The Value Of High Frequency Ultrasound Combined With Shear Wave Elastography In Quantitative Diagnosis Of Frozen Shoulder In Diabetes Mellitus

Objective: The occurrence of frozen shoulder may be closely related to the abnormality of coracohumeral ligament and glenohumeral joint capsule.The risk of frozen shoulder in diabetic patients is higher than that in normal people.In this study,high frequency ultrasound combined with shear wave elastography was used to quantitatively analyze the thickness and shear wave velocity of coracohumeral ligament and glenohumeral joint capsule in patients with diabetic frozen shoulder,and the value of high frequency ultrasound combined with shear wave elastography in diagnosis of diabetic frozen shoulder was quantitatively analyzed.Methods: A total of 74 diabetic patients with shoulder pain accompanied by significant mobility restriction admitted to the Affiliated Hospital of Jining Medical College from October 2020 to February 2023 were collected,and the clinical indications and other imaging examinations confirmed the frozen shoulder,with a total of 77 shoulder joints.In the same period of time,a total of70 patients with diabetes who visited our hospital due to shoulder pain and did not conform to the diagnosis of frozen shoulder by other imaging examinations and clinical diagnosis were used as the control group.Patients in both groups were examined by high frequency ultrasound combined with Shear Wave Elastography technology for shoulder joint and surrounding tissues.Shear wave velocity data of coracohumeral ligament and glenohumeral joint capsule under shear wave elastography(SWE)mode were compared and analyzed between the two groups,and high-frequency ultrasonic examination results of the subjects under high frequency mode were analyzed.Four indicators were included: the thickness of glenohumeral joint capsule,the thickness of coracohumeral ligament,whether the tendon sheath of the long head tendon of the biceps brachialis could be detected and the effusion echo,and whether the blood flow signal could be detected in the rotator cuff space.The selected data area was the area of interest with a diameter of about 3mm.Results: In this study,the high-frequency ultrasonic examination results of the two groups of subjects were compared and analyzed.The thickness of glenohumeral joint capsule(3.50±1.56mm)and coracohumeral ligament(2.57±0.59mm)in the study group under high-frequency ultrasound were all greater than those in the control group(2.22±0.42mm).The effusion of longhead tendon tendon of biceps brachii and the blood flow signal display rate of rotator cuff space in frozen shoulder group were higher than those in control group,and the difference between the two groups was statistically significant(P < 0.05).Shear wave velocity of coracohumeral ligament 9.66±0.96m/s and glenohumeral capsule 8.98±1.44m/s in the study group were higher than those of the control group 8.73±1.14m/s and8.06±1.29m/s,and the differences were statistically significant(P< 0.05).The results of multivariate Logistic regression analysis on meaningful variables in the results of univariate analysis found that,Coracohumeral ligament thickness(OR= 3.038),glenohumeral capsular thickness(OR= 2.762),coracohumeral ligament shear wave velocity(OR= 1.814),glenohumeral capsular shear wave velocity(OR=1.674)and rotator cuff space blood flow signal(OR=14.218)were risk factors for frozen shoulder.ROC curve analysis showed that the sensitivity and specificity of coracohumeral ligament thickness were 75.3% and64.8%,respectively.The sensitivity and specificity of glenohumeral capsule thickness were 70.1% and 80.3%,respectively.The sensitivity and specificity of coracohumeral ligament shear wave velocity diagnosis were 71.4% and 67.6%.The sensitivity and specificity of shear wave velocity were 74.0%and 57.8% respectively.The sensitivity and specificity of the rotator cuff space were 75.3% and 91.6% respectively.The sensitivity and specificity of simultaneous diagnosis were 80.5%and 95.8%,respectively.Coracohumeral ligament thickness(AUC=0.739),glenohumeral capsular thickness(AUC=0.770),rotator cuff space blood flow signal(AUC=0.834),coracohumeral ligament shear wave velocity(AUC=0.737),glenohumeral capsular shear wave velocity(AUC=0.688),and combined diagnosis(AUC=0.950)are of diagnostic value.Conclusion: 1.High frequency ultrasound can clearly show the morphological changes of shoulder ligament in diabetic patients with frozen shoulder,and the thickening of coracohumeral ligament and glenohumeral joint capsule is helpful for the diagnosis of diabetic frozen shoulder.Color Doppler ultrasound can effectively observe the changes of rotator cuff tissue blood flow signals in diabetic patients with frozen shoulder,which is helpful for the diagnosis of diabetic frozen shoulder.Shear wave elastography can evaluate the elasticity of shoulder ligament and joint capsule in patients with diabetic frozen shoulder,which is helpful for the diagnosis of diabetic frozen shoulder.The application of high frequency ultrasound combined with shear wave elastography is of good value in the diagnosis of diabetic frozen shoulder.