Abstract
Adhesive capsulitis (AC) is a disorder that is characterized by shoulder pain and progressive limitation of both active and passive shoulder motion. Although the underlying pathological mechanisms of the disease are not well understood, the inflammatory reactions depending on the stage have been demonstrated histologically. The purpose of the study is to investigate the inflammatory changes that can be demonstrated with Tc-99m HIG in AC, and to determine the presence of correlations between scintigraphic findings and the clinical assessment. Twenty-one patients (12 females and 9 males) with a mean age of 50.57±8.49 were included in the study. AC was diagnosed according to recognized criteria. The planar X-ray images of the affected shoulders of all patients were normal. The patients were evaluated with the Constant Scoring System, and the functional and pain assessment parts of the American Shoulder and Elbow Surgeons’ Form (ASES). Three phase bone scans and Tc-99m HIG scintigraphy were performed at least two days apart. Bone scan and Tc-99m HIG scintigraphy were evaluated visually and HIG uptake was evaluated in comparison with the contralateral normal shoulder. Bone scan demonstrated hypervascularity in 9 of the 21 patients (43%), whereas increased osteoblastic activity was detected in 19 (90%) in the affected shoulder. Tc-99m HIG uptake was positive in 12 (57%), and negative in 9 (43%) patiens. All patients with increased Tc-99m HIG accumulation in the affected shoulder, also had increased osteoblastic activity on Tc-99m bone scintigraphy. A significant correlation was found between HIG uptake and constant, functional and pain scores. The difference between these scores was also statistically significant in patients with HIG positive and negative uptake. This study indicates that there is a good correlation between Tc-99m HIG scan findings and clinical scores. Tc-99m HIG accumulation in the affected shoulder may be related to continuing inflammatory reaction to AC. Tc-99m HIG scan may be a noninvasive, complementary method for demonstrating continuing inflammatory changes and may help in staging the disease.
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References
Harryman DT, Lazarus MD, Rozencwaig R. The stiff shoulder. In:The Shoulder, Rockwood CA, MatsenFA (eds), Philadelphia: WB Saunders Company, 1998; 1064–1112.
Kozin F. Painful shoulder and the reflex sympathetic dystrophy syndrome. In:Arthritis and Allied Conditions, Koopman WJ (ed), Baltimore; Williams & Wilkins Company, 1996: 1887–1922.
Wiley AM. Arthroscopic appearance of frozen shoulder.Arthroscopy 1991; 7: 138–143.
Bunker TD, Anthony PP. The pathology of frozen shoulder. A Dupuytren-like disease.J Bone Joint Surg 1995; 77B: 677–683.
Rodeo SA, Hannafin JA, Tom J, Warren RF, Wickiewiez TL. Immunolocalization of cytokines and their receptors in adhesive capsulitis of the shoulder.J Orthop Res 1997; 15 427–436.
Hannafin JA, Chiaia TA. Adhesive capsulitis, a treatment approach.Clinical Orthopaedics and Releated Research 2000; 372: 95–109.
Palermo F, Baccaletto F, Paolin A, Carniato A, Zoli P, Giusto F, et al. Comparison of technetium-99m-MDP, technetium-99m-WBC, technetium-99m-HIG in musculoskeletal inflammation.J Nucl Med 1998; 39: 516–521.
Durak H, Soylev M, Durak I, Degirmenci B, Capa Kaya G, Uysal B. Tc-99m polyclonal human immunoglobulin G imaging in Graves’ ophthalmopathy.Clin Nucl Med 2000; 25: 704–707.
Delgado CM, Lancha C, Prats E, Mitjavilla M, Abos D, Martin-Curto LM, et al. The diagnostic value of Tc-99m human polyclonal immunoglobulin imaging compared to Tc-99m HMPAO labeled leukocytes in inflammatory bowel disease.Clin Nucl Med 1997; 22: 17–20.
Varoĝlu E, Polat KY, Taştekin G, Akçay F, Polat C. Diagnostic value of99mTc-HIG scintigraphy in the detection of acute appendicitis.Clin Nucl Med 1996; 21: 645–647.
Pons F, Sanmarti R, Herranz R, Collado A, Piera C, Vidal-Sicart S, et al. Scintigraphic evaluation of the severity of inflammation of the joints with99Tcm-HIG in rheumatoid arthritis.Nucl Med Commun 1996; 17: 523–528.
Stoeger A, Mur E, Penz-Schneeweiss D, Moncayo R, Descristoforo C, Riccabona G, et al. Technetium-99m human immunoglobulin scintigraphy in psoriatic arthropathy: first results.Eur J Nucl Med 1994; 21: 342–344.
Macdonald DA. The shoulder and elbow. In:Outcome Measures in Orthopaedics, Pynsent P, Fairbank C, Carr A (eds). London; Butterworth-Heinemann, 1993; 144–173.
Neviaser TJ. Adhesive capsulitis.Orthop Clin North Am 1987; 18: 439–443.
Clunie G, Bomanji J, Ell PJ. Technetium-99m-MDP patterns in patients with painful shoulder lesions.J Nucl Med 1997; 38: 1491–1495.
Leppala J, Kannus P, Sievanen H, Jarvinen M, Vuori I. Adhesive capsulitis of the shoulder (frozen shoulder) produces bone loss in the affected humerus, but long-term bony recovery is good.Bone 1998; 22: 691–694.
Clunie GP, Bomanji J, Renton P, Edwards JC, Ell PJ. Technetium-99m human immunoglobulin imaging in patients with subacromial impingement or adhesive capsulitis.Clin Rheumatol 1998: 17: 419–421.
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Şenocak, Ö., Deĝirmenci, B., Özdoĝan, Ö. et al. Technetium-99m human immunoglobulin scintigraphy in patients with adhesive capsulitis: A correlative study with bone scintigraphy. Ann Nucl Med 16, 243–248 (2002). https://doi.org/10.1007/BF03000102
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DOI: https://doi.org/10.1007/BF03000102