Hydrodistension Injections
This procedure is increasingly used in the treatment of ‘frozen shoulder’ and has been shown to give pain relief and also help regain movement
What is Hydrodistension?
Hydrodistension or also called hydrodilatation is a nonsurgical injection procedure that aims to stretch tight joint capsule. Is mostly used to manage frozen shoulder or adhesive capsulitis
In conditions like frozen shoulder, the soft tissue surrounding the joint (the joint capsule) becomes thick, inflamed, and tight, preventing normal movement. Hydrodistension involves injecting a high volume of sterile fluid (In addition to local anaesthetic and steroid) into this tight space.
Ultrasound-guided hydrodistension to manage frozen shoulder
For those who have been diagnosed with frozen shoulder/adhesive capsulitis hmight have been recommended ultrasound-guided hydro distention of the shoulder.
This page explains the procedure, the research behind its success, and how it compares to other treatments.
Benefits of Hydrodistension
Multiple studies identified specific benefits of Hydrodistension:
- Pain relief: Hydrodistension plus routine treatments showed superior analgesic effects compared to other interventions.
- Range of motion: Passive external rotation improvements were noted both short and long-term.
- Practical advantages: Hydro dilatation was considered preferable over manipulation under anaesthesia due to lower cost and better patient convenience.
- Combined therapy benefits: When followed with (physiotherapy) manipulation, intra-articular injection achieved 94.6% total effective rate at 12 months, with significantly lower pain scores and higher function scores compared to injection alone or local steroid injection.
The Procedure: Step-by-Step
This is an outpatient procedure, meaning you walk in and walk out the same day. It typically takes 20 minutes.
1. Preparation
You will sit or lie down comfortably. The radiologist or doctor will scan your shoulder with ultrasound to identify the best entry point.
2. Cleaning of the skin
The skin is cleaned with chlorhexidine to provide deep cleaning of the to be injected joint. Patient is explained the sensation I might expect during the procedure.
3. The Injection
Under ultrasound Guidance, the needle is brought into the joint. A solution is injected, usually containing:
Saline (Sterile Water): The main volume used to stretch the capsule.
Steroid: To powerfully reduce inflammation (synovitis).
Anaesthetic: To numb the inside of the joint.
4. The Sensation
As the fluid fills the joint, you will feel a strong pressure or a “fullness” in the shoulder. This is the capsule being stretched. It can be uncomfortable, but rarely painful.
The success of this procedure also depends on what you do after you leave the clinic.
- Immediate Movement: Your shoulder will feel numb and potentially “heavy” for a few hours. Try to continue using the arm and avoid holding it still.
- Exercise therapy: You should start exercising the shoulder very soon after the injection usually within a day or so. This is to capitalise on the increased range of motion obtained during the procedure.
- Pain Management: You may feel a “bruised” soreness for a day or two after the local anaesthetic wears off. Ice packs and paracetamol are usually sufficient to manage this.
While safer than surgery, no procedure is risk-free.
- Post-injection flare: Some patients experience a temporary increase in pain for 24 hours.
- Flushing: The steroid can occasionally cause facial flushing or warmth.
- Diabetic Caution: If you have diabetes, the steroid can temporarily raise your blood sugar levels for a few days. Please monitor them closely.
Are you ready to thaw your frozen shoulder?
- Ask your doctor: “Is my shoulder stiffness at the right stage for hydrodistension?” (It is most effective in the ‘frozen’ or stiff phase, rather than the very early painful phase).
- Plan ahead: Book your follow-up physiotherapy appointment before you book your injection date.
Patient information leaflets & Consent form
Procedure information downloads and consent form.
Injection Consent Form
Please click the button below to complete our clinical information and injection consent form before any treatment takes place.
Struggling to get seen for an ultrasound guided injection?
Expert musculoskeletal specialists offering fast access, accurate diagnosis, and precise pain relief, trusted by patients across.