Journal of Shoulder and Elbow Surgery

Magnetic resonance imaging and short-term clinical results of severe frozen shoulder treated with manipulation under ultrasound-guided cervical nerve root block

Published:August 06, 2015DOI:


      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).


      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.


      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.


      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.

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