Glenohumeral hydrodilatation (tension arthography) is an established treatment for adhesive capsulitis of the shoulder (frozen shoulder) and can be performed under multiple modalities.
- adhesive capsulitis of the shoulder
- systemic sepsis
- allergies to contrast, steroid or local anaesthetic
- acute trauma
- history and examination, specifically range of movement of affected shoulder
- informed consent
- review prior imaging
Patient positioning will depend on the modality but the patient will typically be positioned supine with the shoulder for treatment elevated and externally rotated.
- sterile pack, wash, gloves and gown
- 1%/2% lignocaine, 23 G/25 G needle, 10 mL syringe x 2; 30 mL syringe, extension tubing; 21 G/22 G needle
- steroid (e.g. Celestone/Kenacort); 10 mL long-acting local anaesthetic (e.g. ropivacaine/bupivacaine); normal saline; contrast
Ultrasound, fluoroscopy and CT can all be used. The glenohumeral joint is accessed using the same technique for shoulder arthrography but following confirmation of intra-articular position using dilute contrast the glenohumeral joint is maximally distended, first using steroid / long-acting local anaesthetic mixture followed by injection of dilute contrast.
The volume injected is generally accepted as maximally tolerated by pain, until capsule rupture or full distension of subscapular bursa.
Patient should be assessed in regards to range of motion, which should be improved. Care should be taken for the first 48 hours with no heavy or overhead lifting. Follow-up should be with referring doctor and physiotherapist.
Adhesive capsulitis is considered a self-limiting disease with the aim of hydrodilatation to reduce the duration of pain and limited range of motion.
The benefit of shoulder hydrodilatation compared to steroid injection alone or other conservative treatment has not been established with several studies demonstrating mixed results 5,6.
- 1. Watson L, Bialocerkowski A, Dalziel R et-al. Hydrodilatation (distension arthrography): a long-term clinical outcome series. Br J Sports Med. 2007;41 (3): 167-73. doi:10.1136/bjsm.2006.028431 - Free text at pubmed - Pubmed citation
- 2. Interventional Radiology. Oxford University Press. ISBN:0199547726. Read it at Google Books - Find it at Amazon
- 3. Tveitå EK, Tariq R, Sesseng S et-al. Hydrodilatation, corticosteroids and adhesive capsulitis: a randomized controlled trial. BMC Musculoskelet Disord. 2008;9 (1): 53. doi:10.1186/1471-2474-9-53 - Free text at pubmed - Pubmed citation
- 4. D'Orsi GM, Via AG, Frizziero A et-al. Treatment of adhesive capsulitis: a review. Muscles Ligaments Tendons J. 2013;2 (2): 70-8. Free text at pubmed - Pubmed citation
- 5. Maund E, Craig D, Suekarran S et-al. Management of frozen shoulder: a systematic review and cost-effectiveness analysis. Health Technol Assess. 2012;16 (11): 1-264. doi:10.3310/hta16110 - Pubmed citation
- 6. Buchbinder R, Green S, Youd JM et-al. Arthrographic distension for adhesive capsulitis (frozen shoulder). Cochrane Database Syst Rev. 2008; (1): CD007005. doi:10.1002/14651858.CD007005 - Pubmed citation
- 7. Bell S, Coghlan J, Richardson M. Hydrodilatation in the management of shoulder capsulitis. Australas Radiol. 2003;47 (3): 247-51. Pubmed citation