by Dave Baker (Clinical Director, Complete Physio)

Hydrodistension is an effective treatment for frozen shoulder. Frozen shoulder can cause severe shoulder pain and debilitating restriction of movement. It is most common in middle-aged patients, indeed, in Chinese medicine frozen shoulder is described as ’50-year-old shoulder syndrome’. The condition is more common among females than males and is often more likely to occur following an traumatic injury to the shoulder. Other medical conditions are also a factor such as diabetes which has been shown to increase risks of developing a frozen shoulder and may also cause the condition to be more resistant to treatment. Often frozen shoulder can last for 6-24 months.

Hydrodistension symptoms

Typically frozen shoulder will start with severe pain which can then develop into pain with stiffness and marked loss of range of motion around the shoulder. Patients often complain of difficulty sleeping due to the pain frequently waking them. The stiffness of the shoulder typically affects the ability for patients to externally rotate their shoulder (i.e.turn their shoulder outwards) and patients find real difficulties with activities such as washing their hair or reaching their arm into a coat sleeve. Very often investigations such as x-ray and MRI scans are essentially normal aside from the normal age related wear and tear changes seen in this patient age group. GPs will often request scans to help confirm patients diagnosis and rule out other potential sources of the pain. We prefer patients to have an x-ray before performing injection procedures for this presenting condition to help confirm the shoulder is otherwise healthy.

Traditional treatments used for shoulder pain such as stretching and exercise can be very painful and generally have been shown to give little benefit. Increasingly nowadays an injection will be considered as a first line of effective treatment to reduce pain and help improve shoulder movements. Corticosteroid is used as part of a special injection procedure to stretch the shoulder joint helping with movement known as ‘Hydrodistension‘ , hydrodilatation’ or ‘High Volume’ injections have been shown to be the most effective treatment for most people and also allow  exercise and stretches to begin to take affect. Frozen shoulder pain can be extremely debilitating and patients will often attend clinic tired through lack of sleep, anxious and frustrated due to their limited function and ability to perform daily chores. Our unique one-stop-shop for injections allows patients quick access to pain relief.

If you would like to find out more about this treatment please don’t hesitate to contact us for an individual assessment on 02074823875 or email us directly on


Research papers of Interest

Allen, G.M., 2018, January. How should we treat frozen shoulder? Ultrasound guided injection, landmark guided injection, hydrodilatation or surgery. ECR.

Bryant, M., Gough, A., Selfe, J., Richards, J. and Burgess, E., 2017. The effectiveness of ultrasound guided hydrodistension and physiotherapy in the treatment of frozen shoulder/adhesive capsulitis in primary care: a single centre service evaluation. Shoulder & elbow9(4), pp.292-298.

Lewis, J., 2015. Frozen shoulder contracture syndrome–Aetiology, diagnosis and management. Manual therapy20(1), pp.2-9.

Lin, M.T., Hsiao, M.Y., Tu, Y.K. and Wang, T.G., 2018. Comparative efficacy of intra-articular steroid injection and distension in patients with frozen shoulder: a systematic review and network meta-analysis. Archives of physical medicine and rehabilitation99(7), pp.1383-1394.

Wu, W.T., Chang, K.V., Han, D.S., Chang, C.H., Yang, F.S. and Lin, C.P., 2017. Effectiveness of glenohumeral joint dilatation for treatment of frozen shoulder: a systematic review and meta-analysis of randomized controlled trials. Scientific reports7(1), p.10507.

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