Glenohumeral Joint and Hydrodilation

The arm of the seated patient may rest on the patient's knee. Alternatively the patient may be placed in a semi-prone position with the affected shoulder uppermost.
The needle is most frequently introduced lateral to the ultrasound transducer and directed obliquely towards the posterior labrum. A medial puncture can be used but generally there is less room to manoeuvre. Care should be taken not to aim for the glenoid margin itself as a large labrum may displace the needle posteriorly and prevent accurate placement into the joint.
The intra-articular position of the needle can be confirmed by injecting a small amount of local anaesthetic. If the needle is correctly positioned, the injected local anaesthetic will disappear into the joint and no resistance will be felt.

Shoulder Distension for Frozen Shoulder

Prepare the following syringes:

  • 20mls of a mixture of local anaesthetic, normal saline
  • 20mls normal saline
  • 2mls 80mg methylprednisolone

Procedure Steps:

  1. Target the joint either via a posterior approach or through the anterior interval
  2. Once the joint is cannulated, attach a short flexible tube and a three-way connector tap
  3. Attach the 2ml and the first 20ml syringe with local and saline to the tap
  4. Confirm intraarticular positioning has been maintained and then inject the 2ml methylprednisolone
  5. Begin injecting the first 20ml and continue until the patient reports symptoms
  6. Close the tap, then continue with small aliquots closing the tap between each and assessing patient tolerance
  7. Warn the patient that the joint may decompress with a slight popping sensation
  8. If the patient tolerates the injection of the first 20mls, close the three-way tap and attach the second 20ml syringe
  9. The use of the three way tap prevents decompression of the joint as the syringes are being exchanged
  10. The aim is to inject a volume beyond joint capacity in an effort to stretch the capsule and improve the patient's range of motion
  11. Stop at 40ml or when the patient reaches tolerance or if the joint decompresses

Procedure Images

GHJ injection technique images and ultrasound guidance will be displayed here