PRP: PLATELET-RICH PLASMA

General Orthopedic Surgeons located in Benbrook, Ft Worth, TX

A guide to capsular distension, corticosteroid options, PRP, rehabilitation, and choosing a high-quality clinic

WHAT ADHESIVE CAPSULITIS IS

Adhesive capsulitis - commonly called frozen shoulder - is a painful condition in which the glenohumeral joint capsule becomes inflamed, thickened, and fibrotic. The hallmark is progressive loss of both active and passive range of motion, especially external rotation. Symptoms can last many months and sometimes longer than a year.

WHAT HYDRODILATION IS

Hydrodilation (also called hydrodilatation, distension arthrography, or capsular distension) is an image-guided injection that places a larger volume of fluid into the glenohumeral joint to expand the tight capsule. The procedure may use saline or dextrose solution, local anesthetic, and often a corticosteroid. The goal is to reduce pain enough to move and to create capsular stretch so rehabilitation can restore and preserve motion.

HOW IT MAY HELP

• Distends a contracted capsule and can improve external rotation and other ranges of motion.

• Reduces pain when anti-inflammatory medication is included, allowing more effective stretching and exercise. • May shorten the period of severe stiffness for some patients and help avoid or delay manipulation under anesthesia or arthroscopic capsular release. • Creates a window for rehabilitation; the motion gained during or after the procedure must be reinforced with a structured home and therapy program

HYDRODILATION WITH CORTICOSTEROID

Corticosteroid is frequently included because the painful phase of adhesive capsulitis has a strong inflammatory component. Randomized studies show that hydrodilation protocols containing steroid can provide good pain and functional outcomes, and some trials have found better outcomes than hydrodilation without steroid. Other recent trials and systematic reviews show that the added mechanical distension may not always outperform a well-placedintra-articular steroid injection by itself. In practice, the choice depends on stage, pain severity, medical history, glucose control, prior injections, and the clinician’s protocol.

HYDRODILATION WITHOUT STEROID

Capsular distension can also be performed with saline or 5% dextrose and local anesthetic as appropriate. A 2026 randomized trial found capsule-preserving hydrodilation with 5% dextrose produced similar 12-week improvements to a triamcinolone-based hydrodilation protocol, making non-steroid distension a reasonable option for selected patients.

WHERE PRP FITS

PRP is another intra-articular treatment option for adhesive capsulitis. Multiple randomized trials and recent meta-analyses report improvements in pain, disability, and range of motion after PRP, with some studies showing more durable improvement than corticosteroid at later follow-up. The strongest PRP literature evaluates PRP as an intra-articular biologic injection; the evidence is less standardized for combining high-volume capsular hydrodilation and PRP in the same syringe or exact protocol.

WHO MAY BENEFIT

Patients with true restriction of passive shoulder motion, pain and stiffness consistent with adhesive capsulitis, and no major competing diagnosis such as a large acute rotator cuff tear, fracture, advanced glenohumeral arthritis, infection, or cervical radiculopathy. Diabetes and thyroid disease are commonly associated with frozen shoulder and may influence recovery.

WHAT HAPPENS DURING THE PROCEDURE

The clinician confirms the joint and surrounding structures with ultrasound or fluoroscopy, places the needle into the glenohumeral joint, and gradually injects the selected solution to distend the capsule. Technique varies: some clinicians intentionally preserve the capsule while others allow rupture. Published studies use a wide range of volumes, which is one reason there is no universal “best” recipe.

THE MOST IMPORTANT PART AFTERWARD: MOVE THE SHOULDER

Hydrodilation creates an opportunity; rehabilitation determines whether the gain is kept. The typical plan emphasizes frequent comfortable range-of-motion work, progressive stretching, scapular mechanics, and later strengthening. Therapy should be assertive enough to prevent re-stiffening but not so aggressive that it repeatedly triggers a major inflammatory flare.

WHY A TRUSTWORTHY CLINIC MATTERS

• Diagnosis: the clinician should distinguish adhesive capsulitis from rotator cuff disease, arthritis, cervical pain, and other causes of shoulder stiffness.

• Image guidance: accurate intra-articular placement is important; blind injections can miss the joint. • Injectate transparency: you should know whether the plan uses steroid, D5W/saline, anesthetic, PRP, or a combination and why. • Volume and capsular strategy: the clinic should have a rationale for the amount injected and whether the capsule is intended to remain intact. • Rehabilitation coordination: a high-quality program provides or coordinates the mobility plan rather than treating hydrodilation as a stand-alone fix. • Realistic expectations: the goal is meaningful pain and motion improvement, not a promise that every shoulder will be normal immediately.

RISKS AND LIMITATIONS

• Temporary pain or pressure during injection, soreness, swelling, bruising, and short-term flare.

• Steroid-specific risks when corticosteroid is used, including transient glucose elevation and other systemic or local effects.

• Bleeding, infection, vasovagal reaction, or injury to nearby structures are uncommon but possible.

• Hydrodilation may not outperform a well-placed steroid injection in every patient; outcomes vary and rehabilitation remains essential.

• Persistent severe stiffness despite appropriate conservative care may eventually require manipulation under anesthesia or arthroscopic capsular release.

SELECTED REFERENCES

These references are provided for clinical transparency and further reading. Individual treatment decisions require an in-person evaluation.

[1] Rhim HC, Shin J, Olson G, et al. Hydrodilatation for adhesive capsulitis: a systematic review exploring efficacy and optimal technique. Br J Sports Med. 2026 Jul 29. doi:10.1136/bjsports-2025-110539. [2] Gebellí-Jové JT, Buñuel-Viñau A, Canela-Capdevila M, et al. A prospective, randomized, blinded study on the efficacy of using corticosteroids in hydrodilatation as a treatment for adhesive capsulitis. Shoulder Elbow. 2025;17(3):274-281. doi:10.1177/17585732241239030. [3] Nasiri A, Mirhadi M, Nadgaran V, et al. A Comparative Study Between Hydrodilatation and Intra-Articular Corticosteroid Injection in Patients with Shoulder Adhesive Capsulitis: randomized clinical trial. J Pain Palliat Care Pharmacother. 2025;39(2):286-296. doi:10.1080/15360288.2024.2446284. [4] Poku D, Hassan R, Migliorini F, Maffulli N. Efficacy of hydrodilatation in frozen shoulder: a systematic review and meta-analysis. Br Med Bull. 2023;147:121-147. doi:10.1093/bmb/ldad018. [5] Liu Y, et al. Short-term efficacy of ultrasound-guided capsule-preserving hydrodilatation for primary frozen shoulder using 5% dextrose water vs corticosteroid: randomized controlled trial. J Shoulder Elbow Surg. 2026. PubMed PMID: 40466856. [6] Comparison of the efficacy of platelet-rich plasma versus corticosteroid in the treatment of adhesive capsulitis: a systematic review and meta-analysis based on randomized controlled trials. PubMed PMID: 41728615. 2026. [7] Valencia R, Anche G, Cao V, et al. Comparative efficacy of platelet rich plasma, hyaluronic acid, and corticosteroid injections in adhesive capsulitis management: A meta-analysis. PM R. 2025;17(9):1097-1106. doi:10.1002/pmrj.13376. [8] The clinical efficacy and safety of platelet-rich plasma on frozen shoulder: a systematic review and meta-analysis of randomized controlled trials. PubMed PMID: 39242516. 2024.

Southwest Orthopedic Associates

✆ Phone (appointments): 817-731-9400

Fax: 817-731-4282

Address: 6311 Southwest Blvd., Ft Worth, TX 76132

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