What is a Frozen Shoulder?

A Frozen Shoulder can cause severe shoulder pain and debilitating restriction of movement. It is caused by inflammation and tightening of the shoulder joint capsule. It is most common in middle-aged female patients. It often occurs following trauma to the shoulder, but it can come on for no obvious reason (which is termed idiopathic). Certain medical conditions such as diabetes and hypo/hyperthyroidism have been shown to increase risks of developing a frozen shoulder and may also cause the condition to be more resistant to treatment. If untreated, a frozen shoulder will gradually resolve in most people. However, it often takes 18-24 months to fully resolve.

A frozen shoulder will usually start with severe pain, which then develops into pain and stiffness, resulting in a marked loss of range of motion around the shoulder. Patients find real difficulties with activities such as washing their hair, reaching for a seatbelt and putting on a coat.

Other shoulder conditions, such as shoulder arthritis can present with similar symptoms and physical restrictions, so it is important that the patient is fully assessed by an experienced clinician before deciding to proceed with this treatment. We prefer patients to have an x-ray before proceeding with a hydrodilatation injection, to help confirm the shoulder is otherwise healthy.

What is a Hydrodilatation / Hydrodistention / High Volume Shoulder Injection?

Hydrodilatation involves the injection into the shoulder joint capsule. This procedure must be performed under ultrasound guidance to ensure accurate needle placement inside the shoulder joint capsule. A relatively large volume of saline (20-30ml) and small amount of local anaesthetic and steroid (cortisone) is injected into the joint, with the aim of deliberately stretching the tight capsule and reducing the inflammation.

Injection Therapist

Gareth Tremain

Our specialist physiotherapist Gareth Tremain completed a Masters degree module in 'Joint & Soft Tissue Injections' at Keele University in 2013 and has undertaken extensive training with specialist doctors, sonographers and consultant physiotherapists to hone his skills in Ultrasound-Guided Injections. He offers a range of Ultrasound-Guided Injections, including Cortisone, Hyaluronic Acid, High Volume and Hydrodilatation to treat a wide range of persistent injuries and chronic pain. Gareth will also advise you regarding the most appropriate exercise programme to complement your injection.

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How Many Injections will I need?

Most people only need one injection to help them achieve satisfactory pain relief and help them gradually improve their shoulder range of movement. However, it is possible to repeat the procedure if you feel it is necessary. We recommend a minimum of 3 weeks between injections and recommend no more than 3 injections into your shoulder in one year.

What does the Research say?

Traditional treatments such as stretching exercises, (without first having an injection) can be very painful and often provide little benefit.

There is still some uncertainty regarding which injection provides the best result. Injecting a small dose of cortisone into and around the shoulder joint (Ultrasound-Guided Cortisone Injection) also provides very good results if undertaken during the early stages of a frozen shoulder, but it seems as if hydrodilatation may produce slightly better results. Research has shown that undertaking a graded stretching programme following either of these injections leads to a faster return of joint range of movement. Our specialist physiotherapist will advise you regarding an appropriate exercises.

Even though research shows that hydrodilatation or a cortisone injection will speed up the recovery in the majority of patients, it is important to understand that it is not a guaranteed cure. Our specialist will advise you on the alternative options, if this does not work for you.

Hydrodilatation has been shown to be as effective in improving range of movement as a Manipulation Under Anaesthetic - MUA (forcefully stretching shoulder joint capsule whilst the patient is unconscious under general anaesthetic). Patient satisfaction levels have been shown to be significantly higher following hydrodilatation compared to an MUA. If none of the above treatment resolve the pain and stiffness associated with a frozen shoulder, the last resort would be a surgical procedure - generally this involves an arthroscopic surgical release. This is essentially keyhole surgery, whereby the surgeon makes small incisions in the joint capsule to attempt to improve the range of movement and pain.