Intractable Frozen Shoulder Unresponsive to Steroid Injections and Exercise

Frozen shoulder, also known as adhesive capsulitis, is a shoulder joint disorder characterized by decreased range of motion without abnormalities on simple radiographs.Pathologically, it involves inflammatory changes and fibrosis of the joint synovium, leading to contracture of the synovial joint of shoulder.The stages of frozen shoulder progress through inflammatory, freezing, frozen, and thawing stages, each requiring different therapeutic approaches.While initial stages may respond to conservative treatments like NSAIDs, steroid injections, and exercises, more advanced stages often require interventions such as scapular nerve blocks, hydrodistension, and manipulation under anesthesia.Among these, ultrasound-guided hydrodistension is highlighted as an effective and safe method, combining potent anti-inflammatory effects with mechanical expansion of the contracted capsule.Clinicians should review the efficacy and safety of various interventional treatments for frozen shoulder, considering the importance of selecting appropriate methods based on the clinical stage of frozen shoulder.(Clinical Pain 2024;23:61-65)