Hydrodilation at Tunbridge Wells Hospital

What is hydrodilatation?

Hydrodilatation is a treatment for a painful, restricted shoulder often known as a frozen shoulder. It works by injecting a mixture of saline, local anaesthetic and steroid into the shoulder joint to gently stretch the tight joint capsule.

What conditions does hydrodilatation treat?

Hydrodilatation treats frozen shoulder (adhesive capsulitis), a condition where the capsule surrounding the shoulder joint becomes inflamed and tightens, causing pain and restricted movement.

It's generally offered once gentler approaches, physiotherapy and anti-inflammatory medicines among them, haven't brought enough improvement on their own.

What are the benefits of hydrodilatation?

The aim is to ease pain and improve how far you can move your shoulder, by expanding the joint and freeing up sticky adhesions that have built up inside it.

It's regarded as less invasive than surgical alternatives, where the shoulder is either forcibly moved under anaesthetic or the capsule is opened up using keyhole techniques.

Are there different types of hydrodilatation?

The procedure can be carried out under different types of imaging guidance:

• ultrasound guidance, where your clinician watches the fluid enter the joint directly, without needing any contrast dye
• X-ray (fluoroscopic) guidance, where a touch of contrast dye is injected first, to confirm the needle sits correctly before the treatment fluid is given.

What happens before hydrodilatation?

There's nothing special to prepare beforehand. You can eat, drink and take your regular medication as normal

• Let your doctor know if you're taking blood-thinning medication, such as warfarin, apixaban or rivaroxaban, since you may need to pause this beforehand.
• Mention any allergies, particularly if you've reacted to contrast dye in the past.
• Arrange for someone to drive you home afterwards, since you may feel dizzy following the procedure.

What happens during hydrodilatation?

1. You'll be positioned on your back, arm placed by your side or out to the side, depending on the technique used.
2. The skin around your shoulder is cleaned and draped with a sterile covering.
3. Local anaesthetic is injected to numb the area.
4. A fine needle is carefully guided towards the shoulder joint, its position checked using ultrasound images or, if X-ray is used, a touch of contrast dye first.
5. A mixture of saline, steroid and more local anaesthetic then flows in through the needle to gradually stretch the joint capsule.
6. Once done, the needle comes out and a dressing goes over the site.

The injection itself is usually over within about 15 minutes, though an ultrasound-guided appointment can take up to an hour in total.

What does recovery look like?

Most people go home shortly after the procedure. You are medically and legally prohibited from driving a car for the first 24 hours following the procedure. You must only return to the road once all dizziness has completely resolved, you are off all sedating painkillers, and you possess full, unhindered steering power to handle an emergency maneuver safely.

You may have a temporary flare of pain when the local anaesthetic wears off.

Physiotherapy is often suggested to start soon afterwards, to help you keep the movement you've gained, and staying active with your shoulder as you recover helps you get the most out of the treatment. Your team will give you advice about this.

Time off work or sport depends on what you do: tasks involving heavy lifting or repeated overhead reaching need a longer break, ranging anywhere between a week and six weeks. Your physiotherapist can advise on what's right for your situation.

What are the risks and complications?

Possible risks of hydrodilatation include:

• infection, which is rare, though you should seek urgent medical advice if your shoulder becomes red, warm, swollen or increasingly painful
• a slight chance of bleeding at the injection site
• the treatment not working
• short-term changes to blood sugar levels if you have diabetes
• dizziness immediately after the procedure.

Hydrodilatation may not be suitable if you're taking blood-thinning medication; your doctor will discuss this with you beforehand.