Frozen Shoulder Treatment London | Private Ultrasound Diagnosis & Injections

Frozen Shoulder Explained

What is a Frozen Shoulder?

Frozen shoulder is a common condition that describes the onset of pain and significant stiffness in shoulder movements, developing due to inflammation of the soft tissue capsule around the shoulder (glenohumeral joint).

Frozen Shoulder Symptoms

A frozen shoulder typically lasts from the initial onset of symptoms to resolution over a period of one to three years and usually follows a pattern of three phases:

The first phase is the painful freezing stage, where stiffness begins to develop alongside severe shoulder pain caused by inflammation within the shoulder soft tissue capsule. Once this active inflammatory phase has subsided, the shoulder will become less painful but will remain stiff for a period of weeks or months. Finally, the shoulder will progress to stage III, where the scar tissue within the shoulder soft tissue capsule and ligaments begins to remodel, and flexibility gradually returns to the shoulder.

What Causes a Frozen Shoulder?

Although the exact mechanism of this inflammation is unknown, we have established data that frozen shoulder is far more prevalent in females than males, typically between the ages of 40 to 60, and in people with other metabolic and immune system problems such as diabetes and high cholesterol.

Studies that have examined the capsule during surgical procedures have found a significant increase in immune-triggered cells as well as inflammatory-mediated cells. As such, we believe frozen shoulder may be triggered by an immune system response, which in turn initiates inflammation of the soft tissue capsule and ligaments.

Frozen Shoulder Diagnosis

Ultrasound examination can be a very useful tool for suspected frozen shoulder, as it is able to exclude other causes of the significant capsular restriction pattern in shoulder movements. Shoulder ultrasound can exclude any significant rotator cuff tears or calcific deposits within the rotator cuff tendons, as well as exclude substantial shoulder joint effusion or arthritis.

Frozen Shoulder Ultrasound Guided Injections

How is a Frozen Shoulder injection administered?

Treatment options for frozen shoulder include managing the condition conservatively with a range of gradual physical therapy exercises, which should be tailored to the stage of the frozen shoulder. Alternatively, an ultrasound-guided injection or hydrodilatation of the shoulder joint can be considered.

An ultrasound-guided glenohumeral joint injection and hydrodistension is performed with the patient either sitting or side-lying, with their affected arm gently crossed across the body. The ultrasound probe is positioned to allow visualisation of the posterior aspect of the humeral head, so the needle can be introduced either medially or laterally into the shoulder capsule and onto the posterior humeral head. This ultrasound view provides excellent visualisation of distension of the shoulder joint capsule during high-volume injections and hydrodilatation.

What to Do After Your Frozen Shoulder Injection

Needle Path & Post-Injection Pain
The shoulder glenohumeral joint is a relatively deep structure, and in most individuals, the needle path does not cause significant trauma. We typically access the joint from the posterior (back) aspect of the shoulder.
Because of this approach, post-injection pain directly related to the needle is uncommon.
However, in some cases of steroid or hyaluronic acid injections, the joint may become painful due to a post-injection flare. This is believed to occur because the medication and injectate react with the synovial fluid in your joint.
If this occurs, over-the-counter painkillers (as directed on the patient information leaflet) can be taken.

Wound Care & Infection Risk
Avoid exposing the needle site to public or dirty water (e.g., swimming pools, hot tubs, lakes) for 2–3 days after any ultrasound-guided injection, due to the small infection risk.

Activity Guidance
After a frozen shoulder injection, it is advisable to avoid any significant increase in activity for 10 days.
This allows the anti-inflammatory properties of the steroid to work optimally.
Following this period, you should engage in a progressive program of physical therapy exercises but should not push the shoulder into pain.

Follow-Up
Following an frozen shoulder injection, please contact me immediately if you experience any difficulties.

Other Treatments for Frozen Shoulder

Frozen Shoulder Physical Therapy Exercises - Easy

Frozen Shoulder Physical Therapy Exercises - Intermediate

Frozen Shoulder Physical Therapy Exercises - Advanced

Frozen Shoulder Strengthening Exercises - Late Stage 

Frozen Shoulder | Evidence base

Frozen shoulder is a self-limiting condition with a typical course lasting 12 to 36 months, often divided into three phases: freezing, frozen, and thawing. Evidence strongly supports a conservative, stage-based approach to management. In the early (painful) phase, the primary aim is symptom control. Physiotherapy during this stage focuses on gentle range-of-motion exercises within tolerance and pain management techniques. Aggressive stretching during this phase may worsen symptoms. In the frozen and thawing phases, evidence supports more targeted capsular stretching, mobilization techniques, and active strengthening to restore range and function. High-quality trials support the use of intra-articular corticosteroid injections in the early stages to reduce inflammation and pain, and this may speed recovery when combined with physiotherapy. Repeated injections may offer diminishing returns and should be limited. Hydrodilatation (capsular distension with saline and corticosteroid) has shown promising results in some studies, particularly for rapid improvements in range of motion and pain, though evidence is still emerging. Surgical options, such as manipulation under anaesthesia or arthroscopic capsular release, are reserved for patients with persistent severe stiffness and pain after 6–9 months of failed conservative management. Overall, most cases resolve without surgery, and a tailored physiotherapy program remains the mainstay of treatment.

Questions about your shoulder pain?