Hydrodilatation

Capsulitis (also called adhesive capsulitis or frozen shoulder) is caused by inflammation of the lining of the shoulder capsule. It may be triggered by a minor injury or surgery and is more common in people with diabetes. The initial symptom is usually some pain, but stiffness often becomes chronic.

Preparation

If possible, wear clothing that allows easy access to the area that is being imaged.

Procedure

Before treatment, an accurate diagnosis is essential, which will usually require a diagnostic ultrasound or MRI scan. The ultrasound and injection can usually be done on the same day if your referrer has already discussed an injection with you.

Your skin is cleaned with antiseptic, and a fine needle is positioned into the joint using either x-ray or ultrasound guidance to ensure precise placement. If x-ray guidance is used, a small amount of contrast dye will be injected. The joint is then distended with a corticosteroid, local anaesthetic and sometimes sterile water, between 10 and 20mL in total.

Post-Procedure Care

Do not do vigorous activity for two days. However, in frozen shoulder, a programme of rehabilitation exercises is essential to consolidate improvement after the injection and restore your range of movement. This is best guided by your doctor or physiotherapist. An example given below is for general information only.

1. Shoulder blade squeezes: try to bring your shoulder blades together behind your back.
2. Pendular exercises: leaning forward supporting your good arm, swing your arm forwards and backwards, then around in circles.
3. Wall crawl: stand in front of a wall and slowly “walk” your arms up as high as you can.
4. Hand to back: Put your hand in the middle of your back and then “walk” your hand up your back as high as possible.
5. Keeping your elbow in at your side and bent at 90 degrees, use something like a broom handle in the other hand to rotate the shoulder out as far as you can.

While you should try to overcome stiffness, you should stop if the pain increases.

Risks / Side effects

If the procedure uses a contrast dye for x-ray guidance, there is a minimal risk of an allergic reaction to the dye, which may include flushing, hives and difficulty breathing. Severe reactions are rare, and a life-threatening reaction extremely rare (1 in 170,000).

Any injection carries a small risk of introducing infection, about 1 in 30,000 and we take precautions to minimise this. If you experience increased swelling or redness, please call your doctor.