About Capsular Distension (Hydrodilatation) for Frozen Shoulder
In frozen shoulder, also called adhesive capsulitis, the lining around the shoulder joint becomes inflamed, thickens, and shrinks. This causes painful stiffness, especially when reaching overhead or behind the back, and it can last many months without treatment.
Hydrodilatation fills the joint with a larger volume of fluid than a standard injection. The fluid gently expands the tight capsule, and the medicines calm inflammation. Dr. Gruner and Dr. Chen watch the fluid spread under ultrasound to make sure it stays inside the joint.
The procedure opens a window of less pain and better motion. Physical therapy and a home stretching program started soon after the injection help you make the most of that window.
Where we use Capsular Distension
Watch: Capsular Distension explained
What happens during treatment
- 1.
Your physician examines your shoulder motion and uses ultrasound to rule out other causes of stiffness.
- 2.
The skin is cleaned and numbed, usually at the back of the shoulder.
- 3.
Under live ultrasound, a needle is placed into the joint, and fluid is injected slowly to stretch the capsule.
- 4.
Your physician may gently move the shoulder afterward, and you begin a stretching program within a day or two.
Who may be a good candidate
- People with frozen shoulder who have painful stiffness in several directions.
- People whose motion has not improved with therapy or a standard steroid injection.
- People who want to avoid manipulation under anesthesia or surgery.
- Patients who can follow a regular stretching and strengthening program afterward.
Recovery
The shoulder may feel full, heavy, or sore for a day or two. Stretching and therapy usually start within a few days and continue for several weeks. Motion often improves gradually, and some people benefit from a repeat procedure.
Risks and limits
Risks include post-injection soreness, bruising, bleeding, infection, and rarely irritation of a nearby nerve. Steroid can briefly raise blood sugar in people with diabetes, so we plan for that. Occasionally the capsule tears as it stretches, which is usually part of the intended effect. Hydrodilatation may not help if stiffness has another cause, such as advanced arthritis, and is not given over infected skin.
What to expect at your visit
- 1.
We listen first
Your visit opens with a real conversation: how the problem started, what you have already tried, and the activity you want back.
- 2.
Exam and in-office ultrasound
A hands-on exam, then ultrasound at the exam table, often while you move, so your physician can see the tendon, joint, or nerve involved.
- 3.
A clear diagnosis and plan
You leave knowing what is wrong and what your options are, from strength-based rehab to procedures, and why we recommend each one.
- 4.
Treatment and follow-through
Most procedures happen here in the office. We coordinate with your physical therapist and check progress against the goals you set.
Questions about Capsular Distension
- Does hydrodilatation hurt?
- The skin is numbed, and a numbing medicine is part of the injected fluid. Many people feel pressure or fullness in the shoulder as the capsule stretches. The feeling usually fades within a day or two.
- How soon should I start therapy?
- Ideally within a few days, while pain is lower and the capsule has been stretched. Your physician will give you a home program and coordinate formal therapy when needed.
- Will my frozen shoulder go away on its own?
- Frozen shoulder often improves over time, but the course can last many months or longer, and some stiffness may remain. Hydrodilatation and therapy aim to ease pain and restore motion sooner.