200 Section - Diagnostic Ultrasound Grading of Adhesive Capsulitis in Bangladesh: A Collaborative Approach

Objectives :
To establish a standardized ultrasound-based grading system for adhesive capsulitis (frozen shoulder) and evaluate its clinical relevance in the Bangladeshi healthcare context through a collaborative effort between the Departments of Physical Medicine and Radiology & Imaging at Bangladesh Medical University.

Design: Descriptive cross-sectional study involving adult patients clinically diagnosed with adhesive capsulitis. Musculoskeletal ultrasound (MSK US) was performed using high-frequency linear transducers to measure the coracohumeral ligament (CHL), inferior glenohumeral ligament (IGHL), and axillary recess. The findings were graded according to predefined sonographic criteria correlated with clinical stages.

Results: The study proposed a four-stage ultrasound grading system for adhesive capsulitis:

Stage I (Pre-adhesive): CHL ≤3 mm, mild hypoechogenicity, early vascularity.

Stage II (Freezing): CHL >3 mm, axillary pouch 3–4 mm, persistent Doppler flow.

Stage III (Frozen): CHL/IGHL >4 mm, fibrotic axillary pouch, absent Doppler signal.

Stage IV (Thawing): Reduced ligament thickness, improved distensibility, absent vascularity.
Correlation between ultrasound stage and clinical limitation was consistent in over 90% of cases. The collaborative assessment between PM&R and Radiology improved diagnostic confidence and inter-observer reliability.

Conclusion: Diagnostic ultrasound is a valuable, accessible, and non-invasive method for grading adhesive capsulitis. The proposed four-stage grading model provides a practical framework for clinicians to align imaging findings with clinical management. Collaborative practice between rehabilitation specialists and radiologists enhances diagnostic precision and promotes integrated care for patients in resource-limited environments.