Ultrasound-Guided Capsular Hydrodistension for Adhesive Capsulitis (Frozen Shoulder)

Ultrasound-Guided Capsular Hydrodistension for Adhesive Capsulitis

Ultrasound-guided capsular hydrodistension (hydrodilatation) is a minimally invasive technique that injects fluid into the shoulder joint under ultrasound control to distend the contracted joint capsule typical of a frozen shoulder. I mainly use it in patients with persistent pain and stiffness that limit physiotherapy progression and shoulder mobility exercises.

Key Takeaways

• An ultrasound-guided, minimally invasive technique, with no ionizing radiation.
• Indicated in adhesive capsulitis (frozen shoulder) when pain and stiffness limit rehabilitation.
• Usual volumes: up to 20 ml in the first session and up to 35 ml in later sessions.
• A mixture of saline and local anesthetic is injected; corticosteroids are reserved for selected cases.
• Always combined with physiotherapy and mobility exercises.

Procedure Video

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When Is Capsular Hydrodistension Indicated?

I consider it when frozen-shoulder pain and stiffness persist and limit the progression of physiotherapy and mobility exercises. Frozen shoulder (adhesive capsulitis) causes pain and progressive loss of motion due to contraction of the joint capsule.

What Volumes Are Used?

In my clinical practice I usually begin with up to 20 ml in the first session and up to 35 ml in subsequent sessions, if well tolerated with partial improvement. Although volumes between 20 and 90 ml have been described in the literature:

• Up to 20 ml initially
• Up to 35 ml in subsequent sessions, if well tolerated with partial improvement

What Is Injected?

I commonly use a mixture of saline and local anesthetic, reserving corticosteroids for selected cases:

• Saline solution (18 ml)
• Long-acting local anesthetic: ropivacaine 2% (2 ml)
• Corticosteroids: reserved for selected cases

Local anesthesia of the needle track (and in some cases intra-articular) is performed beforehand using 3 ml of mepivacaine 1%.

How Is It Performed With Ultrasound?

It is easier to reach the capsule from a posterior approach, although it can also be performed from an anterior approach at the rotator cuff interval. Ultrasound guidance provides:

• Real-time visualization of the needle and anatomical structures
• Greater accuracy in injection placement
• Lower risk of complications
• No ionizing radiation

What Happens After the Procedure?

Immediately after the procedure, gentle passive mobilization is started and physiotherapy and mobility exercises are continued, always within a tolerable pain range:

1. Gentle passive mobilization is performed
2. Continued physiotherapy and mobility exercises
3. All within a tolerable pain range

Can the Technique Be Repeated?

Yes. Hydrodistension may be repeated after 2–3 weeks in selected patients with partial improvement and good tolerance.

Consult with Dr. Santiago Robles

If you suffer from frozen shoulder and want to know if capsular hydrodistension may be a treatment option for your case, don't hesitate to schedule a consultation. Dr. Santiago Robles specializes in ultrasound-guided interventional techniques and offers a personalized evaluation for each patient.