Adhesive capsulitis hydrodilatation is a special type of frozen shoulder cortisone injection to treat pain and restriction of movement. But what is a frozen shoulder hydrodilatation injection, and do you need one?

What is a frozen shoulder? 

picture showing adhesive capsulitis

Frozen shoulder, also known as adhesive capsulitis, is a condition causing pain and stiffness in the ball and socket joint. It can develop over time and lead to a loss of functional arm use.

Generally, this condition is more common in women and people over 40. Also, diseases such as diabetes, heart disease, thyroid problems, and stroke increase the chances of developing a frozen shoulder. In addition, common shoulder conditions such as rotator cuff tear, dislocation, or calcific tendinitis can also lead to a frozen shoulder.

Symptoms of Frozen Shoulder 

Usually, people with a frozen shoulder report pain throughout the shoulder and restriction of movement. Simple activities like reaching overhead, undoing a bra strap, or putting on a belt can be extremely painful. Also, pain at night is typical and often disrupts sleep.

Restricted movement is not due to weakness of the shoulder muscles but the rigidity of the capsule. We think that the capsule becomes inflamed and rigid. So, not only can you not move your shoulder, but if someone else tries, they won’t be able to move it.

In general, most cases of frozen shoulder improve without treatment. However, waiting for this condition to improve spontaneously can take a few years. So, it would be best to consider seeking treatment rather than waiting for it to improve.

What should your doctor do?

You must see your doctor to confirm a diagnosis if you have a frozen shoulder.

Your doctor should examine your shoulder to confirm the diagnosis and exclude other conditions.

Unlike other conditions, a frozen shoulder has a reduced movement range in all planes. Also, we use imaging tests such as X-rays, ultrasound or MRI to exclude other causes, such as arthritis.

If you can pick up and treat a frozen shoulder in the early stages, you may be able to stop it from worsening. A recent study suggests improved outcomes of frozen shoulder if treated early.

What treatments are available for a frozen shoulder?

In the early stages, exercise can help improve the range of motion. Your therapist can teach you what exercises to do and what movements to avoid. Also, hands-on manipulation of the joint will help.

Anti-inflammatory tablets and pain relievers such as ibuprofen and codeine can help to reduce pain and allow you to continue the exercises. In some cases, cortisone injections into the shoulder can help.

Frozen shoulder hydrodilatation injection: Is it an option? 

steroid injection in shoulder of young women - cortisone shot done from the back of the shoulder

Generally, cortisone injections for frozen shoulder are helpful in the early or freezing stages to reduce pain and stop the progression. We have evidence that an injection can relieve pain for up to 4 months. Injections must be performed with ultrasound to improve the accuracy of the injection.

A frozen shoulder hydrodilatation or injection is a particular type of injection using a high volume of water with a cortisone injection. We think injecting a high volume into the joint leads to a build-up of pressure and a faster ‘thawing’ out of the frozen shoulder.

Also, studies suggest that an injection performed in the early stages of a frozen shoulder is more effective than the latter stages. For example, in this study on injections in frozen shoulder, subjects who received an injection in stage 1 recovered after 2-6 weeks compared to those in stage 2 who resolved after 7-12 weeks. So, early assessment and injeciton ensure a better effect.

Is a Frozen shoulder hydrodilatation better than a simple injection? 

We think so. We have some evidence for adhesive capsulitis hydrodilatation. Previous high-level studies showed little effect of a frozen shoulder hydrodilatation compared to a simple cortisone injection. However, a recent study says that a frozen shoulder hydrodilatation works much better and improves pain and range of motion than a simple cortisone injection. 

A shoulder hydrodilatation should be performed with ultrasound to improve accuracy and effectiveness.

Dr Masci performs these injections as a ‘one-stop’ injection solution.

Is the volume of fluid injected important for a successful frozen shoulder hydrodilatation?

Potentially yes. We can inject either a moderate volume (20-40mls) or a high volume (over 40mls). Often, high volumes rupture the capsule of the shoulder joint.

We think shoulder hydrodilatation with moderate volume stretches the capsule and is better than very high volumes that rupture the capsule. One study found that stretching the capsule is much better for pain and function than rupturing the capsule. 

So, aim for a moderate volume that stretches but doesn’t rupture the capsule.

Is a frozen shoulder hydrodilatation the same as a cortisone injection? 

Yes. Both injections have cortisone, but a hydrodilatation uses more volume to stretch the capsule while reducing inflammation.

Final word from Sportdoctorlondon about a frozen shoulder hydrodilatation 

Frozen shoulder is common in middle-aged people. Most cases do not have a triggering factor. Generally, frozen shoulder hydrodilatation works well to stop the progression of this disease. Treating your frozen shoulder early is essential to get the best results.

Other common shoulder conditions: