Ultrasound-detected shoulder architectural adaptations following exercise training in patients with adhesive capsulitis: a randomized controlled trial.

BACKGROUND: Adhesive capsulitis is a disabling shoulder disorder characterized by pain, progressive loss of range of motion, and functional impairment AIM: To evaluate the effects of a structured exercise training program on shoulder architecture, pain, range of motion, function, and kinesiophobia in individuals with adhesive capsulitis. METHOD: In this randomized controlled trial, individuals aged 35-65 years with adhesive capsulitis were allocated to either a conventional physiotherapy group or a structured exercise training group in addition to conventional treatment. Assessments were performed at baseline and after 15 treatment sessions over three weeks. Ultrasonographic measurements of the coracohumeral ligament, supraspinatus tendon, infraspinatus tendon, long head of the biceps tendon, and deltoid fascia were defined as primary outcomes. Secondary outcomes included pain (Short-Form McGill Pain Questionnaire), active shoulder range of motion, upper extremity function (QuickDASH), and kinesiophobia (Tampa Scale of Kinesiophobia). Effect sizes, standard error of measurement, and minimal detectable change values were calculated to support clinical interpretation. RESULT: Participants in the structured exercise group demonstrated significantly greater improvements in ultrasonographic parameters (p<0.001), shoulder range of motion (p<0.001), pain intensity (p<0.001) and kinesiophobia (p<0.001) compared with the control group. These changes were associated with large effect sizes and exceeded established SEM and MDC thresholds. Functional outcomes improved in both groups, without a significant between-group difference (p>0.005). CONCLUSION: Short-term structured exercise training resulted in clinically meaningful structural and clinical improvements in patients with adhesive capsulitis. Ultrasonography appears to be a valuable method for detecting rehabilitation-related adaptations in periarticular shoulder tissues.