- ‘Frozen shoulder’ (also known
as ‘adhesive capsulitis’) is a painful condition that causes restriction in the
shoulder joint. There are several causes- these can include traumatic injury
- One of the non-surgical
treatments for this is known as hydrodistension/ hydrodilatation. This involves
injecting the shoulder joint with large volumes of fluid to stretch the
shoulder capsule and disrupt adhesions (scar tissue), thereby freeing up the
joint. Corticosteroid, local anaesthetic and a large volume of sterile saline
is included as part of the procedure.
- There is good evidence that
hydrodistension provides benefits in reducing pain, improving range of movement
and function in ‘frozen shoulder’.
- It appears to be more
effective than corticosteroid injection alone and as effective as
manipulation-under-anaesthesia (MUA), with fewer complications.
- It can avoid the need for
surgery in some patients.
- Repeat injections may be required. It is common to have 2 hydrodistension injections in succession, approximately 2 weeks apart.
What does the procedure involve?
- Hydrodistension involves
stretching the capsule of the joint by injecting a mixture of corticosteroid, long-acting
local anaesthetic and sterile saline. The procedure takes about 30-45 minutes to complete and you will be able to go home immediately afterwards.
- You should have adequate
clear fluids to drink and consume a small meal an hour or two before the
procedure- this is to prevent dizziness or faints which can occur during or
after the procedure due to a combination of pain/ anxiety / excitement.
- You will be asked to lie on
your front (prone position) with your hand hanging over the side of the
procedure couch. The aid of gravity encourages the joint space at the back of
your shoulder to widen.
- The skin at the back of your
shoulder will be cleaned and short-acting local anaesthetic (Lidocaine)
injected under the skin to numb the area well for pain relief.
- Under ultrasound guidance for
accuracy, a sterile needle will be introduced into the shoulder joint via a
posterior approach. The joint is slowly distended with the combination of
sterile saline, long-acting local anaesthetic (Marcaine) and corticosteroid
Safety profile & possible risks:
- The procedure appears to be
very safe, with temporary pain during the procedure being the most common
- There may be temporary
discomfort for a few days after the injection.
- It is carried out under sterile conditions. The risk of infection is
very low (1 in 5,000 risk).
- There is a small risk of
bleeding. This procedure is contraindicated if you are taking high-dose
anti-coagulants such as Warfarin and will require further discussion beforehand
about how best to proceed. Aspirin is fine.
What happens following the procedure?
- Some people experience moderate discomfort due to the joint
distension- this can last up to several hours after the procedure. It is
therefore advisable you bring someone to take you home after the procedure (e.g.
adult friend/ family member).
- Please do not to drive or operate heavy machinery for a minimum of 6 hours
after the procedure.
- You should continue physiotherapy after the procedure and it is recommended
that you see your therapist approximately 2-3 days afterwards as the
hydrodistension procedure buys a ‘window of opportunity’ in which to progress
your physiotherapy rehabilitation. It is important to realise the success rate for
this treatment is significantly reduced without the physiotherapy component afterwards.
- Some patients will experience immediate relief. For others, it can
take a week to two weeks to achieve full benefit.
will be asked to return for clinic review 3-4 weeks later to monitor your
symptoms and progress.