Comparing non-surgical treatment strategies for adhesive capsulitis: A narrative review

Adhesive capsulitis is a debilitating shoulder disorder characterized by persistent pain and progressive restriction of motion due to fibrotic changes within the joint capsule. Although intra-articular corticosteroid injections are commonly used, variable outcomes have prompted interest in targeted injection techniques, alternative injectates, and non-invasive therapies. This narrative review summarizes findings from 49 randomized controlled trials evaluating non-surgical treatments for adhesive capsulitis, including corticosteroids, hyaluronic acid (HA), platelet-rich plasma (PRP), pulsed radiofrequency (PRF), extracorporeal shock wave therapy (ESWT), hydrodilatation (HD), suprascapular nerve block (SSNB), and targeted injection strategies based on anatomical involvement. Evidence suggests that targeting sites like the rotator interval or applying multimodal strategies may enhance early symptom relief. SSNB has also been explored as a pain-relieving adjunct to intra-articular injections. HA offers a steroid-sparing option with comparable long-term outcomes, while PRP may benefit chronic cases via regenerative effects. HD facilitates early mobility through mechanical capsular disruption, while ESWT and PRF offer alternative mechanisms targeting pain modulation and tissue restoration. Tailoring treatment to disease stage and anatomical involvement, rather than applying generalized approaches, may improve outcomes. Standardization of therapeutic protocols and further high-quality trials assessing long-term efficacy are essential to guide clinical decision-making in the management of adhesive capsulitis.