What is the role of hydrodilatation in the treatment of frozen shoulder syndrome (FSS) (adhesive capsulitis)?

Updated: Nov 12, 2020
  • Author: Jefferson R Roberts, MD; Chief Editor: S Ashfaq Hasan, MD  more...
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Hydrodilatation (also termed hydrodistention and distention arthrography) involves the ultrasound-guided injection of a large volume of saline—typically along with a corticosteroid, local anesthetic, and contrast medium—into the joint space. [64] The therapeutic effect of hydrodilatation was initially attributed to rupture of the capsule, but capsular distention may in fact be the mechanism. [64]

Studies of hydrodilatation have yielded conflicting results, especially with regard to patients with diabetes mellitus. For example, a systematic review and meta-analysis concluded that hydrodilatation has only a small, clinically insignificant effect on adhesive capsulitis. [67] On the other hand, the largest single study, in 109 shoulders, concluded that hydrodilatation is effective, although patients with severe cases and those with diabetes tended to respond less well in the long term. [68] A study of 90 patients who underwent hydrodilatation after failure of initial treatment that included physiotherapy and at least one corticosteroid injection reported clinically important improvements in pain and function that remained clearly substantial at 24 weeks. [69]

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