Shoulder Hydrodilatation - A Highly Effective Treatment for Frozen Shoulder

Frozen Shoulder (also known as adhesive capsulitis) is a common cause of shoulder pain in patients aged 40-60 years old and affects women more than men. It usually presents with both pain as well as a marked reduction in shoulder range of motion in all planes of motion. If you are affected by this condition, it is also likely that you will have difficulties with using the shoulder on the affected side, reaching to the back, dressing, participating in sports and lying down on the affected shoulder. 

What causes Frozen Shoulder?

The cause of frozen shoulder is currently unclear, often arising seemingly out of the blue. However, it can also occur following a period of prolonged immobilization, such as wearing an arm sling for an extended time due to a fracture. While the exact cause remains uncertain, several factors may contribute to its development, including hormonal imbalances, autoimmune conditions, and genetic predisposition.

The pathology of frozen shoulder involves inflammation, fibrosis, and contracture of the capsule surrounding the shoulder joint, leading to pain and progressive loss of both active and passive range of motion. The condition follows a characteristic course, progressing through three stages: the painful stage, during which pain is the predominant symptom; the adhesive stage, characterized by increasing stiffness and loss of mobility; and the recovery stage, marked by gradual improvement in symptoms and function.

What is Shoulder Hydrodilatation?

Shoulder Hydrodilatation is a minimally invasive procedure procedure that is used to treat Frozen Shoulder. This procedure is usually performed under local anesthetic (with or without sedation). Under image guidance, a needle is inserted in to the shoulder joint and a large amount of fluids are given to distend the joint. The aim of this procedure is to stretch the joint capsule and reduce inflammation in the shoulder joint (and surrounding ligaments). Following this, the post-procedure care involves daily stretching of the shoulder joint. 

Generally, this procedure is well-tolerated and most patients respond well to this treatment. In a small number of cases, patients may require a second injection 3 months after the index injection. In most cases, patients will experience significant improvement 2 to 3 weeks after the procedure. ​

Frozen shoulder treated with image-guided Shoulder Hydrodilatation

When should one consider Shoulder Hydrodilatation?

It is important for one to understand that frozen shoulder is oftentimes a self-limiting condition. This means that even without treatment, it is likely for one to experience improvement over time. However, in the absence of treatment, frozen shoulder may take up to 2 to 3 years to resolve. Therefore, this procedure should be considered if you are experiencing:
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1. Pain affecting your quality of life
2. Marked reduction in range of motion, affecting your function
3. Complete recovery is important to you - Evidence suggests that frozen shoulder may not fully recover even after 2 to 3 years. Compared to physical therapy alone, hydrodistension has been shown to lead to more complete recovery. Therefore, individuals needing full shoulder movement, such as tennis players, may benefit from this procedure in the long term.

Dr Christopher Liu is a Pain Specialist based at Napier Pain Specialists with an interest in Musculoskeletal Pain. Please contact Napier Pain Specialists if you are suffering from Frozen Shoulder and are interested in finding out more about this procedure.