<p>Adhesive capsulitis (AC), or frozen shoulder, remains a challenging musculoskeletal disorder, particularly in diabetic and postoperative populations. These groups often experience more severe fibrosis, altered healing responses, and suboptimal therapeutic outcomes, underscoring the need for tailored management. Ultrasonography has become central in both diagnosis and treatment, offering dynamic assessment of capsular thickening, vascular changes, and scar tissue, as well as precision guidance for injections, hydrodilatation, and nerve blocks. Advanced modalities, including elastography and superb microvascular imaging, enhance early detection and differentiation of tissue pathology. For diabetic patients, therapeutic strategies must integrate metabolic optimization with image-guided interventions to address tissue friability and neuropathy. In postsurgical cases, ultrasound facilitates scar quantification and targeted therapies to restore function. Beyond current applications, the integration of quantitative ultrasound parameters, artificial intelligence, and telehealth is anticipated to create intelligent, closed-loop “diagnose–treat–monitor” frameworks. Such innovation offers opportunities to personalize therapy, streamline clinical decision-making, and improve outcomes in vulnerable populations. This review synthesizes emerging imaging advances and subgroup-specific strategies, highlighting a pathway toward precision, technology-enabled care in AC.</p>