Reliability of Measuring Coracohumeral Ligament Stiffness with Different Shoulder Positions of Frozen Shoulders

Sep 28, 2026

Uploaded by ahduag

Shear wave elastography (SWE) is used to evaluate coracohumeral ligament (CHL) stiffness in frozen shoulders, yet the measurement posture consistency of the shoulder joint remains insufficiently defined. This study assessed the reliability of commonly used shoulder positions for CHL stiffness measurement. In 55 phase I frozen shoulder patients, two independent observers performed SWE twice at neutral, 30° external rotation, and 60° external rotation with a one-week interval. Intra- and inter-observer reliability differed by position, with excellent reliability at 60° external rotation based on ICC and Bland–Altman results.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusion

Introduction

Materials and Methods

Study design

| Original Article | | --- | | | Reliability of Measuring Coracohumeral Ligament Stiffness with Different Shoulder Positions of Frozen Shoulders Jingfeng Zhang1*, Yanping Wan1, Wenjuan Wang1, Jingjing Meng1, Yanni Yan1, Lei Zhang2,3 1Department of Ultrasound Medicine, Baoji High‑Tech Hospital, Baoji, Shaanxi, China, 2Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Shaanxi, China, 3Department of Radiology, Baoji High‑Tech Hospital, Baoji, Shaanxi, China Abstract Background: Shear wave elastography (SWE) is utilized to detect the stiffness of the coracohumeral ligament (CHL) for the assessment of a frozen shoulder. However, the consistency of shoulder joint posture during the detection process has not been adequately established. This study aims to evaluate the reliability of various commonly employed shoulder postures in measuring CHL stiffness. Methods: SWE was used to assess CHL stiffness in 55 patients with phase I frozen shoulder by two independent observers. Two measurements were taken, with a 1‑week interval, at three shoulder positions: neutral, 30° external rotation, and 60° external rotation. The intra‑ and inter‑observer reliability of CHL stiffness measurements were analyzed using a two‑way randomized model with an intragroup correlation coefficient. Results: Significant differences between intra‑ and inter‑observer measurements of CHL stiffness in the neutral position were observed (P < 0.05) . However, no significant differences were found at 30° and 60° of external rotation (P > 0.05) . Furthermore, poor intra‑ and inter‑observer reliability of CHL stiffness measurements was established in the neutral position intraclass correlation coefficient (ICC ＜ 0.40), moderate reliability at 30° of external rotation (ICC ＞ 0.40, ＜0.75), and excellent reliability at 60° of external rotation (ICC ＞ 0.75) . In addition, the Bland–Altman analyses indicated that the mean differences between intra‑ and inter‑observer measurements of CHL stiffness at 60° of external rotation were closest to the zero scale. Conclusion: The reliability of SWE in assessing the stiffness of the CHL in patients with phase I frozen shoulder at 60° external rotation is highly satisfactory. Keywords: Coracohumeral ligament, frozen shoulder, shear wave elastography, stiffness IntroductIon Frozen shoulder is a common etiology of shoulder pain, with a reported prevalence of 5 .3% in the general population.[1] Among individuals with diabetes mellitus and thyroid disorders, the prevalence of frozen shoulder is notably higher, ranging from 4.3% to 38% .[2] The primary pathological changes in the frozen shoulder involve inflammation and fibrosis of the joint capsule and rotator cuff space.[3] Within the rotator cuff space, the coracohumeral ligament (CHL) plays a crucial role. As such, understanding the pathological changes of the CHL is crucial for the diagnosis of a frozen shoulder. In recent years, several scholars have suggested that thereis thickening and stiffening of the CHL in patients with frozen shoulders, which is likely caused by inflammation and fibrosis. [4‑6] They have used ultrasound shear wave Received: 26‑07‑2024 Revised: 27‑08‑2024 Accepted: 01‑10‑2024 Available Online: 09‑12‑2024 | Supplementary material available online | | | --- | --- | | | | | Access this article online | | | Quick Response Code:
| Website:
[https://journals.lww.com/jmut](https://journals.lww.com/jmut) | | | DOI:
10.4103/jmu.jmu_95_24 | elastography (SWE) to assess the stiffness of the CHL [Table 1] . SWE is a noninvasive, real‑time method used to evaluate the viscoelastic properties of soft tissues, includingthe thyroid gland, breast musculature, and ligaments.[11‑14] The degree of stretching in muscles and ligaments affects tissue stiffness and strain rate during SWE examination.[15] When external rotation of the shoulder occurs, the CHL is stretched, thus impacting the measured ligament stiffness

FAQs

What measurement tool and target structure were used in this study?

The study used shear wave elastography (SWE) to measure coracohumeral ligament (CHL) stiffness in patients with frozen shoulders.

How were observers and shoulder positions organized?

Two independent observers performed SWE measurements twice for each patient with a one-week interval at neutral, 30° external rotation, and 60° external rotation.

Which shoulder position showed the best measurement reliability?

60° external rotation showed the highest reliability, with excellent intra- and inter-observer reliability and Bland–Altman mean differences closest to zero.

Sep 28, 2026

Uploaded by ahduag