TECHNICAL REPORT Targeted ultrasound-guided hydrodilatation via the rotator interval for adhesive capsulitis Philip Yoong & Stephen Duffy & David McKean & Nabil P. Hujairi & Ramy Mansour & James L. Teh Received: 2 September 2014 /Revised: 23 October 2014 /Accepted: 27 October 2014 # ISS 2014 Abstract Objective To describe and evaluate ultrasound-guided hydrodilatation via the rotator interval for the treatment of adhesive capsulitis. Materials and methods Patients referred to our department with adhesive capsulitis were consented for hydrodilatation. Inclusion criteria included a failure to respond to conservative treatment and the absence of full thickness rotator cuff tear. Twenty-one milliliters of a mixture of local anesthetic and steroid was injected into the rotator interval using a 21-gauge needle. Patients were followed up at 2 weeks and 4 months, with documented pain scores from 0 to 10 on a visual ana- logue scale and the Oxford Shoulder Questionnaire. Results Twenty-two patients were suitable for inclusion in the study. Nineteen were female (86 %) and three were male. The mean age was 55 years (range, 32–71 years). The duration of symptoms ranged from 4 weeks to 20 months. At 4 months, 19/22 (86 %) of patients described either complete (7/22) or good (12/22) improvement in their symptoms. The mean pain score was 8.4 prior to the procedure, 3.1 at 48 h and 1.9 at 4 months, and 20/22 (91 %) had a lower pain score after 4 months. There was a statistically significant (p <0.05) im- provement in the Oxford shoulder score, from a mean of 13.6 pre-procedure to 36.5 at 4 months. Conclusions The rotator interval and anterior joint capsule are strongly implicated in the symptomatology of adhesive capsulitis. The novel use of targeted ultrasound-guided hydrodilatation via the rotator interval gives good results in reducing shoulder pain and symptoms in adhesive capsulitis. Keywords Ultrasound . Shoulder . Interventional techniques . Adhesive capsulitis Introduction Adhesive capsulitis, or frozen shoulder, is a common condi- tion resulting in pain and global restriction of motion at the glenohumeral joint. There is inflammation, thickening, and contracture of the joint capsule [1]. It is often idiopathic, but there is an association with diabetes [2] and previous trauma [3]. There is a peak incidence between 40 and 60 years of age, with females more often affected [4–6]. It is primarily a clinical diagnosis, with night pain and significant loss of external rotation characteristic findings [7]. The typical natural history is of gradual resolution of symptoms over a 1 to 3-year period, which may or may not be complete [8]. The anterior capsule and rotator interval are primarily involved in adhesive capsulitis [9]. The rotator interval is a triangular space formed by the boundaries of the supraspinatus, subscapularis, and coracoid, in the anteromedial aspect of the shoulder (Fig. 1). It contains the intra-articular long head of biceps tendon, coracohumeral (CHL), and superior glenohumeral ligaments (SGHL) [10]. The rotator interval is believed to contribute to stability of the long head of biceps tendon and glenohumeral joint [11, 12]. The long head of the biceps tendon passes through the interval towards its insertion on the superior glenoid [13]. In the interval, the biceps tendon sheath is outside the joint capsule but continuous with the glenohumeral joint (i.e., extrasynovial and intra-articular). The floor of the interval is the SGHL and anterior joint capsule. The roof is formed by the CHL, a broad structure arising from the lateral aspect of the P. Yoong (*) Department of Radiology, Royal Berkshire Hospital, Reading, UK e-mail: philipyoong@gmail.com S. Duffy : N. P. Hujairi Department of Radiology, Norfolk and Norwich University Hospital, Norwich, UK D. McKean : R. Mansour : J. L. Teh Department of Radiology, Nuffield Orthopaedic Centre, Oxford, UK Skeletal Radiol DOI 10.1007/s00256-014-2047-7