Capsular Dilation to Restore Shoulder Movement and Reduce Pain
Frozen shoulder, also known as adhesive capsulitis, is a condition in which the shoulder joint capsule becomes thickened, inflamed, and progressively contracted. It typically follows a pattern of three phases: a painful freezing stage, a stiff frozen stage, and a gradual thawing stage. Without treatment, the entire process can take two to four years to resolve.
Hydrodistension (also called hydrodilatation or capsular dilation) is an ultrasound-guided procedure in which fluid is injected under pressure into the shoulder joint capsule. This stretches the contracted capsule from the inside, helping to break up adhesions and create more space within the joint. It is typically combined with a corticosteroid to reduce inflammation and followed by a physiotherapy programme to consolidate the improvement in range of movement.
Motherwell Physio offers this procedure under continuous ultrasound guidance to ensure accurate placement and effective capsular filling.Who This Is For
Hydrodistension / Hydrodilatation is typically appropriate for:
- Patients in the painful or frozen stages of frozen shoulder
- Shoulder stiffness that has not improved adequately with physiotherapy alone
- Pain and restricted movement lasting more than three months
- Those who wish to accelerate recovery and regain movement more quickly
It is less commonly indicated in the thawing phase, when the shoulder is already beginning to improve spontaneously. Your clinician will assess which stage you are in and advise accordingly.
How the Procedure Works
Clinical Assessment
Your first appointment includes a full shoulder assessment covering movement testing, special orthopaedic tests, and an ultrasound scan. The scan helps to confirm the diagnosis, assess the degree of capsular thickening, and plan the approach for the procedure. If hydrodistension is appropriate, the process will be explained and your questions answered before you proceed.
The Procedure
You will be comfortably positioned, typically lying on your back or side. The shoulder is cleaned with antiseptic. Under continuous ultrasound guidance, a needle is placed precisely into the glenohumeral joint (the ball-and-socket component of the shoulder). A mixture of saline, corticosteroid, and local anaesthetic is then injected under controlled pressure, filling and stretching the joint capsule. You will feel a sensation of increasing pressure in the shoulder as the capsule fills. This is expected and confirms the procedure is working. The injection takes approximately 10 to 15 minutes; the full appointment, including assessment and aftercare advice, is typically 45 to 60 minutes.
After the Procedure
Immediately following the injection, you may notice an improvement in shoulder movement as the capsule stretches. A mild flare in pain over the following 24 to 48 hours is common as the local anaesthetic wears off. Ice and over-the-counter analgesia are usually sufficient to manage this.
Physiotherapy should begin within the first week of the procedure to take advantage of the increased capsular volume and consolidate movement gains. Stretching exercises in particular are important during this window.
What to Expect at Your First Appointment
Wear a short-sleeved or loose top that allows full access to the shoulder, or a gown is available. Bring any previous imaging and a list of current medications. A referral from your GP is not required, though one is welcome if you have it.
Please arrange transport home for the day of the procedure. Most patients manage normal activities the day after, though comfort will vary.
Your Treatment Team
Shane Ryan, Director, Advanced Practice Physiotherapist
BSc Physiotherapy, PG Cert in Musculoskeletal Ultrasound, Clinical Specialist in Ultrasound guided injections, Independent Prescriber
CSP No. 098175
HCPC No, PH107655
BSc Physiotherapy, PG Cert in Musculoskeletal Ultrasound, Clinical Specialist in Ultrasound guided injections, Independent Prescriber
CSP No. 098175
HCPC No, PH107655
Pricing and Appointments
Book online at motherwellphysio.co.uk or call the clinic directly.
Conveniently Located in Motherwell
- Motherwell Physio, 406 Brandon Street, Motherwell, ML1 1XA
- Mon - Fri 8am - 6pm
- 01698 692086
- info@motherwellphysio.co.uk
- Free car park across the road
Frequently Asked Questions
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What is the difference between hydrodistension and a standard steroid injection for frozen shoulder?
A standard steroid injection reduces inflammation and can ease pain, but does not mechanically stretch the capsule. Hydrodistension delivers a larger volume of fluid specifically to fill and expand the contracted capsule, addressing the mechanical restriction as well as the inflammatory component. The combination of volume, steroid, and local anaesthetic is what distinguishes the procedure.
Many patients notice some improvement in range of movement immediately after the procedure as the capsule is stretched. The steroid component takes one to two weeks to reach its full anti-inflammatory effect. Consistent improvement is typically seen over four to eight weeks, particularly when combined with physiotherapy.
The procedure causes a sensation of pressure and stretching inside the shoulder, which some patients find uncomfortable. Local anaesthetic is included in the injection mixture, which reduces pain during and immediately after the procedure. A mild flare of 24 to 48 hours is common as the local anaesthetic wears off.
Yes, and this is important. Hydrodistension creates the conditions for improved movement, but physiotherapy is what consolidates it. Starting stretching and mobility work within one week of the procedure significantly improves outcomes compared to hydrodistension alone.
Most patients require a single hydrodistension. If improvement has been partial at follow-up review, a second procedure may occasionally be considered. Your clinician will assess your response at a follow-up appointment and advise accordingly.
Corticosteroids can temporarily raise blood glucose levels in people with diabetes, sometimes significantly. This does not necessarily exclude you from treatment, but it is important to disclose your diabetes management at assessment so that appropriate precautions can be taken and blood glucose monitoring can be planned around the procedure.
Availability on the NHS varies by area and currently requires a very long waiting time- often exceeding 6 months. Many patients access this treatment privately.
Untreated adhesive capsulitis typically runs a course of two to four years, though some patients experience persistent stiffness beyond this. Not all patients regain full movement spontaneously. Treatment aims to shorten this timeline and improve the degree of recovery.
In most cases, yes. Prior injections do not exclude you from hydrodistension. Your full treatment history will be reviewed at assessment to determine the most appropriate approach.
The painful (freezing) and stiff (frozen) stages tend to respond best. In the thawing stage, when movement is already beginning to return naturally, the procedure is less commonly indicated. Your clinician will assess which stage you are in and advise whether hydrodistension is likely to be beneficial at this point.
Ready to Book?
To arrange an assessment for frozen shoulder, call or book online at motherwellphysio.co.uk. 01698 692086