Q & A with radiologist Dr Justin Roebert

Answers to the most frequently asked questions from our MSK Shoulder webinar held on Tuesday 24 August, 2021.

Q & A with radiologist Dr Justin Roebert

Answers to the most frequently asked questions from our MSK Shoulder webinar held on Tuesday 24 August, 2021.


Can hydrodilatation of the shoulder increase range of movement, or reduce pain reliably?  

Hydrodilatation usually reduces pain and increases range of movement. In those with more severe disease, more than one may be required. The initial one usually will only help with pain and the subsequent one will be more helpful in terms of movement.  

When treating frozen shoulder is physiotherapy without CSI/hydrodilatation pointless and potentially harmful? 

For moderate to severe frozen shoulder, hydrodilatation in concert with physiotherapy is best.  

In mild form, anti-inflammatories and physiotherapy may suffice but response would need to be gauged.  

Following hydrodilatation how soon do you suggest mobilising the joint to regain ROM? 

Physiotherapy is recommended from days 3-5 post hydrodilatation. 

Can hydrodilatation be performed by any radiologist? 

Yes, but it depends on the expertise of the radiologist. Please contact your local I-MED Clinic to see if it's a service they offer. 

When is the most appropriate timing for hydrodilatation when treating adhesive capsulitis? 

There is no perfect time, we usually recommend when the diagnosis is made. 

Steroid Injections

What is the best interval between steroid injections? 

This is dependent on the success of the first. It usually takes two weeks to get a response, if after one month there is no help, repeat. For a hydrodilatation with incomplete benefit, I would repeat it after two months. 

Is it safe to inject steroid for a full thickness tear of the shoulder? 

Yes, assuming the patient isn't going to have an operation in the short term, as some surgeons try and avoid injections near the time of surgery. 

Does steroid or local anaesthetic make the tissue frail and is there any role for platelet rich plasma infusions (PRP)? 

In some cases, for tendinopathy/tendon tears yes, but we only perform them in rare circumstances at specialist request. There is no role for PRP for bursitis or capsulitis. 

How many days after bursal injection should patients commence physiotherapy? 

In the context of bursitis, day 10 onwards if they or their clinicians want it. It's not as important as physiotherapy post capsulitis but would be recommended for refractory bursitis. 

While Injections can be beneficial to ease pain, I find it is the often the default option simply because a patient has some shoulder pain, and the ultrasound shows bursitis. What else should be considered to inject the bursae other than evidence of it on imaging? 

Bursitis is very common but can often be asymptomatic and is often over-diagnosed. Not everyone with bursal thickening has true bursitis. Bursal thickening with impingement (painful arc clinically) is required to make the diagnosis of bursitis. 

In a study, 96% of people without any shoulder pain or loss of function had tears, bursal thickening, and many other problems identified on imaging. In most cases, the findings of imaging investigations cannot tell you where your pain is coming from.  Any comments? 

Imaging findings always need to be correlated with the clinical picture. We often perform provocative maneuvers at the time of patient attendance to see if what we are seeing is a clinically relevant finding or not. Imaging characteristics can also usually be used to differentiate between acute or more chronic  

When MRI detects adhesive capsulitis, can you identify how long it has likely been there? 

It's hard to age on MRI. When there is capsular oedema and thickening it's usually less than four months in age, once the oedema has settled, it's usually older.