All statistical analyses were calculated using the statistical software package SPSS version Agreement was classified as poor ICC, 0. Inter-observer reliability of elastic modulus measurements in the CHL was excellent in both the neutral position dominant; interclass correlation coefficients [ICC]: 0.
The intra-observer reliability of elastic modulus measurements in the CHL was excellent in both the neutral position dominant; ICC: 0. There was no significant difference in the average ages of the men Correlation coefficients for age and elasticity of the CHL on the dominant and non-dominant sides are shown in Table 2. The elastic modulus of the older group was higher red than that of the younger group blue Fig. Elasticity of the CHL in the different age groups is shown in Table 3. CHL elasticity increased with increasing age and was at its highest value in patients over the age of The non-dominant side showed similar changes compared to the dominant side.
In the 30s and 40s age groups, the elasticity in the neutral position was equivalent irrespective of side dominance. The most important finding of this study was that CHL elasticity increased with increasing age in healthy individuals. To date, there are no available data obtained using SWE regarding the relationships between CHL elasticity, age, sex, and side dominance in healthy adult subjects.
Naturally, shoulder ROM decreases with increasing age [ 18 ]. It is also affected by poor posture, as in the increased thoracic kyphosis with a forward head position and slouched trunk posture [ 19 , 20 ]. Causes of joint stiffness can be classified as follows: arthrogenic bone, cartilage, synovial membrane, capsule, and ligaments and myogenic muscle, tendon, and fascia [ 21 ].
Among the intra-articular causes, the condition of the joint capsule is the main factor [ 22 ] and a thickened CHL is one of the most characteristic findings of frozen shoulder [ 1 ]. However, the manner in which degenerative changes affect shoulder motion in healthy subjects remains unknown. The CHL originates from the horizontal limb of the coracoid process and covers the RI [ 23 ], extending coverage to the SSP, the infraspinatus, and the SSc muscles and their direct insertions [ 6 ]. The superficial layer of the anterior CHL continues smoothly to the SSc fascia, where it firmly covers an extensive area of the anterior surface of the SSc muscle 6.
Biomechanical studies have indicated that tension in the CHL has a significant effect on stability and ROM, providing resistance to the inferior and posterior translations of the humeral head [ 23 , 25 , 26 ]. Boardman et al. Arm position significantly influences the elasticity of the CHL. Wu reported that the elastic modulus of the CHL in symptomatic shoulders was not significantly greater than that of unaffected shoulders in the maximal ER position [ 12 ].
However, after reaching the maximum ER position, it is difficult to evaluate the CHL elastic modulus appropriately. A thickened CHL is considered to be one of the most characteristic manifestations of frozen shoulder [ 1 , 3 ]. The eventual thickening of the CHL combined with its dense fibrous structure causes increased ER restriction [ 3 , 9 ]. A recent study showed that the elasticity of the patellar tendon significantly decreased in healthy older subjects [ 27 ].
On the other hands, the elasticity of the CHL at the surface of the SSC increased with increasing age in the healthy participants in this study. These changes in the elasticity of tendons and ligaments associated with aging may reflect the aging process in many body parts. Only one study that used SWE to evaluate CHL has been reported in patients with adhesive capsulitis, which showed that the surface of the CHL in the SSC on the affected side was thicker and stiffer than on the unaffected side [ 12 ].
There were no differences in the thickness or elastic modulus of the CHL between the dominant and the non-dominant shoulders in the neutral position under maximal ER in healthy subjects. These findings were consistent with our results [ 12 ]. In previous studies, the elasticity of the CHL in healthy subjects was greater than what we observed in our data. This could be explained by different measurements and protocols.
A measurement taken closer to the muscle attachment site might result in higher CHL elasticity measurements, which would be more consistent with those previous reports [ 12 ]. This study indicated that the elasticity of the CHL is directly related to the aging process regardless of shoulder dominance. This indicates that dominance-related differences are less likely to occur in response to repetitive micro traumas sustained from prior athletic activities.
In the lower extremities, the semitendinosus muscle tendons in men were stiffer than those in women based on SWE evaluations [ 28 ], which is contrary to our results. This could be explained by a difference in measurement locations. Previous reports stated that female subjects in general had significantly greater ROMs compared to male subjects [ 5 ], which could be explained by differences in joint laxity related to muscle mass. This principal exception to this explanation is at the glenohumeral joint. The limitations to this study are as follows: 1 absence of arthroscopic or histological evaluations, 2 absence of frozen shoulder comparisons, 3 absence of ROM and laxity evaluations, 4 non-exclusion of degenerative joint diseases based on imaging, 5 difficulty in assessing tissue hydration and flexion based on age within the scope and technical ability of our testing procedure adopted for this research protocol, and 6 focus on a specific CHL region of interest near the coracoid process.
CHL elasticity generally increased with age. An increase in the elasticity of the CHL is one of the many age-related changes faced by healthy individuals. Further research is needed to evaluate the relationships between age-based pathological changes in CHL elasticity, and how those relationships progressively relate to frozen shoulder diagnoses. Both studies that originated the data used in the present secondary data analysis were conducted in accordance with the standards of the responsible ethic committee and with the Helsinki Declaration of , as revised in and Philippe Hernigou, Ph.
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Abstract Background: Although the shoulder range of motion significantly decreases with advancing age, how the natural aging process affects the joint capsule, including the Coracohumeral Ligament CHL , in healthy subjects is still unknown. Objective To use shear wave elastography to investigate the correlations between age, sex, and shoulder dominance, and elasticity of the CHL in healthy individuals.
Methods: Eighty-four healthy volunteers mean age: Level of Evidence: Level 3 Case-control study. Keywords: Shoulder dominance, Range of motion, Coracohumeral ligament, Shear wave elastography, Ligament elasticity, Frozen shoulder. Materials and Methods 2.
Participants The study protocols were approved by the institutional review board of the Iwate Prefectural Central Hospital approved number: Measurement area of the elastic modulus of the coracohumeral ligament using shear wave elastography. Table 1. Table 2. Correlation coefficient differences for age and CHL elasticity on the dominant and non-dominant sides.
Table 3. The pathology of frozen shoulder. J Bone Joint Surg Br ; 89 7 : CrossRef PubMed. Processing Time: Average publication time of 18 days between final acceptance of revised manuscript and its publication. View Editorial Board. Join Our Editorial Board News release date: March 29, Description: The Open Orthopaedics Journal is an Open Access online journal, which publishes research articles, reviews, letters, case reports and guest-edited single topic issues in all areas of experimental and clinical research and surgery in orthopaedics.
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