Weihua Xu,1 Jiayu Xu,1 Yingying Zhou,1 Weiwei Yang,1 Hui Huang,1 Jun Xue,1 Jing Zhang2 

1Ultrasound Medicine Department, Zhabei Central Hospital in Jing’an District, Shanghai, People’s Republic of China; 2Ultrasound Medicine Department, Daning Community Health Service Center in Jing’an District, Shanghai, People’s Republic of China

Correspondence: Weihua Xu, Ultrasound Medicine Department, Zhabei Central Hospital in Jing’an District, Shanghai, People’s Republic of China, Tel +86-13917752615, Email 835233143@qq.com

Purpose: To explore the early diagnostic value of superb microvascular imaging (SMI) features within the rotator cuff gap for frozen shoulder.
Patients and Methods: This prospective study enrolled patients with acute early-stage frozen shoulder seeking treatment at Zhabei Central Hospital in Jing’an District, Shanghai, between July 2021 and December 2022 were enrolled in this study. Healthy controls were collected in a 1:1 ratio from the same hospital’s physical examination center. All participants underwent SMI and power Doppler ultrasound (PDUS) of the rotator cuff gap.
Results: The study included 79 patients with frozen shoulder and 77 healthy controls. Compared with the healthy control group, the patient group had a higher proportion of hypoechoic rotator cuff gap (81.0% vs 48.1%, P< 0.001), a thicker coracohumeral ligament (2.60± 1.01 vs 2.03± 0.97, P< 0.001), a thicker glenohumeral joint capsule (3.10± 0.99 vs 2.46± 1.17, P< 0.001), and elevated blood grading using SMI (P< 0.001) and PDUS (P=0.014). The highest area under the curve (AUC) was observed for SMI blood flow grading (AUC=0.824, 95% CI: 0.755– 0.880, P< 0.001), resulting in 82% sensitivity and 77% specificity when using a cutoff of 1. SMI blood flow grading was associated with external rotation < 30° (P=0.007) and abduction < 30° (P=0.013) but not with internal rotation < 30° (P=0.630) or flexion < 30° (P=0.562).
Conclusion: The grading of SMI blood flow may emerge as a valuable predictive indicator for the early stages of frozen shoulder. This simple ultrasound technique holds the potential to enhance the diagnostic process, enabling early initiation of treatment and potentially improving patient outcomes.

Keywords: adhesive capsulitis of the shoulder, microcirculation, ultrasonography, early diagnosis, predictive value