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Modified Yoong Ultrasound-Guided Rotator Interval Injection for Adhesive Capsulitis: A 2-Year Follow-Up
Azwan Aziz Mohamad1, Norlelawati Mohamad1, Muhammad Karbela Reza Ramlan1
1Department of Orthopedic and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Wilayah Persekutuan Kuala Lumpur, Malaysia.
Orthopaedic Surgery
|August 5, 2026
Summary
A new ultrasound-guided injection technique targeting the subacromial-subdeltoid bursa improved shoulder function and reduced pain in adhesive capsulitis patients. This modified approach, combined with manipulation, showed sustained benefits over two years.
Area of Science:
- Orthopedics
- Sports Medicine
- Regenerative Medicine
Background:
- Adhesive capsulitis (AC) involves shoulder capsule fibrosis, with the rotator interval (RI) being a key pathological area.
- Ultrasound-guided hydrodilation of the RI is effective but can be challenging due to the thickened coracohumeral ligament (CHL).
Purpose of the Study:
- To evaluate the 2-year outcomes of a modified ultrasound-guided technique targeting the subacromial-subdeltoid (SASD) bursa at the RI in AC patients.
- To assess the efficacy of combining SASD bursa injection with immediate post-injection manipulation.
Main Methods:
- A retrospective case series of 13 frozen-phase AC patients.
- Modified technique: Ultrasound-guided SASD bursa injection (lidocaine, dextrose, triamcinolone acetonide) with mechanical fenestration of the CHL.
- Immediate shoulder manipulation followed by outcome assessment at various intervals up to 104 weeks.
Main Results:
- Significant improvements (p < 0.001) in forward flexion, abduction, and external rotation.
- Mean forward flexion improved from 76.6° to 178.6°, abduction from 60.6° to 178.8°, and external rotation from 31.3° to 78.0° at 104 weeks.
- Visual Analog Scale (VAS) pain scores decreased from 5.6 to 0, and Quick DASH scores improved from 86.7 to 0.2 at 104 weeks; no complications reported.
Conclusions:
- The modified SASD-targeted injection technique combined with immediate manipulation offers sustained pain relief and functional recovery in AC patients.
- This approach provides a viable alternative for managing adhesive capsulitis, particularly when the coracohumeral ligament presents a challenge.