Adhesive capsulitis: the importance of early diagnosis and treatment

Abstract

Background: Adhesive capsulitis (AC), more commonly known as "frozen shoulder", is a painful shoulder condition. The illness progresses through three phases: freezing, frozen and thawing. A gold standard treatment for adhesive capsulitis is not defined. The goal of any treatment is to reduce pain and restore shoulder movement.

Objective: Objective of the present study is to evaluate the efficacy of gleno-humeral hydrodistension associated with physical therapy in patients with diagnosed adhesive capsulitis comparing the outcomes in term of pain and range of motion in patients with a phase 1 and a phase 2 disease.

Method: Between January 2022 and April 2023, We evaluated 87 patients with adhesive capsulitis, 47 were excluded for others concomitant pathologies, finally 40 patients were enrolled for the study, of whom 23 had capsulitis in stage 1 and 17 in stage 2. Patients were evaluated at baseline and at 2, 4 and 6 months after infiltration recording range of motion in all planes, pain and functionality scores.

Results: A significant improvement was recorded in shoulder range of motion in all planes with the except of extension in both groups. Phase 2 patients were able to regain shoulder range of motion in all planes except internal rotation which was recovered with more difficulty. Pain and functionality scores improved significantly between baseline and follow-up visits.

Conclusion: Ultrasound-assisted hydrodistention of the glenohumeral joint combined with targeted exercise has been successful in improving pain relief, reducing disability, and increasing range of motion in subjects with stage 1 and 2 adhesive capsulitis, especially if diagnosed before phase 2 (when the range of motion is completely reduced).

Keywords: Adhesive capsulitis; Early diagnosis; Hydrodistention; Rehabilitation; Ultrasound.

Fig. 1

Thickening of the coraco-humeral ligament

Fig. 2

Thickening of rotator interval (RI)

Fig. 3

Thickening of the inferior recess of the glenohumeral joint capsule (axially on the left and longitudinally on the right)

Fig. 4

Long head of the biceps tendon (LHBT) sheath effusion

Fig. 5

The folding of the infraspinatus tendon during passive external rotation

Fig. 6

Ultrasound-guided infiltrative treatment: hydrodistention of the gleno-humeral joint through a posterior access to the shoulder joint

Fig. 7

a–f Physiotherapy exercises with personal rehabilitation protocol (see text for details)