Shoulder hydrodilatation is a minimally invasive injection that stretches a stiff joint capsule, to reduce pain and help you move your shoulder again.
A frozen shoulder (adhesive capsulitis) occurs when the capsule surrounding the shoulder joint becomes tight, stiff and inflamed, causing pain and restricting movement.1 Hydrodilatation treats this problem directly.
A large volume of sterile saline and local anaesthetic, usually together with a corticosteroid, is injected into the shoulder joint under ultrasound guidance. The fluid pressure gently stretches the tight joint capsule from the inside and loosens the adhesions that cause stiffness. This helps to:
It can be done at any stage of frozen shoulder. To learn more about the condition itself, see our page on frozen shoulder.
Hydrodilatation is suitable for people who have been diagnosed with frozen shoulder and have significant pain and stiffness. You do not need to have tried physiotherapy or medicines first. We often give the injection and teach you exercises at the same time.
Before the procedure, we assess your shoulder to confirm that frozen shoulder is the cause of your pain. Other conditions, such as a rotator cuff problem or arthritis, can look similar and may need a different treatment. Frozen shoulder is more common in people with diabetes,2 and we take extra care with blood sugar because steroids can raise it for a few days.
The procedure may not be suitable if you have:
Hydrodilatation is an ultrasound-guided procedure that is usually done in the clinic. The skin is numbed first, and the needle is guided into the joint using ultrasound so the fluid goes to the right place. X-ray imaging is sometimes used instead. Local anaesthetic, saline and usually a steroid are used, and expert consensus supports image guidance and a gradual, comfortable injection volume.3
As the fluid is injected, you may feel fullness or pressure in the shoulder. Most patients go home and return to normal activities on the same day. Your arm may feel heavy or numb for a few hours because of the local anaesthetic.
Stretching exercises after the injection are important, and expert consensus encourages home exercises and physiotherapy alongside hydrodilatation.3 We teach you a home programme and, if needed, arrange physiotherapy.
In our clinical experience, most patients go home feeling much better, and many notice a big improvement in pain and movement soon after the procedure. The local anaesthetic wears off after a few hours and some soreness for a day or two is common, so we judge the full benefit over the following weeks, together with your exercises.
Results vary between people. In clinical studies, around seven in ten people had lasting improvement after a single procedure. In the others, a second injection may be required. Research shows that hydrodilatation relieves pain and helps movement in frozen shoulder, with benefits that are most clear in the early weeks.4 Frozen shoulder often improves on its own, but this can be slow and take up to 2 to 3 years, and some people have lingering symptoms. Treatment aims to ease the pain and restore movement sooner.
Most patients need 1 to 2 injections for resolution of frozen shoulder symptoms. A second injection may be offered if the improvement is not complete, or if the symptoms return.
The cost depends on the treatment required. This is what a typical visit involves:
| Service | Estimated cost (SGD)* |
|---|---|
| First consultation | from $210 |
| Follow-up consultation | from $155 |
| Shoulder hydrodilatation (professional fee) | from $350 |
| Ultrasound usage fee (if applicable) | from $150 |
| Medications (if applicable) | from $100 |
*Prices are indicative and may differ based on your condition, the setting (clinic or hospital), the medications used and whether image guidance is required.
In most circumstances, shoulder hydrodilatation is covered by insurance. If the cost of the procedure is under the minimum deductible for your insurance plan, most of the fees can also be covered by MediSave. Call us at 8655 5722 to find out more.
Side effects are usually mild and temporary. The most common are:
Serious complications such as infection, bleeding or an allergic reaction are very rare. The procedure is done in a sterile setting, and we will explain the risks to you before you decide.
Go to the nearest emergency department.
Please tell us if you:
Bring any previous scans or reports of your shoulder. It helps to have someone accompany you, as your arm may feel numb or heavy for a few hours afterwards.
Rest the arm for the rest of the day while the local anaesthetic wears off, and avoid driving until it feels normal. From the next day, gentle stretching helps to keep the movement you have gained. Avoid heavy lifting until your doctor advises you. Contact the clinic if you develop fever, increasing redness or swelling at the injection site, or pain that is getting worse instead of better.
The exact cause of frozen shoulder is not fully understood, but it is believed to involve inflammation and thickening of the tissue around the joint. It often happens without any obvious reason. It can also develop after an injury or when the shoulder is kept still for a long time, such as when wearing a sling after a fracture. Diabetes and thyroid conditions can increase the risk.
People notice pain and stiffness that develops slowly. The pain is often worse at night, making it hard to sleep on the affected side. The condition usually progresses in stages, although not everyone goes through them in the same way:
Pain and stiffness can overlap between stages.1 Frozen shoulder is diagnosed from your symptoms and a physical examination. Scans are not usually needed, but may be done if the diagnosis is unclear.
Read more on our frozen shoulder page.
Most people with frozen shoulder improve with non-surgical treatment. Options include:
In rare cases where these treatments do not work, surgery may be considered. We will help you choose the treatment that fits your stage of frozen shoulder and your goals.
MOH accredited Pain Specialist and Medical Director of Alleviate Pain Clinic at Farrer Park Hospital. He completed an interventional pain fellowship at the University Health Network in Toronto and was previously a Senior Consultant in Pain Medicine at Singapore General Hospital.
Read more about Dr LiuThis page gives general information and is not a substitute for medical advice. Please see a doctor about your own symptoms and treatment options.
Most patients need 1 to 2 injections for resolution of frozen shoulder symptoms. A second injection may be offered if the improvement is not complete, or if the symptoms return.
In our clinical experience, most patients go home feeling much better, and many notice a big improvement soon after the procedure. The local anaesthetic wears off after a few hours and some soreness for 1 to 2 days is common, so we judge the full benefit over the following weeks, together with your exercises. Results vary between people.
The skin and joint are numbed with local anaesthetic. You may feel fullness or pressure as the fluid goes in, which is usually brief. Some soreness for 1 to 2 days is common.
Hydrodilatation uses a larger volume of fluid, usually together with a steroid, to stretch the tight joint capsule from the inside. A steroid injection alone uses a small volume to reduce inflammation. Studies show at least as much pain relief overall, with hydrodilatation possibly improving everyday function sooner and helping you turn your arm outwards more. In our clinical experience, hydrodilatation followed by regular home exercises gives most patients a better and faster recovery, which is why we most often recommend it.
You do not need to try physiotherapy first. We often give the injection and teach you stretching exercises at the same time. Regular stretching after the injection is important for recovery, and we can arrange physiotherapy if you need more support.
Yes. It can be done in the freezing, frozen or thawing stage. We will discuss the best timing for you based on your pain and stiffness.
Frozen shoulder is more common in people with diabetes, and many are treated with injections. The steroid can raise blood sugar for a few days, so please tell us you have diabetes. We will advise you on monitoring your blood sugar and whether the timing is suitable for you.
Symptoms can sometimes return, and frozen shoulder can occasionally affect the other shoulder as well. If symptoms come back, a second injection may be offered, and we will review your exercises.
Most patients can return to normal activities on the same day. Your arm may feel numb or heavy for a few hours, so avoid driving until it feels normal. Avoid heavy lifting until your doctor advises you.
Interventional pain procedures are covered by the Ministry of Health’s Table of Surgical Procedures (TOSP). They are therefore reimbursable by all Integrated Shield Plans and most corporate insurance plans. However, it is advisable to obtain preauthorisation from your insurer before the procedure. Our clinic staff will guide you through this process.
Effective pain solutions for a better living. Specialist pain management at Farrer Park Hospital, Singapore.
1 Farrer Park Station Road #08-14
Farrer Park Hospital (Connexion)
Singapore 217562
Mon–Fri 9am–5pm
Sat 9am–1pm · By appointment
