Frozen shoulder can be an extremely painful and frustrating condition. It can affect sleep, work, exercise and even simple activities such as putting on a coat or reaching for a seatbelt.
For some patients, hydrodistension injection for frozen shoulder, also known as hydrodilatation, can form part of a treatment programme designed to reduce pain and help restore shoulder movement.
At LG Physiotherapy, Ultrasound & Injection Clinic, my approach goes beyond simply providing an injection.
ASSESS → SCAN → DIAGNOSE → TREAT → REHABILITATE
The aim is to establish the correct diagnosis, determine whether an injection is appropriate and combine treatment with rehabilitation to help restore function.
What is Frozen Shoulder?
Frozen shoulder is also known as adhesive capsulitis.
It is a condition characterised by shoulder pain accompanied by a progressive restriction in movement. Importantly, both the movement you can produce yourself and the movement available when somebody else moves your shoulder are typically restricted.
People with frozen shoulder often struggle with:
- Reaching overhead
- Reaching behind their back
- Putting on a coat or jacket
- Washing or styling their hair
- Fastening clothing
- Reaching for a seatbelt
- Sleeping comfortably
- Exercising or playing sport
External rotation — turning the arm outwards — is often particularly restricted.
However, not every painful and stiff shoulder is a frozen shoulder.
Getting the Diagnosis Right
Several conditions can produce shoulder pain and restriction.
These include:
- Rotator cuff tendinopathy
- Rotator cuff tears
- Calcific tendinopathy
- Subacromial bursitis
- Glenohumeral osteoarthritis
- Frozen shoulder
This is why I believe the decision to perform an injection should start with an appropriate clinical assessment rather than simply treating the location of the pain.
At LG Physiotherapy, Ultrasound & Injection Clinic, a comprehensive musculoskeletal assessment can be combined with diagnostic ultrasound scanning where clinically appropriate.
Ultrasound can help assess structures including the rotator cuff, bursa and long head of biceps tendon and may help identify or exclude other causes of shoulder symptoms.
If further investigation is required, MRI or X-ray imaging can also be arranged.
What is a Hydrodistension Injection?
Hydrodistension — frequently called hydrodilatation — is an image-guided injection procedure used in the management of frozen shoulder.
The procedure involves accurately introducing fluid into the glenohumeral joint.
Unlike a conventional low-volume joint injection, a larger volume of fluid is introduced with the intention of distending the restricted shoulder joint capsule.
Depending on the patient’s individual circumstances and clinical indications, the injectate may include:
- Sterile saline
- Local anaesthetic
- Corticosteroid
The aim is to help reduce pain and improve movement, creating an opportunity to progress shoulder rehabilitation.
Hydrodistension vs a Standard Steroid Injection
Patients often ask:
“What is the difference between a steroid injection and hydrodistension?”
A standard intra-articular corticosteroid injection places medication into the shoulder joint primarily to help manage pain and inflammation.
A hydrodistension injection introduces a greater volume of fluid into the joint with the additional intention of distending the tight joint capsule.
The two treatments should therefore not necessarily be considered identical.
Importantly, hydrodistension is not automatically better for every patient.
The choice of treatment should consider:
- Severity of pain
- Degree of stiffness
- Duration of symptoms
- Stage of the condition
- Previous treatments
- Relevant medical conditions
- Patient preferences and goals
What Does the Research Say About Hydrodistension?
Current research suggests hydrodistension can provide improvements in pain and shoulder movement for some patients with frozen shoulder.
The British Elbow and Shoulder Society (BESS) frozen shoulder patient care pathway supports hydrodilatation as a treatment option, particularly for short- to medium-term improvement in pain and range of movement.
Systematic reviews have also reported improvements in shoulder disability and passive external rotation following hydrodilatation.
However, it is important to put this evidence into context.
Hydrodistension should not be presented as a guaranteed cure for frozen shoulder, and research continues into which patients benefit most, the optimum technique and how it compares with other treatments over the longer term.
This is why treatment should be individualised.
Why Use Ultrasound Guidance?
Hydrodistension is an image-guided injection procedure.
Real-time ultrasound allows the needle to be visualised as it is advanced towards the shoulder joint.
This allows accurate placement of the injection while visualising the surrounding anatomical structures.
Another advantage within an integrated musculoskeletal service is that diagnostic ultrasound can be used, where appropriate, to assess other structures around the shoulder as part of the overall clinical assessment.
Does Hydrodistension Cure Frozen Shoulder?
There is no single treatment that can guarantee an immediate cure for frozen shoulder.
Hydrodistension is better considered as one potential component of an overall management strategy.
The objective may be to:
Reduce pain → Improve movement → Facilitate rehabilitation → Restore function
Some patients notice relatively rapid improvements, while others recover more gradually.
Managing expectations is therefore important.
Rehabilitation After Hydrodistension
I believe this is one of the most important parts of treatment.
The injection is not the end of the treatment pathway.
If pain and restriction improve following hydrodistension, this can provide an opportunity to progress rehabilitation and restore movement.
An individual rehabilitation programme may include:
- Shoulder mobility exercises
- Progressive range-of-motion exercises
- Appropriate stretching
- Rotator cuff strengthening
- Scapular rehabilitation
- Functional strengthening
- Gradual return to work
- Gradual return to gym or sport
Rehabilitation should be appropriate to the patient’s symptoms and stage of recovery rather than simply forcing a painful shoulder through aggressive exercises.
My “All in One” Frozen Shoulder Appointment
One of the key differences at LG Physiotherapy, Ultrasound & Injection Clinic is the ability to combine different aspects of musculoskeletal care.
ASSESS
A comprehensive clinical assessment of your shoulder, symptoms, medical history and functional limitations.
SCAN
Diagnostic musculoskeletal ultrasound can be performed where clinically appropriate to assess the shoulder and investigate other potential causes of symptoms.
DIAGNOSE
The clinical examination and imaging findings can be brought together to establish the most appropriate working diagnosis.
TREAT
Treatment options are discussed with you.
Where clinically appropriate, this may include an ultrasound-guided shoulder injection or hydrodistension procedure.
REHABILITATE
Treatment is followed by an individual rehabilitation strategy designed to improve movement, strength and function.
Assess. Scan. Diagnose. Treat. Rehabilitate.
Hydrodistension Injection in Essex
If you have been diagnosed with frozen shoulder — or you have a painful and increasingly stiff shoulder and are unsure of the cause — an appropriate assessment is the first step.
LG Physiotherapy, Ultrasound & Injection Clinic provides specialist musculoskeletal assessment, diagnostic ultrasound and ultrasound-guided injection services in Benfleet, Essex.
The clinic also sees patients travelling from surrounding areas including:
Billericay | Brentwood | Stock | Basildon | Rayleigh | Wickford | Southend and surrounding areas of Essex
Frequently Asked Questions
Is hydrodistension the same as hydrodilatation?
Yes. The terms hydrodistension and hydrodilatation are commonly used to describe the procedure of introducing fluid into the shoulder joint to distend the restricted capsule associated with frozen shoulder.
Is hydrodistension the same as a steroid injection?
Not exactly.
A conventional steroid injection normally involves a relatively small volume of medication being injected into the joint.
Hydrodistension involves introducing a greater volume of fluid with the additional aim of distending the restricted joint capsule. Corticosteroid may also form part of the injectate when clinically appropriate.
Is hydrodistension painful?
Patients may experience pressure or discomfort as the joint capsule is distended.
The procedure and what to expect should be discussed before treatment, and local anaesthetic may form part of the procedure.
How quickly does hydrodistension work?
Response varies between individuals.
Some patients may notice improvements relatively quickly, whereas for others recovery is more gradual. Hydrodistension should therefore be considered as part of a wider treatment and rehabilitation programme rather than an instant cure.
Do I need physiotherapy after hydrodistension?
Rehabilitation can be an important part of management following hydrodistension.
Improvements in pain and movement may provide an opportunity to progress mobility and strengthening exercises, helping translate improvements in range of movement into better everyday function.
Can frozen shoulder come back?
Most patients eventually recover, although recovery times vary considerably.
Persistent or recurrent symptoms should be reassessed to ensure that frozen shoulder remains the correct diagnosis and that another shoulder condition is not contributing to the symptoms.
Do I need an ultrasound scan before a frozen shoulder injection?
Frozen shoulder is primarily a clinical diagnosis.
Diagnostic ultrasound can nevertheless be useful when clinically indicated to assess other structures around the shoulder and investigate alternative or co-existing causes of shoulder pain.
Book a Frozen Shoulder Assessment in Essex
If shoulder pain and stiffness are affecting your sleep, work, exercise or everyday activities, you don’t necessarily need to simply wait for the problem to resolve.
An appropriate assessment can establish the likely cause of your symptoms and allow you to discuss the treatment options available.
At LG Physiotherapy, Ultrasound & Injection Clinic, patients can access an integrated:
ASSESS → SCAN → DIAGNOSE → TREAT → REHABILITATE
approach to musculoskeletal care.
Visit the LG Physiotherapy, Ultrasound & Injection Clinic website to find out more or book an appointment.
