Is there an additional benefit of ultrasound-guided coracohumeral ligament hydrorelease in cases with primary adhesive capsulitis undergoing ultrasound-guided shoulder hydrodilatation?

Objective: Primary adhesive capsulitis (AC) of the shoulder is a chronic, painful condition characterized by progressive restriction of shoulder range of motion. While conservative management remains the first-line treatment, its efficacy is sometimes limited, prompting exploration of adjunctive interventions. Recent studies have highlighted the effectiveness of hydrorelease of the coracohumeral ligament (CHL) in improving shoulder mobility. This study aimed to evaluate whether ultrasound-guided hydrorelease of the CHL confers additional clinical benefit in patients with shoulder AC undergoing ultrasound-guided hydrodilatation.

Methods: Patients diagnosed with primary AC were randomly assigned to one of two groups. Group 1 received both ultrasound-guided hydrodilatation and CHL hydrorelease, while Group 2 received ultrasound-guided hydrodilatation alone. Clinical evaluations were conducted at baseline, immediately post-injection, and at 1 week, 1 month, and 3 months post-injection. Outcome measures included the Visual Analog Scale (VAS) for pain, shoulder range of motion (ROM) (including flexion, abduction, internal rotation, and external rotation), and the Shoulder Disability Index (SDI).

Results: Both groups demonstrated significant improvements from baseline in pain intensity, shoulder ROM and SDI scores at all follow-up time points. However, no statistically significant differences were observed between the two groups regarding the magnitude of improvement in any of the evaluated parameters.

Conclusion: Ultrasound-guided hydrodilatation is effective in reducing pain, improving shoulder range of motion and function in patients with primary AC. However, the addition of CHL hydrorelease does not appear to provide further benefit in terms of pain relief, range of motion, or functional outcomes. Key Points •Ultrasound-guided hydrodilatation therapy is an effective treatment choice for primary adhesive capsulitis of the shoulder. •Patients receiving hydrodilatation treatment do not benefit further from applying hydrorelease to the coracohumeral ligament.