Hydrodilatation for Adhesive Capsulitis (Frozen Shoulder)

Q1. What is adhesive capsulitis (frozen shoulder)?

Adhesive capsulitis, commonly known as frozen shoulder, is a condition characterized by stiffness, pain, and a significant loss of movement in the shoulder joint. It occurs when the strong connective tissue surrounding the shoulder joint (the capsule) becomes thick, tight, and inflamed. This makes the joint stiff and difficult to move.

The condition typically progresses through three stages:

• Freezing stage: A gradual increase in pain and a slow loss of shoulder movement.
• Frozen stage: The pain may begin to lessen, but the shoulder becomes very stiff, severely limiting daily activities.
• Thawing stage: The stiffness slowly improves, and your shoulder gradually regains its range of motion over months.

Q2. What is hydrodilatation, and how does it treat a frozen shoulder?

Hydrodilatation (also called joint distension) is a non-surgical procedure designed to treat a frozen shoulder by stretching the tight and scarred joint capsule from the inside. A doctor uses imaging (like ultrasound or X-ray) to insert a needle into the shoulder joint. A sterile fluid mixture is then injected under controlled pressure. The pressure of this fluid gently expands and stretches the tight capsule, breaking up scar tissue and adhesions to restore movement and reduce pain.

Q3. How does hydrodilatation compare to a standard steroid injection?

While both procedures aim to reduce pain and inflammation, they work differently:

• Standard steroid injection: Injects a small amount of anti-inflammatory medication (corticosteroid) and numbing medicine to reduce swelling. It does not physically stretch the tight joint capsule.
• Hydrodilatation: Injects a much larger volume of fluid (saline combined with steroids and numbing medicine) to stretch the tight joint capsule from within, directly addressing the physical tightness of the frozen shoulder.

Q4. Who is a good candidate for hydrodilatation?

You may be a good candidate for hydrodilatation if you have been diagnosed with adhesive capsulitis and:

• You have significant stiffness and pain that limits your daily activities.
• Conservative treatments like oral medications, physical therapy, or standard steroid injections have not provided enough relief.
• You want to avoid surgery (such as manipulation under anesthesia or arthroscopic capsular release).
• Your shoulder is in the frozen stage, where stiffness is the main issue.

Q5. What are the main benefits of having hydrodilatation?

Hydrodilatation offers several key advantages for treating a frozen shoulder:

• Non-surgical: It is performed as an outpatient procedure without the need for surgery, general anesthesia, or hospital stays.
• Fast results: Many patients experience a rapid improvement in shoulder mobility and a significant reduction in pain within days.
• Low risk: It has a very low rate of complications compared to surgery.
• Facilitates rehab: By stretching the capsule, it makes physical therapy exercises much easier and more effective.

Q6. How should I prepare for the hydrodilatation procedure?

Preparation is simple, but you should follow these steps:

• Inform your doctor: Let them know about all medications you take, especially blood thinners, and if you have any allergies or might be pregnant.
• Wear loose clothing: Wear a loose shirt that is easy to remove or adjust to expose your shoulder.
• Arrange a ride: You will need someone to drive you home, as your arm may feel numb or weak for a few hours.
• Manage diabetes: If you have diabetes, discuss it with your doctor, as the steroid injected can temporarily raise blood sugar levels.

Q7. What happens during the hydrodilatation procedure?

The procedure is performed in a clinic or imaging room and takes about 15 to 30 minutes:

• You will be positioned comfortably, either sitting or lying down.
• The skin over your shoulder will be cleaned with an antiseptic solution.
• The doctor will use an ultrasound machine or X-ray to locate the exact space inside your shoulder joint.
• The doctor will numb the skin and path with a local anesthetic.
• Under visual guidance, the needle is guided into the joint, and the fluid mixture is injected to stretch the capsule. You will feel a sensation of fullness or pressure.
• Once completed, the needle is removed, and a small bandage is placed over the injection site.

Q8. Is hydrodilatation painful?

You will feel some discomfort, but steps are taken to make it manageable. Local anesthetic is used to numb the area before the main injection. As the fluid is injected to stretch the capsule, you will likely feel a strong sensation of pressure, fullness, or a dull ache in the shoulder. This feeling is normal and means the tight capsule is stretching. The pressure sensation usually goes away quickly after the procedure is finished.

Q9. What is actually injected into my shoulder joint?

The fluid mixture typically includes:

• Sterile saline (salt water): This provides the volume needed to physically stretch and expand the tight joint capsule.
• Corticosteroid: A strong anti-inflammatory medication that helps reduce swelling, inflammation, and pain inside the joint.
• Local anesthetic: Numbing medicine (like lidocaine or bupivacaine) to minimize discomfort during and immediately after the procedure.

Q10. What should I expect immediately after the procedure?

Immediately after the procedure, you can expect:

• Numbness: Your shoulder and arm may feel heavy, weak, or numb for a few hours due to the local anesthetic.
• Short-term soreness: As the numbing medicine wears off, you may feel some soreness or an ache from the stretching.
• Observation: You may be asked to wait for 15 to 20 minutes to ensure you feel fine before leaving.
• Activity restriction: You should rest your arm for the remainder of the day.

Q11. Are there any risks or potential side effects?

Hydrodilatation is generally very safe, but minor risks and side effects can occur:

• Temporary pain increase: Some soreness or pain for a day or two after the injection is common.
• Infection: A very rare risk with any injection (less than 1 in 10,000).
• Temporary facial flushing: Some patients experience warmth and redness in the face for 24 to 48 hours due to the steroid.
• Blood sugar rise: Patients with diabetes may notice a temporary increase in blood sugar levels for a few days.
• Capsule rupture: In some cases, the capsule may tear or pop during stretching, which is actually a therapeutic goal to release tension and is not harmful.

Q12. How soon will I feel relief, and how long does it last?

Relief timing and duration vary:

• Initial relief: You might feel immediate relief from the numbing medicine, which wears off in a few hours.
• Steroid effect: The anti-inflammatory steroid begins to work within 3 to 5 days, at which point pain and stiffness should begin to improve.
• Long-term outcome: The combination of capsule stretching and reduced inflammation can lead to lasting improvement, especially when followed by physical therapy. A single procedure is often sufficient, though some patients may benefit from a second procedure if stiffness persists.

Q13. Do I need physical therapy after hydrodilatation?

Yes, physical therapy is a critical part of your recovery. The hydrodilatation stretches the tight capsule, opening a \"window of opportunity\" where your shoulder is more mobile and less painful. Starting gentle stretching exercises and physical therapy within 24 to 48 hours is highly recommended to maintain the new range of motion and prevent the shoulder from stiffening up again.

Q14. What activities should I avoid after the procedure?

To allow the shoulder to settle, you should follow these guidelines:

• Day of procedure: Rest your shoulder, avoid driving, and avoid heavy lifting or strenuous activity.
• First 48 hours: Avoid heavy lifting, overhead reaching, or repetitive shoulder movements.
• Stretching: Do perform the gentle, prescribed range-of-motion exercises recommended by your doctor or therapist.
• Return to normal: You can gradually return to regular activities as your pain allows, usually within a few days.

Q15. What if the hydrodilatation does not cure my frozen shoulder?

While hydrodilatation has a high success rate (around 70% to 90% of patients experience significant improvement), it does not work for everyone. If your stiffness and pain persist:

• Second hydrodilatation: Your doctor may recommend repeating the procedure after a few weeks or months.
• Surgical options: If non-surgical methods fail, surgical procedures like manipulation under anesthesia (MUA) or arthroscopic capsular release (keyhole surgery to cut the tight capsule) may be considered to restore movement.

We encourage you to write down any specific questions you have and discuss them thoroughly with your surgeon, doctor, or physical therapist. They are your best resource for personalized advice and care.

Disclaimer: This brochure provides general information and is not a substitute for professional medical advice. Always consult your doctor or qualified healthcare provider with any questions you may have regarding your specific medical condition and treatment plan.