الفهرس 
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Abstract
Conclusion
There are a lot of studies that were made to determine the best treatment modality of adhesive capsulitis, desspite that there is no consenssus about that until now.We suppose this study will help physicians choose best treatment modality for each patient.
Despite the fact that the three modalities under study showed no significant difference in their effect , we can say that intraarticular hydrodilatation gave best results as regard improvement in pain and range of motion as well as the sustainability of its effect. Supracapular nerve lock is better used in patients where pain is the most predominent symptom, and in patients with bilateral adhesive capsulitis , it is also the easiest technique with the shortest duration .
While rotator interval hydrodilatation is an effective procedure, but we found it has less sustained effect as regard range of motion, beside being the hardest, most painful technique, least tolerable by the patient, and the one that took the longest duration, all these factors make it the least recommended procedure for treatmet.
Summary
Adhesive capsulitis is a unique disease process that is defined as a painful clinical condition associated with restricted active and passive range of motion (ROM) in all directions, including flexion, abduction, and rotation .it results from contraction of the glenohumeral joint capsule and adherence to the humeral head. Frozen shoulder was first described in 1934 by Codman. [1]
The incidence of adhesive capsulitis in the general population is about 5% but as high as 20% in patients with diabetes. [6, 7]
Contracture and decrease volume of the glenohumeral capsule is the hallmarkof adhesive capsulitis. extraarticular structures are also involved in the disease process such as the coracohumeral ligament, rotator interval, subscapularis musculotendinous unit, and the subacromial bursae. [3]
The pathophysiology of adhesive capsulitis is poorly understood. However it has long been considered to be a primarily fibrotic disorder. Now it is believed to involve an inflammatory as well as afibrotic process. [3]
Adhesive capsulitis is aclinical dianosis , mostly made with just clinical history and physical examination . It is characterised with progressive loss of range of motion and shoulder pain. It is often a diagnosis of exclusion. Imaging studies are not necessary for the diagnosis of adhesive shoulder capsulitis but may be helpful to exclude other causes of a painful and stiff shoulder. [2]
There is a wide spectrum of treatment options available, both surgical and non-surgical. They all have proved effectiveness. However it should be noted that none of the current therapeutic options are universally accepted as the most effective in restoring symptoms in patients with FS. [83] [85]
Common nonsurgical treatments include medication, physical therapy, exercise, manipulation under anesthesia, steroid injection , hydrodilation or nerve blockers which can provide temporary relief of symptoms
Surgical methods include open or arthroscopic capsular release, which improve the shoulder range of motion and alleviate pain but leave other complications. [86]
That is why the object of this study was to compare between the effect of: suprascapular nerve block, hydrodilatation of shoulder capsule and hydrodilatation of shoulder interval as regard improvement in pain, function and range of motion in patients with frozen shoulder, also to determine the carry on effect of each modality, and to determine which modality is best used for each patient.
We included 54 patients diagnosed as adhesive capsulitis in our outpatient clinic. We randomly divided the patients into 3 groups according to type of intervention. The patients in the first group received ultasonographic guided suprascapular nerve block with 10 ml of 0.5% bupivacaine, The patients in the second group received intra-articular hydrodilatation with first lidocaine (10 ml 1%) is injected in the glenohumeral joint followed by 20 ml of 0.9%sodium chloride, The patients in the third group received shoulder interval hydrodilatation with first lidocaine (10 ml ) is injected in the shoulder interval followed by 20 ml of sterile water slowly. Patients assessment and clinical data was documented at 0 (baseline), just after intervention and 12 weeks after intervention that included: VAS (visual auditory assessment) on a scale of 0-100, Active and passive range of motion measurement including; external and internal rotation, forward flexion and abduction, Evaluation of pain and disability by (SPADI) score .
We found that the patients in the three groups showed highly significant improvement in pain and range of motion, there was no significant difference between their effects. We also found that intraarticular hydrodilatation gave best results as regard improvement in pain and range of motion as well as the sustainability of its effect. Supracapular nerve lock is better used in patients where pain is the most predominent symptom, and in patients with bilateral adhesive capsulitis , it is also the easiest technique with the shortest duration .While rotator interval hydrodilatation is an effective procedure, but we found it has less sustained effect as regard range of motion, beside being the hardest, most painful technique and the one that took the longest duration, all these factors make it the least recommended procedure for treatmet.