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Rehabilitation Practice and Science

Abstract

This narrative review outlines the current practices related to ultrasound-guided (USG) injection treatments for adhesive capsulitis (AC), including injection sites, approaches, medications, and doses.

USG procedures are increasingly accessible for AC, offering diverse injection approaches and medication dosing. Given the methodological variations in existing studies, a summary of current practices is essential. We conducted a narrative review of recent literature retrieved from computerized databases.

Glenohumeral (GH) and coracohumeral ligament (CHL) injections may improve outcomes for AC, with some evidence suggesting potential benefits of targeting the CHL. Subacromial bursa injections alone appear to be less effective. Multi-site injection techniques show promising outcomes compared to single-site approaches. Lower corticosteroid (CS) doses (20 mg) seem to achieve similar results to higher doses (40 mg). Suprascapular nerve block (SSNB) using both proximal and distal approaches demonstrates improvements in pain scores, while pulsed radiofrequency (PRF) combined with physical therapy leads to enhanced pain relief. Hydrodilatation (HD) provides quicker short-term recovery despite comparable six-month outcomes to other injection methods. Hypertonic saline HD has potential early benefits over normal saline. Platelet-rich plasma (PRP) injections exhibit encouraging preliminary results, though more USG studies are needed. Adalimumab could represent a potential future treatment option to be investigated.

In conclusion, a variety of USG- injection techniques exist for AC, with current evidence favoring CHL and GH injections using lower doses of CS. Other possible treatments could include SSNB, PRF, and PRP. However, methodological variations necessitate further research focusing on standardized protocols, long-term safety, and comparative treatment approaches

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