What is it?
This is a procedure whereby fluid is used to dilate the shoulder capsule in order to relieve immobility and improve pain in cases of frozen shoulder, also known as adhesive capsulitis.
How is the procedure performed?
At Uniradiology, the doctor will first discuss with the procedure with you in order to answer any questions you may have. You will be asked to sign a standardised consent form.
You will change into a gown with the affected shoulder exposed.
As the procedure is performed under CT guidance, you will lay on your back on the CT table. The limited CT will be performed to help plan the procedure and guide the needle into the correct position.
The skin is prepped with chlorhexidine, an antiseptic agent. A small amount of local anaesthetic is used to numb the skin. A needle is then placed into the shoulder capsule. Once in the correct position, a small amount of contrast is injected to confirm the correct positioning. Then a combination of Cortisone, local anaesthetic, and normal saline will be injected in order to dilate the shoulder capsule. Up to 40mL can be injected.
A small dressing will be placed on the skin at the injection site.
What will I feel during the procedure?
The local anaesthetic is usually associated with a very short sting.
During the dilatation, the shoulder will feel tight and heavy. Some patients describe a feeling of pressure. Some patients may experience discomfort or pain, and you should let the doctor know, the procedure may be stopped at this point.
How long does the procedure take?
The procedure itself does not take very long, approximately 10 minutes. However, this does not include time for paperwork, preparation of materials, changing gowns, etc. All up, the procedure should take around 20 minutes.
What happens after the procedure?
You will be asked to remain in the department for a short period of time (30 minutes) to make sure you are well enough to go home.
Ideally you should have someone drive you home, or take public transport. You may find that your arm is clumsy after the procedure. It may also feel heavy or tight for a couple of days.
Gentle movements of the shoulder are encouraged to prevent adhesions from reforming. However heavy lifting and intense activity should be avoided for 2-3 days.
You should consult your physiotherapist for advice on an exercise program or how much to use your arm.
Are there any potential complications?
This is a very common and safe procedure. However there are some risks.
Infection is rare but is a known complication arising from this procedure. You may feel the shoulder become hot and increasingly painful. You may develop fevers.
If this happens you should see your local doctor or go to the emergency department for further management and antibiotics. Early antibiotic treatment is very successful and important.
Allergic reactions to contrast material are even rarer, but can be potentially life threatening. If you have a known allergy to contrast you should let the staff and the treating doctor know. An allergic reaction may manifest as breathing difficulties, swelling of the face and airway. This requires immediate emergency medical help.
Bleeding. This is usually only a problem if you are on blood thinning medication such as Warfarin. You should come off these medications and wait until your blood levels have normalised prior to the procedure.
How should I prepare for the procedure?
Apart from those patients who require cessation of their blood thinning medication, no specific preparation is necessary. You should ideally avoid driving and therefore having someone to drive you home is preferable.
Please let the staff know if you have any allergies.
Will I need to pay any up front costs?
At Uniradiology, we charge a $100 fee for the use of Cortisone.
What if I have further questions?
Please feel free to contact our staff if you require further information.