- 023-8218-2416
- info@physio-soton.co.uk
- 297 High Street, Eastleigh, SO50 5NB
- Opening hours: Mon - Fri 10:00 - 20:00, Sat 10:00-15:00
Hydrodilatation is a high volume injection used to treat frozen shoulder. Saline, local anaesthetic and steroid are injected into the shoulder joint under ultrasound guidance to stretch the tightened capsule from the inside. The aim is to restore range of movement and improve function. At Physio Soton in Eastleigh the procedure costs £495.
If your shoulder has slowly stiffened to the point where reaching behind your back, fastening a bra or lifting your arm overhead has become difficult, you may have frozen shoulder. It is a condition that can last years if left alone, and standard painkillers rarely touch it.
This page explains what frozen shoulder is, how it progresses, and how the treatment works at our Eastleigh clinic. You will find honest information about what the evidence does and does not show, what the procedure costs, and when a different option would serve you better.
Frozen shoulder, also called adhesive capsulitis, is a condition where the capsule surrounding the shoulder joint becomes thickened, fibrotic and contracted. The shoulder stiffens to the point where it cannot be moved properly, either by you or by someone else moving it for you. It is the only joint in the body that behaves this way.
Around 0.75 percent of people experience it at some point, so it is rarer than commonly assumed. It mainly affects people aged 40 and above, and women are more prone to developing it.
What makes the condition distinctive is the loss of passive movement. With most shoulder injuries, you can still move the arm if someone lifts it for you, because the limitation comes from pain or weakness. With adhesive capsulitis, the capsule itself has physically tightened, so the joint will not travel through its normal range regardless of who is moving it. External rotation is usually the first and worst affected direction.
Frozen shoulder stages follow a predictable pattern, though the timing varies considerably between people. Knowing which stage you are in matters because it changes which treatment is likely to help.
Freezing stage: Pain builds gradually, and movement starts to reduce. This stage is usually the most painful, and night pain is common.
Frozen stage: Pain often eases, but stiffness dominates. Movement is severely limited in all directions, including when someone else moves your arm for you.
Thawing stage: Movement slowly returns. This can take many months.
The frozen shoulder stages are not always clean-cut. Some people move between them gradually, and some appear to skip parts of the pattern entirely. Knowing your stage matters because hydrodilatation works best in specific phases.
Frozen shoulder very often follows a period of inactivity. A previous shoulder injury, a fracture, or any reason you stopped moving the joint frequently can trigger it. Patients recovering from stroke are also at higher risk.
There are several conditions with a clear and strong link:
Unlike most shoulder injuries, this one does not develop because you did too much. It develops because the joint stopped moving enough. This is why the condition is sometimes described as mysterious.
There is often no single incident to point to. Many patients cannot identify a moment when it started, only that the shoulder gradually became harder to use over several weeks. If you have had a shoulder problem recently and found yourself protecting the arm, that period of reduced movement is frequently the trigger. The cause does not usually change whether hydrodilatation is suitable. The stage does.
Several shoulder problems cause pain and restricted movement, and they require different treatments. The distinguishing feature of adhesive capsulitis is that both passive and active movement are lost.
An ultrasound scan settles most of these questions during the assessment. It shows the tendons, the bursa and any calcium deposits directly, which matters because treating the wrong diagnosis wastes months.
Frozen shoulder typically lasts between one and three years without treatment. Some patients see rapid improvement, but that is rare. The condition is often described as self-limiting, which is technically true, but waiting it out can mean years of restricted movement and disturbed sleep.
That timescale is the main reason people seek active treatment rather than letting it run its course. That timescale is why many patients consider hydrodilatation rather than waiting.
Frozen shoulder treatment falls into four broad categories, and they are not equally invasive. The right choice depends on your stage, your pain level and how much your shoulder is limiting daily life.
| Option | What it involves | Best suited to |
|---|---|---|
| Physiotherapy and exercise | Graded mobility and strengthening work | Mild cases, and alongside every other option |
| Steroid injection | Corticosteroid into the joint to reduce pain | Painful freezing stage, £250 at our clinic |
| Hydrodilatation | High volume distension of the capsule | Freezing and frozen stages, £495 at our clinic |
| Surgery | Manipulation under anaesthetic or capsular release | Cases that fail to respond to everything else |
A useful piece of context on frozen shoulder treatment comes from the UK FROST trial, which compared physiotherapy with steroid injection, manipulation under anaesthesia, and arthroscopic capsular release. All three improved pain and function, and none proved clinically superior to the others. That finding is worth knowing before anyone tells you a single approach is the only answer.
Hydrodilatation works by hydraulic distension. A large volume of fluid, typically around 30ml of saline combined with local anaesthetic and steroid, is injected into the glenohumeral joint. The fluid stretches the contracted capsule from the inside, which is what creates the increase in range of movement.
At our clinic, the injection is delivered under real time ultrasound guidance rather than X-ray, so there is no radiation involved and no contrast dye is needed.
The procedure is particularly effective in the freezing and frozen phases. Both high-volume and low-volume distension techniques are used, and which one suits you is decided at assessment rather than booked in advance.
A systematic review and meta analysis published in 2024 found that hydrodilatation leads to at least transient more marked improvements in shoulder disability and passive external rotation compared with intra articular corticosteroid injections. It also improves passive external rotation over the longer term.
The same review notes that the procedure is recommended as part of the patient care pathway co produced by the British Elbow and Shoulder Society and the British Orthopaedic Association.
Here is the honest caveat. The evidence base for this treatment is not as strong as many clinics imply. A 2022 expert consensus study concluded that an evidence gap remains for high quality evidence comparing it with other common treatments. The procedure has good support and a sound mechanism, but it is not a guaranteed cure.
Hydrodilatation costs £495 at Physio Soton in Eastleigh. That covers the ultrasound guided procedure itself. An initial injection consultation costs £60, and that is where suitability is confirmed before anything is booked.
For comparison, a standard ultrasound-guided steroid injection at the same clinic costs £250. Full pricing for every procedure is published on our injection prices page, with no hidden fees.
Private treatment is worth weighing against the alternative. Frozen shoulder commonly lasts one to three years untreated, and NHS waiting times for the procedure vary considerably by area. The cost question for most patients is not simply the price of the procedure. It is what another year of restricted movement and broken sleep is worth to them.
You may feel pressure or a sensation of fullness in the shoulder during the injection. Tell the clinician if you feel genuine discomfort at any point.
Frozen shoulder exercises work far better after hydrodilatation than before. That is the practical argument for combining the two. The injection creates a window where the shoulder can move further, and rehabilitation is what converts that window into lasting function.
Research describes intensive mobilisation after the procedure as a promising adjuvant treatment. In practice this means starting range of movement work promptly rather than resting the shoulder and waiting.
Skipping rehabilitation is the most common way people waste the benefit of the injection.
The other common mistake is the opposite. Some patients attack the shoulder aggressively once it moves more freely, then flare the joint and lose ground. Steady daily range of movement work beats occasional hard sessions. A structured plan matters more than effort.
Gentle passive stretching, active assisted movement and pendulum work generally form the early stages. Strengthening comes later, once range has improved and pain has settled.
This procedure is not right for every stiff shoulder. It is unlikely to help if your stiffness comes from something other than a contracted capsule, which is exactly what the assessment and scan are for.
Consider a different route if:
For calcium deposits in the rotator cuff, a different procedure called barbotage with lavage is used instead. That is a separate treatment for a separate condition.
Marek Czeladzki is a Chartered Physiotherapist registered with the HCPC and the CSP, an Independent Prescriber, and a musculoskeletal sonographer holding a Postgraduate Certificate in Clinical Ultrasound. He is a member of the British Medical Ultrasound Society and the American Institute of Ultrasound in Medicine.
He performs hydrodilatation and other ultrasound-guided procedures at the Eastleigh clinic. Physio Soton has provided physiotherapy, diagnostic ultrasound and image guided injections in Eastleigh since 2017.
You will feel a sharp scratch from the initial numbing injection, then mostly pressure and a sensation of fullness in the joint. Most patients tolerate the procedure well. Any soreness afterwards usually settles within a day or two.
Some patients notice improvement in movement within days. Others take several weeks, and the response varies considerably. The research describes improvements in disability and external rotation, with some effects being transient rather than permanent.
Repeat procedures are sometimes carried out, but this is a clinical decision based on how your shoulder responded the first time. It is discussed at follow up rather than planned in advance.
No. You can book directly with the clinic. Assessment, scan and treatment can often be arranged without waiting for a referral.
No treatment guarantees that. The procedure aims to restore range of movement and improve function, and the evidence supports meaningful improvement rather than a permanent cure. Rehabilitation afterwards strongly influences the long term result.
Some NHS services use X ray guidance with contrast dye. At our clinic the procedure is ultrasound guided, which avoids radiation and allows real time imaging of the needle.
Tell the clinician before treatment. Around 30 percent of frozen shoulder patients have diabetes, and steroid can temporarily raise blood sugar, so this is factored into the decision.
Yes. Some patients develop it in the opposite shoulder later, particularly those with diabetes. It rarely returns in the same shoulder once it has fully resolved, because the capsule does not usually contract twice in the same joint.
Keep using it within comfortable limits. Complete rest allows further stiffening, which is the mechanism that caused the problem in the first place. Avoid forcing painful end range movements, but keep the shoulder moving through whatever range you have.
Hydrodistension is offered within the NHS, though availability and waiting times vary by area. Many patients choose private treatment to avoid a long wait while the shoulder remains stiff.
If your shoulder has stiffened and is not improving, the first step is confirming what is actually causing it. Hydrodilatation helps a contracted capsule. It does not help every stiff shoulder, and an assessment tells you which one you have.
Call 023 8218 2416 or book online. Physio Soton, 297 High Street, Eastleigh, SO50 5NB. Open Monday to Friday 10:00 to 20:00 and Saturday 10:00 to 15:00.
