Hydrodilatation Injection for Frozen Shoulder

Hydrodilatation also known as Hydrodistention and High-Volume Shoulder Injection is a highly effective treatment for Frozen shoulder, also known as Adhesive Capsulitis.

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.

What effect can I expect from a Hydrodilatation Shoulder Injection?

Hydrodilatation is increasingly used as the first-line treatment of a frozen shoulder and is recommended by the National Institute of Clinical Excellence (NICE). The injection often provides significant relief of pain and speeds up restoration of shoulder range of movement.

Gareth Tremain - Cortisone Injection
Injection Therapist
Gareth Tremain

Gareth has a wealth of knowledge and specialist skills. He has a degree in Sport & Exercise Science as well as a degree in physiotherapy. Gareth has completed extensive Masters Degree level training in injection therapy and is qualified to perform a wide range of Ultrasound- Guided joint and soft tissue injections – including Cortisone, PRP, Hyaluronic Acid and High Volume injections for Frozen Shoulder and Chronic Tendon Pain.

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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.

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.

How much does an Ultrasound-Guided Hydrodilatation Injection cost at iPS?

The total cost of the injection will depend on whether you have previously been assessed by our Injection specialist:

Initial Consultation including full Assessment (45 mins) £67.50 + Ultrasound-Guided Hydrodilatation Injection £230 = Total Cost of £297.50

Follow-Up Consultation (30mins) £45 + Ultrasound-Guided Hydrodilatation Injection £230 = Total cost of £275

How do I book an Appointment?

You can book an Injection clinic Appointment via our online booking system (see links below). You will be required to pay the cost the consultation at time of booking. If you proceed with an injection, you will be required to pay the additional cost immediately following the appointment.

Alternatively, you can contact our admin office on 03456 252 252, Monday to Friday 8.30-5pm or email to request a call back.

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Injection Clinic Appointments

Injection Clinic – Full Assessment (+ Injection/s if appropriate)

Time: 45 Minutes

Cost: £67.50 (additional fees will apply if you proceed with injection)

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Injection Clinic – Follow-up Injection/s

Time: 30 Minutes

Cost: £45 (additional fees will apply if you proceed with injection)

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