What is Frozen shoulder/Adhesive Capsulitis?

Frozen shoulder is an extremely painful condition in which the shoulder is completely or partially unmovable (stiff). It is one of the most painful conditions of the shoulder it often starts without any reason, or a minor injury to the shoulder it has been known to develop after shoulder surgery. It is more common in patients with diabetes and hypothyroidism.

The condition usually goes through three stages, (stage 1) starting with pain (stage 2) pain and stiffness and finally (stage 3) stiffness and slow return of movement. This process can take a long time and has sometimes been known to take as long as two years and longer.

The shoulder joint has a capsule around it, it is normally a stretchable elastic structure. it allows the shoulder to move freely. With a frozen shoulder this capsule (and its ligaments) becomes inflamed, painful and contracted. This normal elasticity is lost and pain and stiffness set in.

What is Shoulder Hydrodistension?

Ultrasound guided hydrodistension involves an injection into the shoulder joint using ultrasound to accurately guide the needle into the shoulder joint. Firstly with local anaesthetic followed by a small amount of corticosteroid then a large amount of saline (water). The purpose of the procedure is to settle down any inflammation and pain and stretch out the stiff/contracted capsule.

The injected fluid can be seen to expand the joint capsule, thereby opening or freeing up the joint allowing for improved range of movement. The current evidence suggests it is as effective as manipulation-under-anaesthesia (MUA), with less complications.

Why have I been offered this treatment?
Your specialist has diagnosed frozen shoulder and you will have usually failed other conservative management options initially.
What is involved?
Shoulder hydrodistension involves stretching the capsule of the shoulder joint by injecting local anaesthetic, corticosteroid and saline into the joint. This open up the joint allowing improved range of movement and significant improvements in pain control.

It takes around 15 minutes, you will be asked to lie on your side with your arm by your side. The skin around the shoulder will be cleaned with sterilising fluid. a fine needle will be guided into the shoulder joint under ultrasound guidance, anaesthetic will be injected to ensure safe positioning and pain relief followed by steroid and saline.

It is safe?
It is a safe procedure. there is a very small risk of infection, as with any joint injection. There is a risk that it may not work (in about 30%). There is a small risk of bleeding. you must inform the team if you are taking anti-coagulants e.g Warfarin. In some cases the capsule can rupture with the distension this does not detrimentally affect the long term outcome of the procedure.
What can I expect to feel during and after the procedure?
Once the area is numbed from local anaesthetic you should feel very little. There may be some pushing and pressure sensation. If you feel discomfort please let our clinician know.
What happens after the procedure?
Some people do have moderate discomfort, which can last for an hour or so after the procedure, due to the distension. It is advised that you bring along someone to drive you home after the procedure, as we would advise that you do not drive or work until the next day. You should continue physiotherapy exercises following the procedure.
Does it work?
Success rates are reported at over 70% in improving the movement of the shoulder and over 90% in improving pain. Many people feel immediate relief, but for some it can take a couple of weeks to achieve full benefit.
What if it fails?
Your clinician will discuss the option of a surgical opinion which would involve a keyhole surgical release (arthroscopic Arthrolysis) or MUA (Manipulation under Anaesthetic). We have some excellent connections with some of the leading orthopaedic consultants in this area.

Conditions Used for


Frozen Shoulder

*We advise a recent x-ray of the shoulder prior to this procedure. We can organise if this has not already been done.




Josh Wheatley

MSc Phys, MCSP, HCPC, PgD Med Ultrasound, Independent Prescriber


Michael Bryant

Consultant MSK Physiotherapist, Sonographer, Independent Prescriber