The Frozen Shoulder Treatment You've Probably Never Heard of

Hydrodilatation (HD) or hydrodistention is a potential conservative treatment option for individuals with frozen shoulder. During the procedure, a radiologist injects fluid into the shoulder joint capsule to distend it. The goal is to gradually stretch the capsule to restore normal joint volume. Your GP or sports medicine doctor can refer you to a specialist who does hydrodilatation.


Ultrasound guided hydrodilatation procedure for frozen shoulder

What is a frozen shoulder?

Adhesive capsulitis is a relatively common shoulder condition characterized by stiffness, pain and limited shoulder range of motion. It tends to affect women more than men, typically between the ages of 40-60 years. According to rough estimates it can affect 2-5% of the population. The three main phases of frozen shoulder is often referred to as 1. Freezing, 2. Frozen and 3.Thawing.


Early diagnosis is quite difficult, as it usually develops gradually, and mimics other shoulder conditions in the first stages. The degree of frozen shoulder, functional shoulder range loss, and length of recovery varies from person to person. It can last anywhere between 6-18 months. Treatment options are surprisingly limited: physiotherapy for pain management, daily exercise program, anti-inflammatory medications, steroid injections, in rare cases surgical interventions. Hydrodilatation is a lesser known option to alleviate SOME of the range of motion restrictions and pain as a result of frozen shoulder.


What’s injected during the HD procedure?

Typically a combination of 30-60 ml of saline, corticosteroid and local anesthetics are injected.


Proposed benefits

  • Most patients will have immediate (within the first 1-4 weeks) improvement in pain, range of motion and function

  • But no prognostic indicator of who will do well and who won't improve as much

  • Best long term results are achieved by a combination of HD + physiotherapy


Who would benefit from it

  • Both primary and secondary frozen shoulder cases

  • Typically patients in stage 2 and 3 (frozen and thawing phase)

  • Any patient who is unresponsive to conservative treatment

  • Or in whom watchful waiting is impractical


Physiotherapy treatment following HD

After the initial 3-5 days, book a session with a physiotherapist who is familiar with the procedure. If tolerated, manual techniques can be performed for pain modulation and for stretching the shoulder. The therapy focuses on exercises stretching the anterior shoulder capsule.



After the first 2 weeks, the initial exercises can be progressed based on tolerance. At this point some form of strengthening (isometric or isotonic) may be commenced. Every case will vary, some progress faster than others. In addition to the sample exercises shown on the video, scapulothoracic strengthening will also take place.



Is hydrodilatation the silver bullet treatment?

Unfortunately, there is usually no silver bullet or magic pill. Will it heal frozen shoulder? No. Will it help to improve the range and pain? In most cases- YES. Given the amount of functional limitations and pain some individuals with frozen shoulder can experience, HD is great option.


Have questions? Contact us.


If you have found this post useful, please email, share and spread the word!


Thank you,

Orsi & Hayley


References:

Watson, Lyn, et al. "Hydrodilatation (distension arthrography): a long-term clinical outcome series." British journal of sports medicine 41.3 (2007): 167-173.


Rymaruk, S., and C. Peach. "Indications for hydrodilatation for frozen shoulder." EFORT open reviews 2.11 (2017): 462-468.


Jain, Tarang K., and Neena K. Sharma. "The effectiveness of physiotherapeutic interventions in treatment of frozen shoulder/adhesive capsulitis: a systematic review." Journal of back and musculoskeletal rehabilitation 27.3 (2014): 247-273.



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