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MRI without contrast is an unreliable method for detection of capsular reaction following shoulder surgery
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
Radiology department, Sabbatsbergssjukhus, Stockholm.
Radiology department, Enköpingssjukhuset, Enköping.
The southern Sweden musculoskeletal research center, department of orthopedics, Lund, Sweeden.
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2012 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455Article in journal (Refereed) Submitted
Abstract [en]


Subacromial decompression is a common surgical procedure in patients with subacromial outlet impingement. The results are often good, although some patients develop adhesive capsulitis with postoperative pain and stiffness. The main aim of the present study was to analyze the reaction of the joint capsule 3 months after subacromial decompression using MRI without contrast.  We also wanted to study if there was a relation between the capsular reaction and the Constant score (CS) or the subjective shoulder value (SSV).


Forty-eight patients with a median age of fifty-six years underwent subacromial decompression with or without AC-joint resection. They were investigated with a standard x ray and MRI pre surgery and MRI three months after surgery. The CS and SSV were measured preoperatively and at three months, six months, and two years postoperatively for SSV. Two musculoskeletal radiologists independently evaluated the MRI images and used a scoring system from 0-7.


The relationship between the baseline CS and the MRI pre-surgery score was significant for both raters. There were a significant difference between the raters’ pre and post-surgery average MRI scores, which simply means that there was a difference found in the average score between baseline and three months. However, the inter-rater reliability was poor. The improvement in the CS from baseline to three and six months postoperation was significant. The subjective shoulder value improved at three, six and 24 months after surgery.


MRI is an unreliable method to study capsular reaction in the shoulder joint due to the high subjectivity of the radiologists. Considerable improvements were observed in the CS and the SSV.

Place, publisher, year, edition, pages
National Category
URN: urn:nbn:se:uu:diva-167686OAI: oai:DiVA.org:uu-167686DiVA: diva2:492300
Available from: 2012-02-07 Created: 2012-01-31 Last updated: 2012-03-29Bibliographically approved
In thesis
1. Soft Tissue Aspects of the Shoulder Joint
Open this publication in new window or tab >>Soft Tissue Aspects of the Shoulder Joint
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to study different aspects of the soft tissues of the shoulder joint. The variation in the quality of the tendons and ligaments can be explained by genetic factors. To test the hypothesis that collagen 1 α1 Sp1 polymorphism is related to the occurrence of cruciate ligament ruptures and shoulder dislocations, a total of 358 patients (233 patients with cruciate ligament ruptures and 126 with shoulder dislocations) were included in the study. We found a decreased risk of these injuries associated with collagen type 1 α1 Sp1 polymorphism.

To study the mechanical properties of a better type of fixation of soft tissue to bone, 10 skeletally mature New Zealand white rabbits were operated bilaterally on the knees. The medial collateral ligaments were fixed by two types of plates one with a flat undersurface and the other with a pegged undersurface. After 4 weeks the force at failure, stiffness and energy uptake was almost double in the knees operated with the pegged plates.

The prevalence and dysfunction of rotator cuff tears was investigated in 106 subjects who had never sought for their shoulder complaints, using Constant score, ultrasound and plain x-ray. The prevalence of full-thickness cuff tears was 30% (21% of all shoulders). The Constant score was lower in subjects with full-thickness tears. Partial-thickness tears and acromioclavicular joint osteoarthritis had no impact on shoulder complaints or Constant score. The subacromial index was lower for shoulders with full-thickness tears.

Forty-eight patients with median age 56 years underwent subacromial decompression with or without acromioclavicular joint resection, investigated with MRI pre- and 3 months postoperatively. The Constant score and subjective shoulder value were measured preoperatively and at 3 and 6 months after surgery and even 2 years for subjective shoulder value. Two raters investigated the MRI. The results showed poor inter-rater reliability for MRI. However, both Constant score and subjective shoulder value improved over time. MRI is not a reliable method to study the capsular reaction after subacromial decompression due to high subjectivity of the radiologists.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. 62 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 743
cruciate ligament, shoulder dislocation, polymorphism, collagen, biomechanical properties, rotator cuff tear, shoulder ultrasound, adhesive capsulitis, MRI
National Category
urn:nbn:se:uu:diva-168236 (URN)978-91-554-8278-7 (ISBN)
Public defence
2012-03-30, Rosénsalen, Barnsjukhuset Ingång 95/96, Akademiska Sjukhuset, Uppsala, 09:00 (Swedish)
Available from: 2012-03-09 Created: 2012-02-06 Last updated: 2012-03-29Bibliographically approved

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