BJSM - 2026-07-29 - Journal Article
Hydrodilatation for adhesive capsulitis: a systematic review exploring efficacy and optimal technique.
Rhim HC, Shin J, Olson G, Fetterman R, Guo RC, Combs DB, Pan X, Ruiz J, Dhawan R, Robinson DM, McInnis KC
Topics
Key Takeaway
Hydrodilatation achieved greater external rotation than corticosteroid injection alone at 12 weeks (SMD 0.61) but produced no significant differences in pain VAS, SPADI, abduction, or forward flexion, with high heterogeneity (I² 81.6%) undermining confidence in even that finding.
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Summary
This systematic review with meta-analysis evaluated hydrodilatation versus corticosteroid injection alone and versus physical therapy across 103 studies. Hydrodilatation showed a statistically significant but clinically modest external rotation advantage over corticosteroid injection alone (SMD 0.61) and marginal pain and SPADI improvements over physical therapy alone, but no range-of-motion gains as a PT adjunct. Evidence certainty was low to very low for all positive findings, and technique variability (volumes 8.3–200 mL, anterior vs. posterior approach, fluoroscopy vs. ultrasound guidance) precluded definitive conclusions.
Key Limitation
High heterogeneity (I² up to 81.6%) combined with low-to-very-low GRADE certainty ratings means the statistically significant findings cannot be translated into reliable clinical effect estimates.
Original Abstract
OBJECTIVE
Patients with adhesive capsulitis are often referred for conservative management, including corticosteroid injection or hydrodilatation of the glenohumeral joint. This systematic review aimed to evaluate the efficacy of hydrodilatation compared with other interventions and summarise reported techniques.
DESIGN
Systematic review with meta-analysis.
DATA SOURCES
PubMed, Embase and Web of Science. ELIGIBILITY
CRITERIA FOR SELECTING STUDIES
Randomised clinical trials (RCTs) and non-RCTs reporting outcomes related to hydrodilatation for idiopathic adhesive capsulitis.
RESULTS
A total of 103 studies (9951 patients and 44 RCTs) were included, and the selected RCTs were used to perform meta-analyses. The mean hydrodilatation volume from the included studies was 36.0±26.3 mL, and the median volume was 28 mL (range: 8.3-200). The anterior approach was more common with fluoroscopy guidance (anterior n=31 vs posterior n=5), while the posterior approach was more common with ultrasound guidance (anterior n=9 vs posterior n=40). At 12 weeks, hydrodilatation resulted in greater external rotation (standardised mean difference (SMD) 0.61, 95% CI 0.14 to 1.08, I 2 81.6%) than corticosteroid injection alone (low certainty of evidence), but without significant differences in pain Visual Analog Scores (VAS), shoulder pain and disability index (SPADI), abduction and forward flexion. When combined with physical therapy or exercise, at 12 weeks, hydrodilatation resulted in better pain VAS scores (low certainty of evidence) (SMD 0.288, 95% CI 0.01 to 0.57, I 2 20.7%) and SPADI scores (very low certainty of evidence) (SMD 0.52, 95% CI 0.08 to 0.96, I 2 52.3%) compared with physical therapy alone, but no additional gains in range of motion. The reported incidence of infection associated with hydrodilatation was 0.02% (two cases among 8754 patients).
CONCLUSION
Significant variability exists in hydrodilatation techniques. Current evidence, combining these various techniques, does not support meaningful clinical improvements from hydrodilatation compared with corticosteroid injection alone or as an adjunct to physical therapy in patients with adhesive capsulitis. The ideal injection volume, capsular status, and number of injections remain inconclusive.