Novel Treatment Option for Frozen Shoulder

Sonographically-Navigated Frozen Shoulder Release (S-FSR): A Modified Technique

Sonographically-Navigated Frozen Shoulder Release (S-FSR) is an advanced, minimally invasive, in-office technique for treating adhesive capsulitis (frozen shoulder). This approach uses real-time ultrasound imaging (sonography) to guide the injection of fluid into the shoulder joint capsule (hydrodilatation), targeting adhesions, inflammation, and stiffness with high precision. The technique is designed to improve range of motion, relieve pain, and restore shoulder function without requiring surgery.

Overview of the Modified Technique

S-FSR builds upon traditional hydrodilatation by integrating advanced sonographic guidance to precisely navigate the tight and fibrotic areas of the capsule. This ensures effective release of adhesions and targeted therapeutic delivery, all performed in an outpatient setting.

Key Steps in the S-FSR Procedure

1. Patient Evaluation and Positioning

  • Pre-Procedure Assessment:
    • The clinician evaluates the stage of adhesive capsulitis and confirms the diagnosis through clinical examination and imaging (e.g., ultrasound or MRI).
  • Positioning:
    • The patient is seated or reclined with the affected shoulder exposed. Proper positioning allows clear visualization of the shoulder joint on ultrasound and facilitates needle navigation.

2. Real-Time Ultrasound Imaging

  • The clinician uses a high-frequency ultrasound probe to map the anatomy of the shoulder joint, including the glenohumeral capsule, rotator cuff tendons, and surrounding neurovascular structures.
  • The tight, fibrotic areas of the joint capsule are identified, particularly in the rotator interval and axillary pouch, which are common sites of restriction in adhesive capsulitis.

3. Local Anesthesia

  • The skin and underlying tissues are anesthetized with a local anesthetic to ensure patient comfort during the procedure.

4. Ultrasound-Guided Needle Insertion

  • Under continuous ultrasound guidance, a fine needle is carefully inserted into the joint capsule.
  • Sonography ensures precise placement of the needle into the intra-articular space without causing damage to surrounding structures like the rotator cuff or labrum.

5. Hydrodilatation with Modified Technique

  • Solution Injection:
    • A therapeutic fluid mixture is injected into the joint, typically consisting of saline, local anesthetic, and sometimes corticosteroids or hyaluronic acid.
    • The injection is performed slowly, and the volume is gradually increased to distend the capsule and separate adhesions.
  • Dynamic Release:
    • Real-time ultrasound imaging allows the clinician to observe the distension and spreading of fluid within the joint.
    • The clinician may manipulate the shoulder to facilitate stretching and breaking of adhesions during the injection process.

6. Capsular and Pericapsular Treatment (Optional Enhancements)

  • Pericapsular Hydrodilatation:
    • Additional fluid may be injected into pericapsular spaces to target synovitis or areas of pericapsular restriction.
  • Adjunct Therapies:
    • Platelet-rich plasma (PRP) or prolotherapy may be administered for regenerative benefits, depending on the patient’s needs.

7. Post-Procedure Physical Therapy

  • Immediately after the procedure, the patient performs guided range-of-motion exercises to maximize the benefits of the capsular release and prevent re-adhesion.
  • Physical therapy continues in the following weeks to restore full mobility and strengthen surrounding musculature.

Advantages of S-FSR

1. Enhanced Precision

  • Real-time sonographic guidance allows the clinician to precisely locate the fibrotic regions of the capsule and deliver therapy where it is most needed.

2. Minimally Invasive

  • Performed entirely in an office setting with minimal discomfort and no need for general anesthesia or surgical intervention.

3. High Efficacy

  • The combination of hydrodilatation, ultrasound navigation, and post-procedure mobilization provides significant improvements in range of motion and pain relief.

4. Reduced Risks

  • The risk of complications, such as joint infection or injury to surrounding structures, is minimized with ultrasound visualization.

5. Cost-Effective and Convenient

  • As an outpatient procedure, S-FSR is more accessible and cost-effective than surgical options like arthroscopic capsular release.

Indications for S-FSR

  • Patients with primary adhesive capsulitis in the freezing or frozen stage.
  • Those with persistent shoulder stiffness that has not responded to physical therapy, oral medications, or corticosteroid injections.
  • Individuals seeking a minimally invasive alternative to surgery.

Potential Risks and Complications

While S-FSR is generally safe, possible risks include:

  • Temporary pain or swelling at the injection site.
  • Minor bleeding or bruising.
  • Rarely, joint infection or allergic reactions to the injected solution.

Expected Outcomes

  • Immediate Benefits: Improved range of motion and reduced pain are often observed within days.
  • Long-Term Benefits: With consistent physical therapy, patients typically experience sustained improvements in mobility and shoulder function over the following months.

Conclusion

Sonographically-Navigated Frozen Shoulder Release (S-FSR) represents a highly effective, patient-centered approach to managing adhesive capsulitis. By combining the precision of ultrasound imaging with the therapeutic benefits of hydrodilatation, this modified technique offers a minimally invasive solution for frozen shoulder, enabling patients to regain mobility and improve quality of life with minimal downtime.