Intra-articular Pressure Profiles of Painful Stiff Shoulders Compared With Those of Other Conditions

Chung, Sun G.; Lee, Kyu Jin; Kim, Hee Chan; Seo, Kwan Sik; Lee, Yong-Taek

doi:10.1016/j.pmrj.2009.01.024

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Volume 1, Issue 4 , Pages 297-307, April 2009

Intra-articular Pressure Profiles of Painful Stiff Shoulders Compared With Those of Other Conditions

Sun G. Chung, MD, PhD
- Department of Rehabilitation Medicine, College of Medicine, and Rheumatism Research Institute, Medical Research Center, Seoul National University, Seoul, South Korea^⁎
- Address correspondence to S.G.C., Department of Rehabilitation Medicine, Seoul National University Hospital, 28 Yeon Geon Dong, Jong No Gu, Room#12606, Seoul, South Korea, 110-744
Kyu Jin Lee, PhD
- Interdisciplinary Program, Biomedical Engineering Major, Graduate School, Seoul National University, Seoul, South Korea^†
Hee Chan Kim, PhD
- Department of Biomedical Engineering, College of Medicine and Institute of Medical & Biological Engineering, Medical Research Center, Seoul National University, Seoul, South Korea^‡
Kwan Sik Seo, MD, PhD
- Department of Rehabilitation Medicine, College of Medicine, Seoul National University, Seoul, South Korea^§
Yong-Taek Lee, MD, PhD
- Department of Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea^¶

Received 14 August 2008; accepted 27 January 2009.

Objective

To test two questions raised by a previous study: whether high and steeply rising intra-articular (IA) pressure achieved by controlled fluid infusion would be specific to the painful stiff shoulder (PSS) and whether rupture occurs immediately after the appearance of the third phase so that it could be considered as a preruptural sign.

Design

Case series.

Setting

University Outpatient Clinic of Physical Medicine and Rehabilitation.

Participants

Fourteen PSS patients who had limited range of motion of the shoulder in at least 2 directions for more than a month were participants, and 6 shoulders of 5 people with other conditions including 2 healthy shoulders served as controls.

Intervention and Main Outcome Measures

Real-time pressure monitoring was done with fluid infusion in a constant-volume rate. For PSS patients, fluid was infused until rupture occurred. More than 25 mL of fluid was instilled in the shoulders of the control group. The pressure-volume (P-V) profiles, number of phases, maximal volume (V_max) and pressure (P_{v_max}) at V_max, stiffness of the capsule (K_ph2), and the fluid volume (V_ph3) infused from the appearance of the triphasic curve to the rupture were evaluated.

Results

Among the 14 PSS patients, 12 demonstrated steeply increasing pressure (8 triphasic, 4 biphasic), but 2 showed flat and low-pressure profiles. In contrast, the entire control group revealed flat pressure profiles. The PSS subjects showed far higher P_{v_max} at lower V_max than the control subjects. The K_ph2 was significantly higher in the PSS group. The V_ph3 was 5.03 ± 3.18 mL ranging from 2.33 to 10.99 mL.

Conclusions

The steeply rising, high IA pressure can be considered as a predominant characteristic of the PSS compared with other conditions that showed flat, low-pressure profiles, suggesting the P-V profiles might be used in evaluation of the capsular tightness of various shoulder problems. The triphasic curve appears to be a preruptural sign; however, there are several practical limitations to terminating hydraulic distension before rupture occurs.