Preliminary clinical and structural outcomes of a standardized ultrasound-guided diagnostic and interventional protocol for refractory adhesive capsulitis.

INTRODUCTION

Adhesive capsulitis is common and often prolonged condition characterized by pain and progressive restriction of glenohumeral motion, with a substantial proportion of patients experiencing persistent symptoms and functional limitations. Despite the wide range of available treatments, clinical outcomes remain variable, reflecting heterogeneity in both diagnostic approaches and therapeutic strategies.

OBJECTIVE

To describe the short-term clinical and sonographic evolution following a standardized ultrasound guided diagnostic and interventional pathway combining suprascapular nerve block and glenohumeral hydrodilatation in patients with refractory adhesive capsulitis.

METHODS

This study is a retrospective analysis of a prospectively maintained clinical database of patients managed within a standardized care pathway in a tertiary musculoskeletal interventional unit between December 2023 and April 2024. Patients with clinically and sonographically confirmed refractory adhesive capsulitis who underwent the combined protocol were included. Pain intensity, shoulder range of motion, and ultrasound-measured capsular thickness were recorded at baseline and at 3-months. Routine clinical follow-up was available for up to 12 months.

RESULTS

16 patients with confirmed adhesive capsulitis underwent the combined intervention. At 3 months, pain scores and range-of-motion measurements had improved compared with baseline, and ultrasound assessment demonstrated a reduction in inferior glenohumeral capsular thickness. No major procedural complications were documented. During routine clinical follow-up to 12 months, no recurrence was documented; one patient had persistent residual symptoms attributed to concomitant calcific tendinopathy.

CONCLUSION

In this small uncontrolled cohort, a standardized ultrasound-guided pathway was followed by clinically meaningful improvements in pain and shoulder mobility and by a reduction in capsular thickness at 3 months. The parallel clinical and sonographic changes observed in this refractory population support further investigation of this integrated pathway. Although causality and the independent contribution of individual procedural components cannot be established, these preliminary findings provide a rationale for prospective controlled evaluation with blinded outcome assessment.