial elbow pain in baseball players. Radiology 279(3):827–837. https://doi.org/10.1148/radiol.2015151256CrossRefPubMed

25.

Shrestha-Taylor S, Clarke JL, Poulos A, Ginn K (2022) Ultrasound features for the diagnosis of adhesive capsulitis/frozen shoulder: a systematic review. Ultrasound Med Biol 48(12):2379–2397. https://doi.org/10.1016/j.ultrasmedbio.2022.07.003CrossRefPubMed

26.

Stella SM, Gualtierotti R, Ciampi B, Trentanni C, Sconfienza LM, Del Chiaro A et al (2021) Ultrasound features of adhesive capsulitis. Rheumatol Ther 9(2):481–495. https://doi.org/10.1007/s40744-021-00413-wCrossRefPubMedCentralPubMed

27.

Tamborrini G, Möller I, Bong D, Miguel M, Marx C, Müller AM et al (2017) The rotator interval—a link between anatomy and ultrasound. Ultrasound Int Open 3(3):E107–E116. https://doi.org/10.1055/s-0043-110473CrossRefPubMedCentralPubMed

28.

Tasto JP, Elias DW (2007) Adhesive capsulitis. Sports Med Arthrosc Rev 15(4):216–221. https://doi.org/10.1097/JSA.0b013e3181595c22CrossRefPubMed

29.

Tedeschi R (2024) Reevaluating the drucebo effect: implications for physiotherapy practice. J Psychosoc Rehab Mental Health. https://doi.org/10.1007/s40737-024-00425-zCrossRef

30.

Tedeschi R, Platano D, Donati D, Giorgi F (2024) Integrating the Drucebo effect into PM&R: enhancing outcomes through expectation management. Am J Phys Med Rehabil. https://doi.org/10.1097/PHM.0000000000002544CrossRefPubMed

31.

Vita F, Pederiva D, Tedeschi R, Spinnato P, Origlio F, Faldini C et al (2024) Adhesive capsulitis: the importance of early diagnosis and treatment. J Ultrasound. https://doi.org/10.1007/s40477-024-00891-yCrossRefPubMedCentralPubMed

32.

van Zuuren EJ, Logullo P, Price A, Fedorowicz Z, Hughes EL, Gattrell WT (2022) Existing guidance on reporting of consensus methodology: a systematic review to inform ACCORD guideline development. BMJ Open 12(9):e065154. https://doi.org/10.1136/bmjopen-2022-065154CrossRefPubMedCentralPubMed

Title: A comprehensive scoring system for the diagnosis and staging of adhesive capsulitis: development, application, and implications
Authors: Fabio Vita
Danilo Donati
Roberto Tedeschi
Marco Miceli
Paolo Spinnato
Flavio Origlio
Enrico Guerra
Marco Cavallo
Salvatore Massimo Stella
Luigi Tarallo
Giuseppe Porcellini
Stefano Galletti
Cesare Faldini
Publication date: 28-09-2024
Publisher: Springer Paris
Keyword: Shoulder Stiffness
Published in: European Journal of Orthopaedic Surgery & Traumatology / Issue 8/2024
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-024-04098-z

Cancellation and short postponement of primary hip or knee arthroplasty does not influence postoperative joint specific function or health related quality of life

Hip-TEP
Original Article

Management of hip osteoarthritis: harnessing the potential of mesenchymal stem cells—a systematic review

Open Access
Osteoarthrosis
General Review

Buried filet of limb flaps for the reconstruction of forequarter and hindquarter amputations

Original Article

Diamond-like carbon (DLC) surface treatment decreases biofilm burden by S. aureus on titanium alloy in vitro— a pilot study

Open Access
Original Article

Trends in inpatient versus outpatient upper extremity fracture surgery from 2008 to 2021 and their implications for equitable access: a retrospective cohort study

Forearm Fracture
Original Article

Influence of statin use on progression of postoperative fatty infiltration in the arthroscopic rotator cuff repair

Arthroscopic Rotator Cuff Repair
Original Article

Keynote webinar | Spotlight on adolescent vaping

Springer Medicine

A comprehensive scoring system for the diagnosis and staging of adhesive capsulitis: development, application, and implications

Abstract

Introduction

Methods

Results

Conclusion

Level of evidence

Other articles of this Issue 8/2024

Cancellation and short postponement of primary hip or knee arthroplasty does not influence postoperative joint specific function or health related quality of life

Management of hip osteoarthritis: harnessing the potential of mesenchymal stem cells—a systematic review

Buried filet of limb flaps for the reconstruction of forequarter and hindquarter amputations

Diamond-like carbon (DLC) surface treatment decreases biofilm burden by S. aureus on titanium alloy in vitro— a pilot study

Trends in inpatient versus outpatient upper extremity fracture surgery from 2008 to 2021 and their implications for equitable access: a retrospective cohort study

Influence of statin use on progression of postoperative fatty infiltration in the arthroscopic rotator cuff repair

Keynote webinar | Spotlight on adolescent vaping

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Level of evidence

Please log in to get access to this content

Cancellation and short postponement of primary hip or knee arthroplasty does not influence postoperative joint specific function or health related quality of life

Management of hip osteoarthritis: harnessing the potential of mesenchymal stem cells—a systematic review

Buried filet of limb flaps for the reconstruction of forequarter and hindquarter amputations

Diamond-like carbon (DLC) surface treatment decreases biofilm burden by S. aureus on titanium alloy in vitro— a pilot study

Trends in inpatient versus outpatient upper extremity fracture surgery from 2008 to 2021 and their implications for equitable access: a retrospective cohort study

Influence of statin use on progression of postoperative fatty infiltration in the arthroscopic rotator cuff repair