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Contracture of the Deltoid Muscle: Sonographic Evaluation with MRI Correlation

Chung-Cheng Huang1, Sheung-Fat Ko1, Jih-Yang Ko2, Hsuan-Ying Huang3, Shu-Hang Ng4, Yung-Liang Wan4, Min-Chi Chen5, Yu-Fan Cheng1 and Tze-Yu Lee1

1 Department of Radiology, Chang Gung Memorial Hospital at Kaohsiung, Chang Gung University, 123 Ta-Pei Rd., Niao-Sung Hsiang, Kaohsiung Hsien 833, Taiwan.
2 Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Kaohsiung, Chang Gung University, Kaohsiung Hsien, Taiwan.
3 Department of Pathology, Chang Gung Memorial Hospital at Kaohsiung, Chang Gung University, Kaohsiung Hsien, Taiwan.
4 Department of Radiology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuen Hsien, Taiwan.
5 Department of Public Health and Biostatistics, Chang Gung Memorial Hospital at Kaohsiung, Chang Gung University, Kaohsiung Hsien, Taiwan.



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  		Fig. 1 —28-year-old healthy woman volunteer. Normal sonographic free-style transverse extended view of intermediate portion of deltoid muscle with normal short linear perimysium (small arrows), intermuscular tendons (open arrows), and epimysium (large arrow) between intermediate portion and posterior portion of deltoid muscle (PM).

 


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  		Fig. 2A —43-year-old woman presenting with shoulder pain. Sonographic free-style transverse extended scan shows pattern I deltoid contracture lesion as hyperechoic lesion with blurred outline (arrows) and multiple small hypoechoic spots (open arrows) in middle third of intermediate deltoid.

 


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  		Fig. 2B —43-year-old woman presenting with shoulder pain. Transverse gradient-echo MR image corresponding to A reveals pattern I lesion with multiple small (< 5-mm) hypointense nodules (open arrows) in intermediate deltoid. Note presence of hyperintensities, which correspond to relatively immature fibrosis, around hypointense mature fibrotic foci.

 


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  		Fig. 3A —62-year-old woman presenting with shoulder pain and limited range of motion. Sonographic free-style transverse extended scan shows pattern II deltoid contracture lesion as heteroechoic lesion predominantly occupied by several 8-12-mm hypoechoic areas (open arrows) with interspersed hyperechogenicities and hyperechoic rim (arrows) in intermediate deltoid.

 


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  		Fig. 3B —62-year-old woman presenting with shoulder pain and limited range of motion. Transverse gradient-echo MR image corresponding to A reveals pattern II lesion with several greater than 8-mm hypointense fibrotic areas (open arrows) in intermediate deltoid. Note presence of relatively immature fibrosis with slight hyperintensity (thin arrow) between thick hypointense fibrotic cords.

 


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  		Fig. 3C —62-year-old woman presenting with shoulder pain and limited range of motion. Photomicrograph shows dense sclerotic hypocellular fibrous tissues with thickened collagenous fibers (triangles) accounting for hypoechoic area on sonogram or hypointense area on MRI. Prominent vascularities and numerous myofibroblasts within loose fibrous stroma in fibromuscular junction (open arrows) with relatively immature fibrosis accounting for hyperechogenicity on sonography and hyperintensity on MRI. (H and E; original magnificatiox 100).

 


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  		Fig. 4A —50-year-old man presenting with palpable mass in deltoid and restricted range of shoulder motion. Sonographic free-style transverse extended scan shows pattern III deltoid contracture lesion involving whole length of deltoid muscle and 2.5-cm calcified mass (open arrows) with obvious acoustic shadow at lower third of intermediate deltoid.

 


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  		Fig. 4B —50-year-old man presenting with palpable mass in deltoid and restricted range of shoulder motion. Transverse proton density-weighted image corresponding to A reveals pattern III deltoid contracture lesion with 2.5-cm hypointense fibrotic mass (open arrow) in intermediate deltoid.

 


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  		Fig. 4C —50-year-old man presenting with palpable mass in deltoid and restricted range of shoulder motion. Shoulder anteroposterior radiograph shows lateral down-sloping of acromion, lateroinferior rotation of scapula, and dense calcification (open arrow) in lower third of deltoid muscle.

 

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