- ‘Frozen shoulder’ (also known
as ‘adhesive capsulitis’) is a painful condition associated with 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 a large volume 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.
- There are several ways of doing this procedure. For example, you may 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. Alternatively, you may be asked to lie on your side, with the painful shoulder pointing towards the ceiling and internally rotated.
- The skin at the back of your
shoulder will be thoroughly cleaned and sterilised. Short-acting local anaesthetic (Lidocaine) will initially be injected under the skin (subcutaneously) to numb the area well and provide pain relief.
- Using ultrasound to provide accurate guidance, a sterile needle will be introduced into the shoulder joint via a
posterior approach (from the back). The joint is then slowly distended with a 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 5,000-20,000 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 to clinic for a review 3-4 weeks later to monitor your
symptoms and progress.