Stretching Beyond Pain: Why hydrodistension triumphs over steroid injections for frozen shoulder

Frozen shoulder, also known as adhesive capsulitis, is a painful condition associated with restriction in the shoulder joint, lasting months, or years in some cases. There are several causes including traumatic injury, inflammation, autoimmune conditions such as arthritis or prolonged immobilisation of the shoulder joint, however in many cases a cause can not be identified.

Hydrodistension, also known as hydrodilatation, and steroid injections are two common treatments for frozen shoulder, and whilst both methods aim to alleviate pain and improve range of motion, there are many advantages for hydrodistension that outweigh simple steroid injections.

Ultrasound-guided steroid injections have been used for years.  Providing rapid relief, the minimally invasive and cost-effective steroid injections are a direct injection of a steroid into the shoulder joint.  However, the increasingly popular hydrodilatation has shown to be successful at reducing pain, improving range of movement and function, and in some cases providing immediate relief. 

Hydrodistension is an injection performed under local anaesthesia, using ultrasound (or X-ray) guidance that aims to stretch the tightened joint capsule, loosen adhesions and help reduce inflammation.  High volume injections of local anaesthetic, cortisone and saline are injected into the shoulder joint. Increasing amounts of saline are applied, forcing the joint capsule to expand, breaking adhesions, increasing the range of movement of the joint. Sometimes an audible “pop” is heard as the capsule adhesions release.

Here are some pros of hydrodistension over a simple steroid injection:

Improved Range of Motion: Hydrodistension can effectively stretch the tight capsule of the shoulder joint, allowing for greater mobility - leading to better range of motion compared to steroid injections alone.

Longer Lasting Relief: While the immediate effects of hydrodistension may be similar to steroid injections, some studies suggest that the benefits of hydrodistension may last longer - meaning patients may experience prolonged relief from pain and stiffness.

Diagnostic Benefits: Hydrodistension not only treats frozen shoulder but also serves as a diagnostic tool. The procedure can help confirm the diagnosis by demonstrating the characteristic findings of a tight capsule and restricted joint space.

Potential for Tissue Breakup: The force exerted during hydrodistension may help break up adhesions and scar tissue within the joint, which can contribute to frozen shoulder - leading to more comprehensive treatment outcomes by addressing underlying causes of the condition.

Stimulation of Healing Response: The mechanical stretching provided by hydrodistension can stimulate a healing response in the shoulder joint, promoting tissue repair and remodelling – potentially contributing to long-term improvements in shoulder function.

After the procedure, some individuals may experience mild discomfort lasting up to 30 minutes. Bruising around the injection site and temporary numbness of the skin can occur for several hours, along with swelling and discomfort in the shoulder area. Typically, these side effects resolve within 48 hours and over-the-counter painkillers can be taken if needed. Most individuals return to normal activities within 24 hours, including work. It's generally advised to refrain from driving or operating heavy machinery for the remainder of the day after the procedure.

It's recommended to restart physiotherapy promptly, ideally within two to three days following the procedure, to optimise the benefits obtained during the treatment.

The choice between hydrodistension and steroid injection depends on various factors including the severity of symptoms, patient preferences, and the recommendations of the treating physician. Hydrodistension can be effective where other approaches have failed, appearing to be more effective than corticosteroid injection alone, and as effective as manipulation-under-anaesthesia (MUA), with fewer complications, and it can avoid the need for surgery in some patients.

Both injections are available at the Leigh Injection Clinic, based on the coast in Leigh on Sea, Essex – perfect for patients in Essex, Kent, London, and surrounding areas.   

https://www.leighinjectionclinic.co.uk/musculoskeletal-msk-and-spinal-injections

https://www.nhs.uk/conditions/frozen-shoulder/

https://www.kch.nhs.uk/wp-content/uploads/2023/01/pl-940.1-frozen-shoulder-adhesive-capsulitis.pdf

https://sonoscope.co.uk/blog/can-steroid-injections-help-with-frozen-shoulder/

https://www.topdoctors.co.uk/medical-articles/hydrodistension-injection-for-frozen-shoulder