Ultrasound in Adhesive Capsulitis: A Narrative Exploration from Static Imaging to Contrast-Enhanced, Dynamic and Sonoelastographic Insights.
Journal
Diagnostics (Basel, Switzerland)
Journal Volume
15
Journal Issue
15
Start Page
1924
ISSN
2075-4418
Date Issued
2025-07-31
Author(s)
Abstract
Adhesive capsulitis is a painful and progressive condition marked by significant limitations in shoulder mobility, particularly affecting external rotation. Although magnetic resonance imaging is regarded as the reference standard for assessing intra-articular structures, its high cost and limited availability present challenges in routine clinical use. In contrast, musculoskeletal ultrasound has emerged as an accessible, real-time, and cost-effective imaging modality for both the diagnosis and treatment guidance of adhesive capsulitis. This narrative review compiles and illustrates current evidence regarding the role of ultrasound, encompassing static B-mode imaging, dynamic motion analysis, contrast-enhanced techniques, and sonoelastography. Key sonographic features-such as thickening of the coracohumeral ligament, fibrosis in the axillary recess, and abnormal tendon kinematics-have been consistently associated with adhesive capsulitis and demonstrate favorable diagnostic performance. Advanced methods like contrast-enhanced ultrasound and elastography provide additional functional insights (enabling evaluation of capsular stiffness and vascular changes) which may aid in disease staging and prediction of treatment response. Despite these advantages, the clinical utility of ultrasound remains subject to operator expertise and technical variability. Limited visualization of intra-articular structures and the absence of standardized scanning protocols continue to pose challenges. Nevertheless, ongoing advances in its technology and utility standardization hold promise for the broader application of ultrasound in clinical practice. With continued research and validation, ultrasound is positioned to play an increasingly central role in the comprehensive assessment and management of adhesive capsulitis.
Subjects
contrast-enhanced ultrasonography
dynamic examination
frozen shoulder
sonoelastography
sonography
Type
review