Advanced Frozen Shoulder Treatment | Real Clinical Discussion With Mike Bryant

🎓 Ready to raise your standards in MSK ultrasound? Book a SMUG course now: https://rdar.li/8z93oM9 In this episode of the SMUG Musculoskeletal Ultrasound Podcast, Chris Myers and Mike Bryant discuss hydrodistensions and injection technique for frozen shoulder. This session offers valuable insights into managing shoulder pain, with a particular focus on adhesive capsulitis and bursitis. It's an excellent resource for clinicians looking to refine their approach to shoulder ultrasound and sports medicine applications. 00:00 Introduction to frozen shoulder injections with Big Mike 00:36 Why offer an injection early in frozen shoulder 01:20 Can early steroid alter the disease pathway? 02:08 Recognising the acute presentation vs calcific tendinitis 03:20 Steroid alone or hydrodistension for acute patients? 03:50 The dual injection: glenohumeral plus subacromial bursa 04:43 Side-lying posterior approach explained 05:19 Why not to inject in a sitting position 05:51 Managing fainters during injection 06:09 Posterior vs anterior joint approach 07:36 Local anaesthetic outside the capsule to reduce pain 08:39 Follow-up: how often to bring patients back 09:46 Type 1 diabetics and repeated injections 10:05 Combining bursa and joint injections in private practice 11:32 Chris's approach to acute pain: steroid first 12:48 Why volume may matter less than you think 13:12 Mike's current 31ml hydrodistension recipe 13:30 Three-way tap and extension tube technique 15:36 Injecting saline in a controlled, staged way 17:36 Immediate post-injection passive mobilisation 18:42 Why Mike reduced his hydro volume over the years 19:17 Capsular preserving vs capsular rupturing volumes 20:01 Why "capsular rupture" is the wrong term 20:44 Where does the fluid actually leak? 22:11 What surgeons see: the true fibrotic capsule 22:44 How much is guarding vs true restriction? 23:30 Defining capsule-preserving volumes (20–30ml) 24:04 Lower volumes may give better results 25:43 The advantage of the three-way tap 26:43 Chris's hybrid hydrodistension technique 30:35 Getting something into the joint is what matters 31:06 Reducing unnecessary hydrodistensions in the NHS 33:10 Is frozen shoulder really self-limiting? 34:30 Five-year follow-up data on hydrodistension outcomes 36:05 The role of physiotherapy in frozen shoulder 38:00 Quickfire: what is a hydrodistension actually doing? 39:34 How many injections to get good at hydrodistensions 40:37 Practical advice for clinicians starting out 41:39 Bedside manner during a long procedure 43:18 The value of a cadaveric course 44:10 Mike's podcast guest recommendations 45:18 Closing thoughts