This can be thought of as expanding an empty balloon it with water.
This procedure is performed for adhesive capsulitis, which is a term that refers to an inflamed, restricted capsule. It is commonly seen in the shoulder, which is often called frozen shoulder.
What is Adhesive Capsulitis?
The shoulder is a ball and socket joint, surrounded by a capsule. Usually the capsule allows movement, but when it becomes irritated, it starts to shrink and restrict movement. The reasons behind why this occur are not fully clear, but it is thought to occur after some trauma or new medical diagnosis. It is associated with diabetes and low thyroid function. Frozen shoulder can last anywhere from 6 to 18 months, and moves through characteristic stages (see below).
Clinical Presentation (Reeves 1975)
Inflammatory (2-9 months): Painful phase with development of diffuse, severe, and disabling shoulder pain that is worse at night, and increasing stiffness
Freezing (4-12 months): Stiffness and severe loss of shoulder motion, but with pain becoming gradually less pronounced
Thawing (5-24 months): Gradual return of range of motion
Depending on which stage a patient is in, a decision can be made whether a patient would benefit the most from steroid only, hydrodilatation only, or a combination of the two.
The procedure uses ultrasound guidance to access the shoulder joint. Three solutions are typically injected.
Local anesthetic for immediate, temporary relief
Steroid for later, lasting relief
Saline, to mechanically distend the joint
What are the benefits?
Pain relief and function. Different centres approach the procedure in different ways, but a systematic review 2276 studies demonstrated that hydrodilatation combined with corticosteroid injection expedites pain-free movement, with the greatest benefit at 3 months (Catapano 2018).
What are the alternatives?
Conservative treatment includes activity modification, simple pain meds, and physiotherapy.
In terms of procedures, options include hydrodilatation, steroid injection, or a combination of the two. A suprascapular nerve block can also be performed, which addresses the pain associated with the condition, but not the underlying problem.
Next, the joint can be manipulated under anesthesia, or the capsule can be released with minimally invasive surgery (arthroscopically).
How long will my pain be reduced?
The goal of the procedure is to take advantage of the synergistic effect of hydrodilatation and the corticosteroid injection to relieve pain and improve function. In that sense, combined with physiotherapy, we hope that the pain is dramatically reduced and remains that way.
How often can I have this done?
It is our goal that only one procedure is ever needed.
Who can’t have this done?
Any patient who may appear to have:
Infection within the body, near the site of administration, or the actual joint itself
What are the side effects?
This depends on whether steroid was injected or not. Your physician can help guide you which option is better for you.
Side effects of steroid: Glucorticosteroid injection
Side effects of no steroid: Needle fenestration
Can I drive afterwards?
If you were able to drive to the appointment, most people can drive afterwards. Nonetheless, we ask all patients to remain in the clinic waiting room for a minimum of 15 minutes afterwards to observe for any adverse reactions if steroid was provided.