Ultrasound-guided Shoulder Hydrodistension for the treatment of adhesive capsulitis/frozen shoulder
Shoulder hydrodistension is a relatively new treatment for adhesive capsulitis or frozen shoulder. As its name states, it involves series of progressively larger volumes of fluid (hydro) into the shoulder joint that is sore and not moving well, to release the ligamentous capsule (distension). The protocol that I currently follow involves a series of three treatment sessions where on the first visit we inject 19ml of normal saline and 1ml of a corticosteroid intra-articularly, then a few weeks later (typically 4 weeks), I proceed to 40ml of normal saline, then if needed, a few weeks after the last injection, I then inject 60ml of normal saline. In order to optimize your outcome, it is best to have manual therapy with a qualified rehabilitation professional within a few days of each treatment. Of note, if your shoulder range of motion is limited due to rotator cuff disease and/or osteoarthritic changes in the joint, this procedure would offer little benefit.