Frozen shoulder, or adhesive capsulitis, is a condition that causes pain and restricted movement in the shoulder. The joint of the shoulder is held together by a joint capsule, which becomes thickened and results in a global restriction of shoulder movement. This manifests with shoulder motion being stuck or frozen.
Various triggers have been associated with adhesive capsulitis, and surgery is a common trigger with the rate of frozen shoulder after surgery projected to be 5 to 33%. To learn more about causes and traditional treatments for adhesive capsulitis or frozen shoulder click here.
High-volume distention of the shoulder joint capsule has been shown to provide pain relief and immediate improvement in range of motion. This procedure has shown superior results when compared to other conservative treatments, and in a recent study by Gallacher et al. (2018) showed similar results to surgery. In this study, high-volume distention showed similar improvement in range of motion and pain when compared to surgery (arthroscopic capsular release).
High-volume distention is an office-based procedure performed with local anesthesia and involves injecting fluid into the intra-articular space to expand the stiff joint capsule and eliminate adhesion or scar tissue limiting range of motion and causing pain. High-volume dilation should be considered before surgery.
The procedure is performed in the office. Local anesthetic is used to numb the joint and perform a nerve block. The shoulder joint capsule is then injected into the intraarticular space. The fluid raises the intraarticular pressure and expands the stiff joint capsule eliminating adhesions or scar tissue that was limiting range of motion. The shoulder is the stretched in the office with osteopathic manipulative medicine.
The results of the procedure are typically felt immediately or within a few days.
High-volume dilation for frozen shoulder or adhesive capsulitis is covered by insurance.
Not all physicians performing ultrasound-guided procedures are adequately trained, and the high-volume shoulder dilation or distention procedures are an advanced technique. It is important that your physician has training in advanced-imaging placement.
PRP or platelet rich plasma injections have been shown to be more effective than physical therapy or cortisone injection in improving pain or range of motion in adhesive capsulitis. Learn more here.
High volume dilation is a procedure performed in the office and studies have shown similar results with this procedure as with arthroscopic release, but high volume dilation does not involve the risk of general anesthesia. Learn more here.