Ultrasound-Guided Capsular Hydrodistension for Adhesive Capsulitis (Frozen Shoulder)
Ultrasound-guided capsular hydrodistension for adhesive capsulitis (frozen shoulder). Technique, volumes, indications and post-procedure protocol by Dr. Santiago Robles.
Ultrasound-Guided Capsular Hydrodistension for Adhesive Capsulitis
I mainly use this technique in patients with persistent pain and stiffness limiting physiotherapy progression and shoulder mobility exercises.
Procedure Video
Volumes Used
Although volumes between 20 and 90 ml have been described in the literature, in my clinical practice I usually begin with:
- Up to 20 ml initially
- Up to 35 ml in subsequent sessions, if well tolerated with partial improvement
Injection Composition
I commonly use a mixture of:
- 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%.
Ultrasound Approach
It's easier reaching the capsule from posterior view. But it can also be performed from anterior view 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
Post-Procedure Protocol
Immediately after the procedure:
- Gentle passive mobilization is performed
- Continued physiotherapy and mobility exercises
- All within a tolerable pain range
Repeat Sessions
Repeat hydrodistension may be considered 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.