Frozen Shoulder Treatment
Ultrasound-Guided Hydrodilatation

Frozen shoulder, clinically known as adhesive capsulitis, is a condition where the capsule of tissue surrounding the shoulder joint becomes inflamed, thickened and tight. This restricts the normal gliding movement of the joint, causing pain and a progressive loss of range of movement.

It most often affects people aged 40 to 60, is more common in women, and is strongly associated with diabetes, thyroid disorders and the perimenopause. It can also follow a period of shoulder immobility, for example after an injury or surgery. In many cases there is no obvious trigger at all.

While frozen shoulder can eventually settle on its own, this can take one to three years, which is why many people seek treatment to relieve pain and restore movement far sooner.

Frozen shoulder typically progresses through three overlapping stages, and the dominant symptom changes as it does:

• Freezing (painful) stage. Gradually worsening pain, often worse at night and when reaching or lying on the shoulder. Movement starts to reduce. Lasts roughly 2–9 months.
• Frozen (stiff) stage. Pain may ease but stiffness dominates; everyday tasks like dressing, washing your hair or reaching behind your back become difficult. Lasts roughly 4–12 months.
• Thawing (recovery) stage. Movement slowly returns. Lasts roughly 6 months to 2 years.

Common day-to-day signs include a deep ache in the shoulder and upper arm, difficulty raising the arm, disturbed sleep, and reduced movement in all directions - a key feature that distinguishes frozen shoulder from other shoulder problems. An ultrasound assessment confirms the diagnosis and rules out other causes.

At the Harley Street Ultrasound Group, your appointment begins with a diagnostic ultrasound assessment, performed by your specialist consultant doctor. Ultrasound shows the soft tissues and joint capsule in real time and is used to confirm frozen shoulder and. It also rules out other causes of shoulder pain such as a rotator cuff tear, calcific tendinopathy or bursitis, which can feel similar but need different treatment.

Diagnosing the problem accurately first is what makes the treatment precise. Because the same ultrasound is then used to guide the injection, your consultant can place the needle exactly into the target structure, rather than by external approximations.

If the assessment shows that a different treatment would serve you better, your consultant will tell you on the day. See “What if I don’t need an injection?” below.

The most effective non-surgical treatment for frozen shoulder is ultrasound-guided hydrodilatation. It works by gently injecting a volume of sterile fluidm, usually a mix of saline, local anaesthetic and a small amount of steroid, into the tight joint capsule to stretch and expand it, breaking down the restriction that limits movement.

Because the procedure is performed under real-time ultrasound, your consultant can ensure the injection reaches the exact location and confirm the medication is going precisely to where it is needed. This precision is what makes the treatment both effective and safe, avoiding nearby nerves and blood vessels.

Other options your consultant may discuss include a steroid (cortisone) injection alone for pain in the early stage. Hydrodilatation is generally preferred where stiffness is the main problem, because it directly addresses the tightened capsule.

Most patients find hydrodilatation far more comfortable than expected. Local anaesthetic is used, so you typically feel a small sting as it goes in, followed by a sensation of pressure or fullness as the capsule is expanded. This is normal and settles quickly.

The appointment usually takes around 20–30 minutes from assessment to completion:

• Your consultant scans the shoulder to confirm the diagnosis.
• The skin is cleaned and local anaesthetic is applied.
• The injection is delivered under live ultrasound guidance.
• You rest briefly and are given aftercare guidance before you leave.

There is no general anaesthetic and no overnight stay. You can usually drive yourself home, though arranging a lift is sensible if your shoulder feels sore afterwards.

Your treatment is performed by a consultant specialist doctor, not a physiotherapist, nurse or GP. This matters, as the majority of MSK injections in the UK are delivered by non-consultant practitioners, often without ultrasound image guidance.

At the Harley Street Ultrasound Group, you receive both the clinical judgement of a senior specialist and the precision of real-time ultrasound examination in a single appointment. Your consultant assesses the shoulder, confirms the source of pain, performs the procedure and explains your aftercare personally.

We will never give you an injection you do not need. If, after your ultrasound assessment, your consultant decides an injection is not the right treatment for you, the procedure simply won’t go ahead. You will be charged at our standard diagnostic ultrasound rate, not the full treatment price.

This is a deliberate commitment to clinical integrity. Some providers treat every appointment as a guaranteed procedure; we don’t. You can book knowing that you will receive a genuine specialist assessment first, and that treatment only proceeds when a senior clinician believes it is genuinely warranted.

If an injection isn’t appropriate, your consultant will explain why and set out the alternatives. This may include physiotherapy, a different injection, such as PRP, or onward referral, meaning you still leave with a clear plan.

Many patients notice improved comfort and movement within a few days to two weeks, as the anaesthetic wears off and the steroid and capsule stretch take effect. The full benefit typically builds over the following weeks, especially when combined with gentle stretching exercises.

Hydrodilatation has a good success rate for reducing pain and improving range of movement, and for many people a single treatment is enough. Results vary with the stage of frozen shoulder and individual factors such as diabetes; some patients benefit from a repeat procedure or a course of physiotherapy. Your consultant will give you a realistic picture based on your own assessment.

There is no significant downtime. You can return to everyday activities the same day, though it is sensible to avoid heavy lifting or strenuous shoulder use for 24–48 hours. Some mild soreness or a feeling of fullness in the shoulder for a day or two is normal.

The single most important part of aftercare is gentle, regular stretching to maintain and build on the movement the procedure restores. Your consultant will recommend specific exercises, and many patients benefit from a short course of physiotherapy alongside the treatment.

You will receive clear written aftercare guidance, and our team remains available if you have any questions as you recover.

Yes, there is a recognised link. Frozen shoulder becomes more common during the perimenopause and menopause, and researchers believe falling oestrogen levels play a role, because oestrogen helps maintain healthy collagen and connective tissue around the joint.

Women in their late 40s and 50s are the group most affected by frozen shoulder, and many are surprised to learn their shoulder pain may be connected to hormonal change. If this applies to you, it is worth discussing alongside any wider menopause care, but the shoulder itself can be assessed and treated directly and effectively with ultrasound-guided hydrodilatation.

You can read more in our dedicated guide to frozen shoulder and the menopause.

Ultrasound-guided hydrodilatation for frozen shoulder at The Harley Street Ultrasound Group is £645, all fees inclusive. There are no extra charges for the consultant assessment, the diagnostic ultrasound, the procedure itself, or your written report.

What’s included in the price:

• Consultant specialist assessment and diagnostic ultrasound
• Ultrasound-guided hydrodilatation procedure
• Local anaesthetic and all consumables
• Written report and tailored aftercare guidance
• No referral required and no waiting list

Importantly, if your consultant assesses you and decides an injection is not clinically appropriate, you are charged only at our standard diagnostic ultrasound rate, not the procedure price. We accept self-pay and most major UK private health insurers; please confirm cover with your insurer before booking.

Coming to us privately does not affect your NHS care. Our goal is to get you answers and treatment quickly, without the long waits often involved in accessing injection therapy on the NHS.

You are seen by a consultant specialist who can assess, diagnose and, where appropriate, treat your frozen shoulder in a single visit. Your report and images can be shared securely with your NHS GP or any specialist, and if your situation needs onward NHS care your consultant will write to your GP accordingly.

We don’t want you waiting months in pain when effective treatment is available now.