From the Research
Adhesive capsulitis (frozen shoulder) is characterized by thickening of the joint capsule, particularly in the rotator interval and axillary recess, decreased joint volume, and enhancement of the capsule with contrast on MRI, as demonstrated in a study published in 2023 1. The MRI findings for adhesive capsulitis include:
- Thickening of the joint capsule, particularly in the rotator interval and axillary recess
- Decreased joint volume
- Enhancement of the capsule with contrast
- T2-weighted images may reveal hyperintensity due to inflammation in early stages, while fibrosis appears as hypointensity in later stages
- Thickening of the coracohumeral ligament and articular capsule in the rotator cuff interval, as well as partial or complete obliteration of the subcoracoid fat triangle, are also characteristic findings, as reported in a study published in 2012 2
Treatment options for adhesive capsulitis include:
- Conservative approaches, such as NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for pain and inflammation
- Physical therapy, focusing on gentle stretching exercises to maintain and improve range of motion, typically 2-3 sessions weekly for 6-12 weeks
- Intra-articular corticosteroid injections, such as triamcinolone 40mg or methylprednisolone 40-80mg, which can provide significant pain relief, especially in the early inflammatory phase, as demonstrated in a meta-analysis published in 2017 3
- For persistent cases, more invasive options include hydrodilatation (capsular distension with saline and steroid), manipulation under anesthesia, or arthroscopic capsular release
It is essential to note that most cases of adhesive capsulitis resolve within 1-3 years even without treatment, but early intervention can significantly reduce this timeframe and improve outcomes, as the condition involves initial inflammation followed by fibrosis of the shoulder capsule, which explains why anti-inflammatory treatments work better in early stages while physical interventions may be needed for established fibrosis.