Hydrodistension Injection
For patients diagnosed with adhesive capsulitis (frozen shoulder), an effective and conservative treatment option is a hydrodistension/hydrodilatation injection.
What is a hydrodistension injection?
This injection involves a mixture of local anaesthetic, steroid and sodium chloride (saline). The injection is administered under ultrasound guidance to confirm the exact needle placement inside the joint capsule. The volume of fluid injected creates a distension effect within the shoulder joint which can be helpful for modest improvements in range of movement but very effective in reducing the pain associated with a frozen shoulder.
Am I an appropriate patient for a hydrodistension?
Firstly, you will have been diagnosed with a frozen shoulder by one of our specialists. This may include having a plain film x-ray initially to exclude any other causes of your stiff and painful shoulder. You will also have a preliminary diagnostic ultrasound scan to assess the integrity of the rotator cuff, as this needs to be intact for this injection to work well and create a distension effect. If this is not the case, alternative options will be discussed.
What is involved with the procedure?
There are a number of different ways to carry out this procedure successfully. The injection can be administered anteriorly at the level of the rotator cuff interval, but more commonly a posterior approach is often used. You will typically be side-lying with your painful shoulder closest to the ceiling.
The area will be marked, prepped and cleaned. Once the exact location is found using the ultrasound for guidance, a needle with local anaesthetic will be guided into the shoulder joint for both local anaesthesia and confirming accurate needle placement. Once confirmed, a further mix of local anaesthetic and steroid is injected into the shoulder joint, followed finally by sodium chloride (saline), which will produce a distension effect which can be clearly visualised on the live ultrasound images.
The quantity of medication used will vary slightly on a case-by-case basis as decided appropriate by the specialist. Most hydrodistension injections will fall between the quantities of 20-40ml of total injectate. This includes the combination of local anaesthetic, steroid and saline, which will account for the majority of the medication. Evidence has shown going above these levels carries no real added benefit to the patient.
It is Safe / What are the risks?
This is a minimally invasive procedure and is considered very safe. The procedure should take no more than 10 minutes in total and is well tolerated by patients. The risks are the same with any injection. Which include but are not limited to bleeding/bruising, infection, possible allergic reaction to the medication and persistence of symptoms/reoccurrence. For more information regarding the potential generic risks, please see our corticosteroid injection page.
Does it work?
Anecdotally, yes, we have carried out hundreds of these procedures over the last few years and have found that they are well tolerated and patients are usually very happy with the outcomes. The general consensus is that 75%+ of patients suffering from frozen shoulder will have a positive outcome, avoiding the need for any further intervention or surgery. You will be encouraged to comply with physiotherapy after the procedure to continue to improve your shoulder movements.
The remaining 25% may need a repeat injection if they have a partial response or if symptoms reappear, typically a few months later but usually with less severe symptoms. A small percentage of patients do not respond. These are more commonly the type 1 diabetic patients who typically present with more severe symptoms and joint contracture. At this stage their options would be an orthopaedic opinion for consideration of an arthroscopic capsular release, which is normally the definitive treatment; however, even with this there is a small risk of residual symptoms.
Please see the hyperlinks below highlighting the current evidence base for this procedure.
Efficacy of hydrodistension for frozen shoulder: A systematic review and meta-analysis – PMC
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