Hydrodilatation for Frozen Shoulder

 


Hydrodilatation for Frozen Shoulder: A Complete Guide to Treatment, Benefits, and Recovery

Frozen shoulder, also known as adhesive capsulitis, is a painful condition that restricts movement in the shoulder joint and can greatly impact daily life. While there are several treatment options available—from physiotherapy to corticosteroid injections—hydrodilatation for frozen shoulder has gained popularity as an effective, minimally invasive procedure that accelerates recovery.

In this comprehensive guide, we will explore what frozen shoulder is, how hydrodilatation works, its benefits, potential risks, and recovery expectations. Whether you are a patient researching your treatment options or a healthcare professional looking for detailed insights, this article will serve as a valuable resource.

What Is Frozen Shoulder?

Frozen shoulder is a condition where the shoulder joint capsule becomes thickened and stiff, leading to pain, reduced mobility, and significant functional limitations. It usually develops gradually and progresses through three stages:

  1. Freezing Stage – Pain increases, and shoulder movement becomes limited.

  2. Frozen Stage – Pain may decrease, but stiffness worsens, severely limiting mobility.

  3. Thawing Stage – Movement begins to improve slowly, and stiffness reduces.

The entire process can last anywhere from 12 to 36 months if untreated. Common causes include prolonged immobilization (e.g., after injury or surgery), diabetes, thyroid disorders, and sometimes no identifiable cause at all.

What Is Hydrodilatation?

Hydrodilatation—sometimes referred to as distension arthrography—is a minimally invasive procedure designed to stretch and expand the shoulder joint capsule. It involves injecting a combination of saline solution, local anesthetic, and often corticosteroids into the joint under imaging guidance, such as ultrasound or fluoroscopy.

The goal of hydrodilatation for frozen shoulder is to break adhesions, reduce inflammation, and restore mobility. By expanding the capsule, the joint gains more room to move, which directly translates into improved range of motion.

How Does Hydrodilatation Work?

The process typically involves the following steps:

  1. Preparation – The patient is positioned comfortably, and the skin is cleaned to maintain sterility.

  2. Imaging Guidance – Ultrasound or fluoroscopy is used to accurately locate the shoulder joint capsule.

  3. Injection – A mixture of sterile saline, corticosteroid, and anesthetic is injected into the capsule.

  4. Capsular Stretching – As the fluid fills the capsule, it gently stretches the tight joint structures.

  5. Post-Injection Movement – Patients are often encouraged to move the shoulder immediately after the procedure to maximize benefits.

The procedure usually takes less than 30 minutes and is performed on an outpatient basis, meaning patients can go home the same day.

Who Is a Candidate for Hydrodilatation?

Hydrodilatation is recommended for patients who:

  • Have been diagnosed with adhesive capsulitis.

  • Experience severe stiffness and pain unresponsive to conservative management.

  • Have tried physiotherapy or oral medications without significant improvement.

  • Prefer a minimally invasive alternative to surgery or manipulation under anesthesia.

Patients with uncontrolled diabetes, infection in the shoulder joint, or severe allergies to anesthetics may not be suitable candidates.

Benefits of Hydrodilatation for Frozen Shoulder

Hydrodilatation offers several advantages compared to other treatments:

1. Rapid Pain Relief

The corticosteroid component reduces inflammation and eases pain within days to weeks.

2. Improved Range of Motion

By physically stretching the capsule, the procedure provides immediate improvements in shoulder mobility.

3. Minimally Invasive

Unlike surgery, hydrodilatation does not require incisions, general anesthesia, or prolonged recovery.

4. Outpatient Procedure

It can be performed in a clinic or hospital radiology department, and patients return home the same day.

5. Faster Return to Activity

Most patients can resume normal activities much sooner compared to waiting for natural recovery or undergoing surgical interventions.

Risks and Side Effects

While generally safe, hydrodilatation may have potential side effects:

  • Temporary pain or discomfort at the injection site.

  • Swelling or bruising around the shoulder.

  • Allergic reaction to injected medication (rare).

  • Infection (very rare, as the procedure is performed under sterile conditions).

Serious complications are uncommon, and the benefits often outweigh the risks for patients struggling with severe frozen shoulder.

Hydrodilatation vs. Other Treatments

To better understand why many specialists recommend hydrodilatation, let’s compare it with alternative treatments:

Physiotherapy

  • Focuses on exercises to improve mobility and reduce stiffness.

  • Effective but may take months before significant improvement is seen.

  • Works best when combined with hydrodilatation.

Corticosteroid Injections

  • Reduce inflammation and pain but do not directly stretch the capsule.

  • Hydrodilatation combines steroids with mechanical stretching for superior results.

Manipulation Under Anesthesia (MUA)

  • Performed in the operating room under general anesthesia.

  • The shoulder is forcibly moved to break adhesions.

  • Higher risk of complications compared to hydrodilatation.

Surgical Capsular Release

  • Involves arthroscopic surgery to cut tight capsule tissue.

  • Reserved for severe cases unresponsive to less invasive measures.

  • Longer recovery period compared to hydrodilatation.

What to Expect After Hydrodilatation

Immediate Results

Many patients experience noticeable improvement in mobility immediately after the procedure, though some may feel temporary discomfort.

Physiotherapy

Post-procedure physiotherapy is crucial to maintain gains in mobility. Stretching and strengthening exercises should be performed daily.

Recovery Timeline

  • First Week: Pain relief and improved motion begin.

  • 2–6 Weeks: Continued improvement with physiotherapy.

  • 3–6 Months: Most patients regain significant shoulder function.

Long-Term Outcome

Studies show that hydrodilatation can shorten recovery time from several years (natural course) to just a few months.

Scientific Evidence Supporting Hydrodilatation

Multiple clinical studies have demonstrated the effectiveness of hydrodilatation:

  • A randomized controlled trial in BMJ Open found hydrodilatation provided faster pain relief and mobility gains compared to steroid injections alone.

  • Research published in Clinical Radiology showed patients had sustained improvement in shoulder function for up to a year post-procedure.

  • Meta-analyses suggest that when combined with physiotherapy, hydrodilatation delivers the most consistent and lasting results.

This evidence makes hydrodilatation a frontline recommendation for patients struggling with adhesive capsulitis.

Lifestyle Tips to Support Recovery

In addition to medical treatment, lifestyle adjustments can aid recovery:

  • Stay Active: Perform prescribed stretches and avoid immobilizing the shoulder.

  • Heat Therapy: Applying warm compresses can help loosen stiff tissues before exercises.

  • Ergonomic Adjustments: Modify workstations to reduce shoulder strain.

  • Healthy Diet: Anti-inflammatory foods like fish, nuts, and leafy greens can support healing.

  • Diabetes Management: Keep blood sugar levels controlled, as diabetes increases frozen shoulder risk.

Frequently Asked Questions (FAQs)

1. Is hydrodilatation painful?
Some patients experience mild discomfort during the injection, but local anesthesia minimizes pain. Afterward, temporary soreness is common.

2. How many sessions are needed?
Most patients require only one session, though some may benefit from a second procedure if symptoms persist.

3. Can frozen shoulder return after hydrodilatation?
Recurrence is rare, especially if patients continue physiotherapy and maintain shoulder activity.

4. How soon can I return to work?
Most patients return to light work within days and full activity within weeks.

Conclusion

Hydrodilatation for frozen shoulder is an effective, minimally invasive treatment that offers rapid pain relief and significant improvement in shoulder mobility. Compared to traditional approaches like physiotherapy alone or surgical options, it provides faster recovery with fewer risks. When combined with structured physiotherapy and lifestyle adjustments, hydrodilatation can help patients regain full use of their shoulder in a matter of months rather than years.

If you are struggling with adhesive capsulitis and conventional treatments have not worked, consult with your healthcare provider to see if hydrodilatation is the right option for you.