The role of inflammatory markers in the differential diagnosis of stiff shoulder disease
Muhammed Furkan Tosun1
, Murat Çiçeklidağ1, Resul Bircan2, Semih Yaş2, Mustafa Melik Can3, Alim Can Baymurat4, Mehmet Ali Tokgöz4, Ulunay Kanatlı4
1Department of Orthopedics and Traumatology, Yenimahalle Training and Research Hospital, Ankara, Türkiye
2Department of Orthopedics and Traumatology, Abdurrahman Yurtaslan Training and Research Hospital, Ankara, Türkiye
3Department of Orthopedics and Traumatology, Kulu Public Hospital, Konya, Türkiye
4Department of Orthopedics and Traumatology, Gazi University Faculty of Medicine, Ankara, Türkiye
Keywords: Frozen shoulder, inflammatory markers, lymphocyte to monocyte ratio, neutrophil to lymphocyte ratio.
Abstract
Objectives: The aim of this study was to assess the diagnostic value of pre-treatment inflammatory markers, including neutrophil-tolymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR), in distinguishing frozen shoulder (idiopathic stiff shoulder) from secondary stiff shoulder caused by shoulder pathologies.
Patients and methods: Between February 2008 and August 2021, a total of 176 patients (64 males, 112 females; mean age: 54.0±9.9 years; range, 24 to 82 years) were retrospectively analyzed. The patients underwent analysis of surgical video recordings. Seventy-one patients with rotator cuff pathology were classified as having secondary stiff shoulders, while 105 patients without a history of trauma or cuff pathology were classified as having frozen shoulder (primary stiff shoulder). Demographic and preoperative laboratory data, including white blood cell count (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), neutrophil, lymphocyte, monocyte, platelet counts, along with NLR, PLR, and LMR values, were evaluated.
Results: Significantly higher levels of WBC, neutrophils, and NLR were observed in patients with secondary stiff shoulder (p<0.001 for all). In contrast, LMR (p=0.013) and platelet values (p=0.046) were found to be significantly higher in the frozen shoulder group. No statistically significant differences were observed between the groups regarding CRP, ESR, lymphocyte count, monocyte count, or PLR (p>0.05).
Conclusion: The NLR and LMR values have diagnostic utility in differentiating primary and secondary stiff shoulder. Elevated NLR values are associated with more acute inflammatory responses typical of secondary stiff shoulder, while higher LMR and platelet levels are linked to chronic and fibrotic processes observed in frozen shoulder.
Citation: Tosun MF, Çiçeklidağ M, Bircan R, Yaş S, Can MM, Baymurat AC, et al. The role of inflammatory markers in the differential diagnosis of stiff shoulder disease. Jt Dis Relat Surg 2025;36(2):415-419. doi: 10.52312/jdrs.2025.2000.
Idea/concept and design: M.F.T., M.Ç., U.K.; Data collection and/or processing: S.Y.,M.M.C.; Analysis and/or interpretation and control/supervision: M.F.T.,R.B., A.C.B., M.A.T.; Literature review: S.Y., M.M.C.; Writing the article: M.F.T., M.Ç., M.M.C.; Critical review: M.F.T., M.Ç., M.A.T., U.K.; References and fundings: R.B., S.Y.; Materials: M.F.T., A.C.B.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The authors received no financial support for the research and/or authorship of this article.
The data that support the findings of this study are available from the corresponding author upon reasonable request.