Ultrasound-guided intervention in adhesive capsulitis: A comprehensive review of therapeutic strategies

Adhesive capsulitis is a painful and disabling shoulder condition characterized by progressive synovial inflammation, capsular fibrosis, and global restriction of motion. Conventional treatment strategies, including physical therapy and landmark-guided intra-articular corticosteroid injection, often yield variable outcomes. Ultrasound-guided interventions have emerged as a precision-based therapeutic approach, enabling real-time visualization of pathological structures, accurate needle placement, and dynamic assessment of capsular mechanics. This narrative review summarizes current evidence on ultrasound-guided corticosteroid injection, hydrodilatation, coracohumeral ligament-targeted procedures, suprascapular nerve block, and silent manipulation under cervical nerve root block. Across studies; injection target, injectate composition, and mechanical distension strategy appear to influence short-term pain relief and functional improvement. Rotator interval-targeted injections and coracohumeral ligament release specifically address anterior capsular contracture and loss of external rotation. Hydrodilatation provides mechanical capsular expansion, although superiority over corticosteroid injection alone remains inconsistent. Suprascapular nerve block primarily facilitates early analgesia to support rehabilitation, whereas silent manipulation restores mobility through structured capsular release under ultrasound-guided anesthesia. Collectively, contemporary evidence supports a shift from uniform application of technique toward stage-specific, structure-oriented, and pathology-driven management. Integration of dynamic ultrasound assessment into treatment planning may further refine patient selection and optimize long-term functional recovery. Future investigations should focus on long-term durability, optimal injectate parameters, and individualized intervention algorithms.