This document discusses arthrographic hydrodilatation as a treatment for frozen shoulder. Arthrographic hydrodilatation involves injecting local anesthetic, steroid, and saline into the frozen shoulder joint under imaging guidance to relieve pain and stretch the contracted joint capsule. A study of 51 patients found that arthrographic hydrodilatation significantly improved shoulder range of motion, pain levels, and outcome scores up to 8 months post-procedure, with 86% of patients satisfied. The procedure provides an effective non-surgical option for treating both primary and secondary frozen shoulder.

1. ARTHROGRAPHIC HYDRODILATATION
FOR FROZEN SHOULDER
Christopher Manning
Phil Wright
Lennard Funk

2. Background
Arthrographic Hydrodilatation
A fine needle is inserted into the frozen shoulder joint and
contrast medium is injected to ensure the needle is in the joint.
Hydrodilatation is effective by several modes of action;
• Long lasting local anaesthetic offers pain relief
• Steroid provides an anti-inflammatory effect
• Saline stretches the contracted joint capsule
Normal Arthrogram –
normal volume of dye
contained within the
joint.
Frozen Shoulder –
Tight joint with dye
rupturing out through
capsule.

3. Published Data
• Published results for Hydrodilatation are supportive of its
effectiveness and use despite differing;
• Hydrodilatation technique
• Physiotherapy regime
• Sample size
• Outcome measures used
• Length of follow-up
!!
- Buchbinder, R., S. Green, et al. (2008). "Arthrographic distension for adhesive capsulitis (frozen shoulder)." Cochrane Database Syst Rev(1): CD007005.
- Bell, S., J. Coghlan, et al. (2003). "Hydrodilatation in the management of shoulder capsulitis." Australas Radiol 47(3): 247-251.
- Haolvfeficrseo.“n, L. and R. Maas (2002). "Shoulder joint capsule distension (hydroplasty): a case series of patients with "frozen shoulders" treated in a primary care
- QuJraoisnht i, N. A., P. Johnston, et al. (2007). "Thawing the frozen shoulder. A randomised trial comparing manipulation under anaesthesia with hydrodilatation." J Bone

4. Aims
To evaluate the efficacy of arthrographic
hydrodilatation for the treatment of frozen shoulder,
over a three year period.

5. Methods
Fifty one patients were prospectively followed for a mean period of eight months
post Hydrodilatation for Frozen Shoulder (30 primary, 21 secondary).
Patients were evaluated for:
1- Constant-Murley Score
2- Oxford Shoulder Score
3- Range of Movement
4- Pain (Visual Analogue Scale)

6. Range of Motion
Range of Movement (o)
160
120
80
40
0
Flexion Abduction Internal Rotation
Movement
38
143
154
33
128
141
0
34
53

7. Outcome Scores
90
68
45
23
0
Constant-Murley Score Oxford Score
Scoring Method
44
83
40
68
24 25
Pre Hydrodilatation
6 weeks
8 months

8. Pain Scores
VAS
9
7
5
2
0
0 6 36

9. Results
!
• Patient satisfaction at 6 weeks and 8 months
was 86%.
!
• 7 of the patients went on to have arthroscopic
capsular release for ongoing stiffness.

10. Conclusion
Arthrographic hydrodilatation is a safe and
effective intervention for both primary and
secondary frozen shoulder, with significant
improvements in both pain and stiffness as early
as six weeks post-procedure.
For more details on this study, please see the
Education section of www.shoulderdoc.co.uk