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Case Study: Diagnosing Adhesive Capsulitis (Frozen Shoulder) with High-Resolution Ultrasonography

Our Patient


The patient is a middle-aged male who came to us complaining of shoulder pain so severe that he could not sleep on the affected side. The patient’s shoulder range of motion was significantly reduced.

Our Diagnostic Approach


We examined the patient’s shoulder region using high-resolution ultrasound imaging and found classic indicators of adhesive capsulitis, aka frozen shoulder syndrome.

The ultrasound exam revealed:

  • Thickening of the joint capsule
  • Thickening of the cortical-humeral ligament
  • Fluid in the synovial recess
  • Changes in collagenous tissue architecture

Our Treatment Approach


We treated the patient’s shoulder with defocused shockwave therapy and INDIBA radiofrequency therapy, using different resistive and capacitive electrodes and varying frequencies. In just two weeks, we were able to successfully restore the patient’s shoulder range of motion and eliminate his shoulder pain.

Discussion


Conventional treatment for adhesive capsulitis is physical therapy, but physical therapy alone rarely produces fast or satisfactory results, and patients often suffer from the condition for a year or longer before it self-resolves.

At NYDNRehab, our clinical expertise and advanced technologies equip us to provide fast and effective results in a fraction of the time of conventional physical therapy.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

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Complete tear of rectus femoris
with large hematoma (blood)

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Separation of muscle ends due to tear elicited
on dynamic sonography examination

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