Modified Yoong Ultrasound-Guided Rotator Interval Injection for Adhesive Capsulitis: A 2-Year Follow-Up

Adhesive capsulitis (AC) is characterized by progressive fibrosis of the glenohumeral capsule, with the rotator interval (RI) as a key pathological site. Ultrasound-guided hydrodilation of the RI (Yoong technique) is an established intervention, but traversal of a thickened coracohumeral ligament (CHL) can be technically challenging and painful. This study reports preliminary 2-year outcomes of a modified technique targeting the subacromial-subdeltoid (SASD) bursa at the RI, combined with immediate postinjection manipulation.

A retrospective case series was conducted on 13 patients with AC in the frozen phase treated between January 2023 and September 2023 at a single sports medicine clinic. The modified technique involved ultrasound-guided SASD bursa injection (20 mL mixture: 4 mL 1% lidocaine, 15 mL 5% dextrose, 1 mL triamcinolone acetonide 40 mg) with mechanical fenestration of the CHL, followed by immediate shoulder manipulation. Outcomes included forward flexion, abduction, external rotation, Visual Analog Scale (VAS), and Quick DASH scores measured at baseline, 2, 12, 24, 52, and 104 weeks.

Mean age was 51.9 years (SD 7.52); 92.3% were female; 53.8% had diabetes. Significant improvements were observed across all outcomes (p < 0.001). Forward flexion improved from 76.6° (SD 6.3°) at baseline to 178.6° (SD 3.7°) at 104 weeks; abduction from 60.6° (SD 6.3°) to 178.8° (SD 2.7°); external rotation from 31.3° (SD 9.1°) to 78.0° (SD 3.6°). VAS decreased from 5.6 (SD 0.9) to 0 at 52 and 104 weeks. Quick DASH improved from 86.7 (SD 5.8) to 0.2 (SD 0.7) at 104 weeks. No complications were reported.

This modified SASD-targeted injection technique, combined with immediate manipulation, was associated with sustained pain relief and functional improvement over 2 years in a small cohort of AC patients.