Distension arthrogram

This is a procedure used to treat a condition called a frozen shoulder.

This condition affects the capsule (lining of the shoulder), where it becomes thickened and inflamed resulting in symptoms of pain and restriction of movement.

Distension arthrogram is usually carried out in the X-ray department by a Radiologist. They use X-rays to locate the inside of the joint capsule. A needle is placed under image guidance inside of the shoulder capsule, this is confirmed by the injection of some xray contrast.  The fluid is injected to stretch/ cause a rent in the tight capsule. The combination of the fluid injected is felt to be more effective than just a steroid injection.

What are the possible problems

Infection risk is very low but estimated to be 1 in 1000 (0.1%)

Some patients report feeling the injection of sterile fluid uncomfortable, but generally it is well tolerated by patients.

The steroid component of the treatment can cause a ‘flare’ of pain which can last up to 72 hours.

It is possible for allergies to X-ray contrast or the injected steroid but these are very rare.

Before the procedure

It is better not to drive on the day of the procedure, so make alternatives to get to the hospital. You should have already been asked already if you are on any blood thinning medicines as you may not to stop them for a short while, if in doubt contact the X-ray department at Ross Hall and they will advise.

Procedure

Patients are asked to lie on a xray table and the procedure is carried out under local anaesthetic. Once position of the needle is confirmed, the capsule is stetched by the injection of sterile fluid (saline), then a steroid injection is given into the shoulder which acts as a powerful anti-inflammatory.

Diabetes

If you are diabetic, you should keep a close eye on your blood sugars as they can be increased by the steroid component.

After the procedure

It is important that you keep the shoulder moving, and begin some physiotherapy within a week of the procedure.

Initially the goal of rehab is to gain and keep range of motion, exercises that promote range of motion are key and ‘hands on’ joint mobilisation are key.

Expected Outcomes

We estimate that at least 7 out of 10 patients will get relief from the treatment.

We see two patterns of failure of the treatment. One where there is no benefit noted right from the start and secondly where the effects are mainly steroid related and the benefits wear off.

Self directed Exercises

Here are some self directed exercises that can be done while waiting for the physiotherapy treatment.

Table top step back

Table Top Slides

Arm Rotation

 Wall Slides 

Andrew Brooksbank