The role of grey-scale ultrasound in the diagnosis of adhesive capsulitis of the shoulder: a systematic review and meta-analysis

Aims: In this systematic review and meta-analysis, we discuss the value of grey-scale ultrasonography (US) in diagnosing adhesive capsulitis of the shoulder (ACS). Material and methods: We retrieved relevant studies from PubMed, Cochrane Library, and Embase before 8 April 2019. We selected 7 studies concerning 446 patients (490 shoulders) that used grey-scale US to diagnose ACS and magnetic resonance imaging (MRI) or arthroscopy as the reference standard. We assessed the diagnostic accuracy of US on the basis of combined sensitivity, specificity, likelihood ratio (LR), and the area under the summary receiver operating characteristic (SROC) curve (AUC). Results: The combined sensitivity, specificity, positive LR and negitive LR were found to be 88% (95%CI: 74-95), 96% (95%CI: 88-99), 23.89 (95%0: 6.31-90.51) and 0.12 (95%CI: 0.05-0.29), respectively. The AUC was 0.97 (95%0: 0.96-0.98). ACS was diagnosed on the basis of four US features: coracohumeral ligament thickening, inferior capsule/axillary recess capsule thickening, rotator interval abnormality, and restriction of the ranee of motion, The corresponding sensitivities were 64.4 (95%CI: 48.8-78.1), 82.1 (95%CI: 73.8-88.7), 82.6 (95%CI: 74.1-89.2) and 94.3 (95%CI: 84.3-98.8), respectively, and specificities were 88.9 (95%CI: 76.0-96.3), 95.7 (95%CI: 90.3-98.6), 93.9 (95%CI: 89.8-96.7), and 90.9 (95%CI: 75.7-98.1), respectively. Conclusions: Our meta-analysis showed that grey-scale US plays a significant role in the diagnosis of ACS. Because of its high sensitivity and specificity, US can be added to the existing clinical diagnosis program.