Adhesive capsulitis (AC) is a prolonged and distressing shoulder disease classified into 4 stages. It is well documented that an earlier diagnosis during the initial stages could lead to timeous therapeutic intervention, ultimately decreasing the duration of the disease. Diagnosis of AC is considered to be clinical in nature with MRI able to assist in a diagnosis during the later stages of the disease. Recent advances in the literature has suggested ultrasound to have significant potential in aiding an early diagnosis of the disease which ultimately served as motivation for this research. The aim of this study was, therefore, to establish the relationship between different ultrasound features and the clinical diagnosis of early AC (stage 1 and 2). Features evaluated are in accordance with pathophysiological changes associated with the disease and include hypoechoic changes seen in the rotator interval (RI) with B-mode imaging, increased vascularity in the RI with conventional Doppler methods, colour Doppler (CD) and power Doppler (PDUS), and thickening of the coraco-humeral ligament (CHL). There is, furthermore, paucity in the literature regarding the contribution of newly introduced advanced Doppler software in the form of superb micro vascular imaging (SMI) in demonstrating vascularity in the RI of patients clinically diagnosed with early AC, which further warranted this investigation. The study was conducted in two private settings in Tshwane, Gauteng with 40 participants clinically diagnosed with early AC included in the sample. The asymptomatic contralateral shoulder of all participants served as a control group in order to confirm the significance of the sonographic findings while also excluding involvement of the said asymptomatic shoulder. Data was collected in a methodical manner which is clearly stipulated in order to ensure reproducibility. A second rater evaluated all images to assess inter-observer reliability. Data was interrogated with the aid of descriptive statistics and cross tabulations, using the SPSS version 26 software package. Statistical analysis showed support for ultrasound changes in keeping with early AC (stage 1 and 2). Although vascular changes in the RI, associated with inflammation, can be demonstrated in some patients with conventional Doppler methods (CD and PDUS), advanced Doppler methods in the form of SMI is shown to be superior, especially during the 1st stage of the disease (symptoms < 3 months). B mode morphological changes seen in the RI of patients with early AC, can be demonstrated in most patients (70%), with the occurrence being slightly more prominent(72%) during the 2nd stage (symptoms 3 - 12 months). Lastly CHL thickening, due to fibroblastic changes, can be demonstrated on ultrasound with a suggested cut-off measurement of 1.8 - 2mm. By implementing the above mentioned criteria, as suggested from our study and the literature, it is evident that ultrasound can contribute substantially in the early diagnosis of this disease and subsequently aid in developing an expedited therapeutic management plan which can considerably decrease the duration of symptoms and profound disruptive effect on the lives of those who suffer from it.
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