Shoulder
Intra-articular injection / hydrodilatation for adhesive capsulitis
The stiff joint of the frozen shoulder is gently distended with fluid under ultrasound guidance, to regain mobility and reduce pain.
How it is performed
In frozen shoulder, the joint capsule thickens and contracts, limiting movement. Using ultrasound guidance, the needle reaches the joint space and a controlled volume of saline, anaesthetic and corticosteroid is injected: the fluid progressively distends the capsule, reducing inflammation and freeing movement. The procedure is outpatient and well tolerated.
Who it is for
- Adhesive capsulitis (frozen shoulder) in the painful or stiff phase
- Marked restriction of passive shoulder movement
- Persistent night pain despite medication and physiotherapy
Recovery
You return home immediately. Physiotherapy should start in the days immediately after, when the shoulder is less painful: it is the combination of both treatments that gives the best result.
Conditions treated in this area: calcific tendinopathy of the rotator cuff, frozen shoulder (adhesive capsulitis), subacromial bursitis.
Scientific evidence
A systematic review of hydrodilatation with corticosteroid documents significant improvements in pain and range of motion in adhesive capsulitis. A recent randomised trial shows that the combination of hydrodilatation, injection and physiotherapy is superior to physiotherapy alone.
References on PubMed
- Hydrodilatation With Corticosteroid for the Treatment of Adhesive Capsulitis: A Systematic Review
Catapano M, Mittal N, et al. — PM R, 2018 · PMID 29129609
- Efficacy of Combination Therapy (Hydrodilatation and Subdeltoid Bursa Injection With Corticosteroid, Mobilization, and Physical Therapy) vs Physical Therapy Alone for Treating Frozen Shoulder: A Randomized Single-Blind Controlled Trial, Phase I
Huang YH, Kuo YC, et al. — Arch Phys Med Rehabil, 2023 · PMID 38092231
Published data describe average results in groups of patients and are not a prediction of an individual outcome. The indication for treatment must always be assessed during a consultation.
Risks, costs and opinions
The three questions patients ask most often before deciding, with clear answers.
What are the risks of intra-articular injection / hydrodilatation for adhesive capsulitis?
It is an outpatient procedure performed with a thin needle under local anaesthesia and continuous ultrasound guidance, which makes it possible to see the needle, the target and the structures to avoid in real time. The most common issues are transient: pain or swelling for 24-48 hours, a small bruise. Joint infection is a rare event, prevented by sterile technique. In treatments with cortisone, facial flushing or a temporary rise in blood sugar may occur in diabetic patients. Personal risks and contraindications are assessed during the consultation.
How much does the intra-articular injection / hydrodilatation for adhesive capsulitis cost?
The cost depends on the setting in which the procedure is performed: some treatments are available through the National Health Service or under agreement, others privately or through insurance. The quote is given clearly before scheduling the treatment, and includes the assessment, the procedure and the planned follow-up. During the consultation I tell you which pathway is available in your case: you do not have to decide before knowing the cost.
Does it really work? What patients and the literature say
The most frequent questions are "how long does the benefit last?" and "can I repeat it?". The answer depends on the diagnosis and the stage: some injections resolve the painful episode, others serve to open a window in which rehabilitation becomes effective. Experiences read in forums concern cases different from yours. During the consultation we review your imaging and I tell you frankly what to expect, how many sessions may be needed and when another approach is better.
Want to know if it is right for you?
At the first consultation we review your clinical history and previous imaging together.