What is a hydrodilatation/hydrodistension procedure for Frozen shoulder?

What is a hydrodilatation/hydrodistension procedure for Frozen shoulder?

Frozen shoulder, also known as adhesive capsulitis, is a painful condition that causes restriction of movement in the shoulder joint. It can be incredibly debilitating, making everyday activities such as reaching for objects or dressing yourself a struggle.

It is most commonly seen in women, between the ages of 40-60 years and characterised by gradual onset of pain and restricted movements of the shoulder.

Thankfully, there are treatment options available, and a hydrodilatation is a minimally invasive injection procedure performed at The Joint Injection Clinic, that can offer significant relief.

What is a Frozen Shoulder?

A healthy shoulder joint normally allows for a wide range of motion.  In frozen shoulder, the capsule that surrounds the joint becomes thickened and tight, significantly restricting movement, in particular rotation, i.e. when reaching behind the head and behind the lower back.

This tightening of the capsule can be caused by inflammation, scar tissue, or a combination of both. Frozen shoulder typically progresses through three stages:

  • Freezing stage: This stage is characterized by increasing pain, particularly at night. Movement gradually becomes more restricted.
  • Frozen stage: Pain may plateau or even decrease slightly, but stiffness becomes the main issue. The shoulder becomes very difficult to move, causing issues with simple daily activities.
  • Thawing stage: Movement gradually returns, and pain becomes less frequent.

The Role of a Hydrodilatation procedure:

A shoulder Hydrodilatation is a minimally invasive procedure often used to treat frozen shoulder during the frozen stage where the predominant feature is one of gross restriction of movement. It aims to achieve two main goals:

  1. Stretching of the capsule: A sterile solution, typically consisting of steroid, local anaesthetic and saline (or water for injection), is injected into the joint capsule. This fluid distends the capsule, helping to break down the adhesions and scar tissue, increasing space for movement.
  2. Reducing inflammation: Corticosteroids, often referred to as steroids, are usually used alongside the water solution.  Steroids help to reduce inflammation within the joint, alleviating pain and discomfort.

Who is a Candidate for Hydrodilatation?

Hydrodilatation is not suitable for everyone with frozen shoulder. Here are some factors a doctor might consider when recommending this procedure:

  • Severity of symptoms: If pain is manageable and movement isn't severely restricted, other conservative treatments, such as physiotherapy, might be preferred initially.
  • A hydrodilatation tends to be used when the patient struggles to place their hands behind their head due to severe stiffness and tightness or has severe limitation and asymmetry when reaching behind their lower back.

What to Expect During a Hydrodilatation procedure:

A Hydrodilatation is performed at The Joint Injection Clinic as an outpatient procedure:

  • Before the procedure: Your doctor will discuss the risks and benefits of hydrodilatation and answer any questions you may have. You may be advised to stop taking certain medications beforehand and the doctor will run through a written consent form, discussing the proposed risks and benefits.
  • During the procedure: You will be asked to lie on your side with the frozen shoulder side up. Under ultrasound guidance, a doctor will precisely insert a needle into the shoulder joint. A local anaesthetic injection will initially be used to numb the area to minimize discomfort. Then, the saline solution with steroid will be injected. You might feel pressure or a stretching sensation during this part. Some patients describe a feeling like a “dead arm”.  The entire procedure usually takes about 5 minutes.
  • After the procedure: You may experience some soreness or discomfort in your shoulder for a few days. Your doctor will provide specific instructions on pain management, applying ice, and initiating physiotherapy exercises to maximize the benefits of the procedure.

Benefits and Risks of Hydrodilatation

Hydrodilatation can be a very effective treatment for frozen shoulder. Studies show significant improvements in pain reduction and increased range of motion following the procedure.  As with any medical intervention however there are risks.  The main risks include

  • Infection: There is a 1 in 5000-10000 risk of developing a local infection post-injection.  If the patient develops localised redness, warmth, tenderness or swelling then they are advised to contact the clinic ASAP and the doctors will consider antibiotic treatment as required.
  • Bleeding: There is a 1 in 5000-10000 risk of localised, minor bleeding at the site of the injection.  If this happens then the doctor will apply pressure until the bleeding stops.
  • Nerve injury: Damage to a nerve near the injection site is an extremely rare but potential complication. 
  • Incomplete pain relief: While the procedure often helps, it might not completely alleviate pain in all cases.

Recovery and Next Steps

Following the procedure, physiotherapy plays a crucial role in helping to regain a full range of motion and preventing stiffness from recurring. Your therapist will guide you through gentle exercises to stretch and strengthen the shoulder joint. It may take several weeks or even months to see the full benefit of a hydrodilatation combined with physiotherapy.


Hydrodilatation offers a minimally invasive approach to treating frozen shoulder. By stretching the joint capsule and reducing inflammation, this procedure can significantly improve pain and restore movement. If you are experiencing symptoms of frozen shoulder, discuss your treatment options with the doctors at The Joint Injection Clinic. A Hydrodilatation, combined with physical therapy, could be the key to regaining control and mobility in your shoulder.