Is Shoulder Joint Distension Safe Without Ultrasound Guidance?

Shoulder rehabilitation for frozen shoulder?

Hello Doctor: I am currently not in Taiwan and have finally seen a doctor after several months of physiotherapy.
The doctor diagnosed me with frozen shoulder and mentioned that I need to undergo a distension procedure to open up the adhesions.
I would like to ask if it is safe to perform shoulder joint distension with saline without ultrasound guidance and without anesthesia.
I have already passed the stage of severe pain that prevented me from sleeping at night.
Although my range of motion is not normal, it is better than when I was in severe pain.
Is it worth the risk to proceed with the distension procedure, or would it be better to continue with gradual rehabilitation, even if it takes longer? I am very concerned that without ultrasound guidance, the saline may not reach the targeted area, and I am unsure if the amount of saline injected is appropriate, which could cause additional harm.
If the injection is not targeted correctly, what is the worst-case scenario? Thank you!

Niming, 40~49 year old female. Ask Date: 2022/03/18

Dr. Lin Ruixiang reply Rehabilitation

Hello, regarding the course of frozen shoulder (adhesive capsulitis), your current condition shows an increase in shoulder joint range of motion along with a decrease in pain, which indicates that you are in the resolution phase of the condition.
This phase is typically the final stage of the disease, which generally lasts about six months before recovery occurs (although a small percentage of individuals may experience some residual joint restriction).

As for joint distension therapy, its benefit is that it can reduce the duration of the condition by approximately 70%.
While shoulder joint injections can be performed without ultrasound guidance, it is preferable to use ultrasound guidance in the current clinical setting.
If only normal saline is used, it is generally safe.
The addition of anesthetic is optional; including it may make the injection process smoother, but omitting it does not affect the prognosis.

The most significant potential side effect is the rupture of the joint capsule; however, since normal saline is being injected, it does not pose any harm to the body.
The ruptured area typically heals on its own, but the downside is that pain may prolong the recovery process.
The Hualien Hospital of the Ministry of Health and Welfare cares about your health.

Reply Date: 2022/03/18

More Info

Shoulder joint distension, also known as shoulder joint hydrodissection, is a procedure often used to treat conditions like adhesive capsulitis (frozen shoulder) by injecting saline into the joint to help break up adhesions and improve mobility. However, performing this procedure without ultrasound guidance raises several concerns regarding safety and efficacy.

1. Safety Concerns: Performing shoulder joint distension without ultrasound guidance can be risky. Ultrasound helps the physician visualize the anatomy of the shoulder joint in real-time, ensuring that the needle is accurately placed within the joint space. Without this guidance, there is a higher risk of injecting saline into the wrong area, such as surrounding soft tissues or blood vessels, which could lead to complications like pain, swelling, or even more severe injuries.

2. Efficacy: The effectiveness of the procedure is significantly enhanced when ultrasound is used. The ability to visualize the joint allows for precise targeting of the adhesive areas, maximizing the potential benefits of the distension. Without this precision, the likelihood of achieving the desired therapeutic effect diminishes, and the procedure may not provide the relief you are seeking.

3. Potential Complications: If the saline is injected into the wrong location, several adverse outcomes could occur. These may include:
- Infection: Introducing a needle into the shoulder joint carries a risk of infection, which could be exacerbated if the injection is not performed in a sterile manner or if the needle is misplaced.

- Joint Damage: Incorrect placement could potentially damage the surrounding structures, including nerves, blood vessels, or other soft tissues.

- Increased Pain: If the saline is injected into an area that is not the joint capsule, it may lead to increased pain and inflammation rather than relief.

4. Alternative Options: Given your concerns about the risks associated with the procedure, it may be worth considering alternative treatment options. Physical therapy is a well-established approach for managing frozen shoulder and can be effective in restoring mobility and reducing pain over time. While it may take longer to see results compared to a distension procedure, it is generally safer and can be tailored to your specific needs.

5. Decision Making: Ultimately, the decision to proceed with shoulder joint distension without ultrasound guidance should be made in consultation with a qualified healthcare professional. Discuss your concerns openly with your physician, including the potential risks and benefits of the procedure versus continued physical therapy. They may be able to provide additional insights or suggest alternative treatments that align better with your comfort level and health goals.

In conclusion, while shoulder joint distension can be a beneficial procedure for certain conditions, performing it without ultrasound guidance poses significant risks. It is crucial to weigh these risks against the potential benefits and consider safer alternatives, such as physical therapy, especially if you are already experiencing some improvement in your range of motion. Always prioritize your safety and well-being when making decisions about medical procedures.

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