If you are experiencing shoulder pain and stiffness, with limited movement of your shoulder and are diagnosed with a frozen shoulder (also known as adhesive capsulitis), your consultant at Sportswise may advise that you would benefit from a hydrodilatation injection to your shoulder.This is an ultrasound guided procedure where steroid and a large volume (30ml) of normal saline (salt water) is injected into the shoulder. The volume of fluid within the shoulder stretches the capsule (joint lining) and is aimed at improving the range of movement of the shoulder. The steroid should settle any inflammation and as a consequence reduce pain.
You will need to lie on your side with the affected side facing up. You may wish to have a pillow under your affected arm to make you more comfortable. An ultrasound scan of your affected shoulder will be performed from the back to locate the back of the shoulder joint where the injection will be given. The area for injection will be cleaned and the needle inserted, using ultrasound to guide the needle-tip to the back of the shoulder joint. Our nurse will then inject 30mls of normal saline and 40mg of depomedrone (steroid) into the shoulder. You are likely to feel some pressure at this point and we will be guided by you as to how quickly we proceed with the injection. When this is finished we will ask you to lie on your back while we show you your images. We will then re-examine you to assess for any improvement.
Usually most patients feel a great improvement in pain and some improvement in their range of movement. However, the outcome can be difficult to predict and can range from no benefit to a great success. When improvement occurs, this may be immediate, though can take up to two weeks. It is important to continue with shoulder exercises, along with guidance and treatment from your physiotherapist, so that the range of movement continues to improve. A small minority of patients may require a second procedure.
There will be some discomfort from inserting the needle into the shoulder and injecting the local anaesthetic. Most patients tolerate the procedure very well, however some patients may feel uncomfortable or may feel a bit faint. You may experience some pain in the days after the hydrodilatation, but normal painkillers should be sufficient to manage this.
The steroids come in a crystal suspension that dissolves slowly and only a small amount will go into the blood stream. Systemic side effects from the steroid are very unlikely, unless you are diabetic. If you are diabetic your blood sugar levels are likely to be higher than usual for about a week following the injection. I recommend you check your sugar levels more often and you may have to adjust your insulin dose accordingly.
With respect to potential risks at the injection site, if the steroid is injected too close to the skin it can cause permanent skin thinning and/or discoloration. A pain flare (from the steroid) can occur in some patients – this is when more pain can be experienced for 1-3 days following the injection. This is a well-documented and you should ice and take paracetamol 1g (up to 4 times per day) to help settle this. Infection is a very rare complication following injection, one that we have not had at Sportswise. However, if you notice increasing redness, swelling and pain 3-10 days after the injection you should seek advice from your consultant at Sportswise, your GP or a Doctor in A&E.
Tenderness at the needle insertion site can occur for a few hours after the procedure and can be treated by applying an ice pack for 10 to 15 minutes once or twice an hour or taking simple pain-killers like Paracetamol. You should not drive or operate heavy machinery for 24 hours and it is advised you should be accompanied home. You will be advised at the injection clinic regarding the plan for your follow-up appointment but usually a physiotherapy review at 5-7 days.