Freezing
6 weeks to 9 monthsPain leads. It builds gradually, bites at the ends of movement and breaks up sleep, while stiffness is only beginning.
Frozen Shoulder Care
Ultrasound-guided care in Ware, Hertfordshire
Ultrasound-Guided Injections for Frozen Shoulder
You have not slept on that side for months, and you still cannot reach behind your back. Frozen shoulder does settle in time, and what is worth doing about it depends on the stage you are in now.
Clinic location
Hertfordshire
Understand where your shoulder is now before deciding what to do next
Start with your symptoms
What is your shoulder doing now?
You cannot sleep on that side
Shoulder pain is still making nights difficult.
You cannot reach behind your back
Everyday shoulder movement feels restricted or stiff.
You are unsure what stage you are in
What is worth doing depends on where the shoulder is now.
You do not need to know which treatment you need before getting in touch.
Asking a question costs nothing and does not commit you to treatment.
Frozen shoulder
What Is Frozen Shoulder?
Frozen shoulder, or adhesive capsulitis, is a condition where the capsule around the shoulder joint thickens and tightens, causing pain and lost movement.
Rob Mast treats it at Sonoscope in Ware, Hertfordshire, with ultrasound-guided injections placed under live imaging.
£250
Assessment, scan and injection happen in one visit. All-inclusive treatment starts from £250.
Do I have frozen shoulder?
How do you know if it is frozen shoulder?
Frozen shoulder is recognised by stiffness that limits movement in every direction, together with pain that is worse at night. Turning the arm outwards, away from your body, is usually the movement that fails first.
Start with the movement pattern.
Stiffness in every direction matters more than pain at one awkward angle.
Try the simple home movement check
There is a check you can do at home. Tuck your elbow into your side, bend it to ninety degrees, then rotate your forearm outwards and compare it with the other arm. Losing more than half that range is the pattern clinicians look for, and it is the same measure used to select patients for the UK's largest frozen shoulder trial.
What people usually notice
- Pain that wakes you, particularly lying on that side
- Difficulty fastening a bra, reaching a back pocket or putting on a coat
- Stiffness in all directions, rather than at one awkward angle
- A dull ache spreading down into the upper arm
Age, diabetes and how common it is
Age forty to sixty is the common window, and around 2 to 5 in every 100 people are affected at some point. That rises sharply with diabetes, where prevalence is estimated at 13.4 per cent, roughly five times the general rate. People with diabetes make up about 30 per cent of everyone with the condition. So if you have diabetes and a stiffening shoulder, this is a likely explanation rather than a coincidence.
40 to 60
Common age window
2 to 5 in 100
Affected at some point
13.4%
Estimated prevalence with diabetes
What else it could be
What else could be causing the pain?
Several shoulder problems produce pain and restriction that feel much the same from the outside. Telling them apart changes the treatment completely.
Six conditions can look similar
- Rotator cuff tear
- Subacromial bursitis
- Calcific tendinopathy, where calcium deposits in the rotator cuff tendon
- Osteoarthritis of the shoulder joint
- Arthritis of the acromioclavicular joint
- Long head of biceps tendinopathy
Why a normal scan can still matter
Here is the part that catches people out. A true frozen shoulder usually looks normal on ultrasound, and normal on X-ray as well. Scanning is still worth doing, because its job here is to rule the other six out rather than to prove this one.
What gives confidence
Seeing an intact rotator cuff on screen is what allows a confident diagnosis and treatment in the same appointment.
The three stages
What are the three stages, and why does yours matter?
Frozen shoulder moves through three overlapping stages, and each responds differently. Timings vary widely and the stages blur into one another, so treat these as a guide rather than a schedule.
Three overlapping stages
Frozen
4 to 12 monthsPain settles and stiffness takes over. Movement is limited in every direction, and daily tasks become awkward rather than sharply painful.
Thawing
6 months to 2 yearsMovement returns slowly. Pain has largely gone by this point, and progress is real but gradual.
Why the stage matters
The case for an injection is strongest while pain is the dominant symptom. Once a shoulder has gone stiff and quiet, the same injection has less to work on.
How long does it last?
How long does frozen shoulder last?
Most cases settle without any treatment at all, but slowly. Following 51 people who received no treatment, 94 per cent recovered normal function and movement, taking 15 months on average. The range ran from 4 months to 36 months.
That average hides the real problem. Nobody can tell you in month two whether you are a four-month case or a three-year one. Up to 40 per cent of people report symptoms still present four years after onset.
Which makes the honest framing this. Treatment is rarely about curing something that would never have settled on its own. It is about how much of the next year or two you spend in pain, and how much sleep you lose getting there.
Recovery can vary enormously
Average shown on the scale
4 months
15 month average
36 months
Up to 40%
report symptoms still present four years after onset
Pull figure
15
months average
Range: 4 to 36 months.
Treatment by stage
What can be done at each stage?
Two injections are used for frozen shoulder, and they do different jobs.
When pain leads
Steroid injection
Best suited to the freezing stage when pain and lost sleep dominate.
When stiffness leads
Hydrodistension
Comes into its own when restricted movement becomes the main problem.
Freezing stage
A steroid injection
A steroid injection into the joint reduces the inflammation driving the pain. It suits the freezing stage, when pain is the main complaint and sleep is the thing you want back. There is more on what a corticosteroid does inside the joint capsule.
When stiffness dominates
Hydrodistension
Hydrodistension adds a volume of sterile saline alongside the steroid, stretching the capsule with fluid from the inside. It aims at stiffness rather than pain, so it comes into its own once movement is the limiting factor.
Live ultrasound guidance
Both are placed under live imaging, so the medicine reaches the joint itself rather than the tissue around it.
92.5%
with ultrasound
72.5%
by feel
Neither replaces movement.
Injections are often used to create a window for rehabilitation, when the shoulder is comfortable enough to be worked on properly. The NHS protocol developed from the UK FROST trial pairs the injection with structured physiotherapy for that reason.
Steroid injection
£250
Hydrodistension
£300
Each fee covers the clinical examination, the ultrasound scan, the
injection and a written report, in a single visit. You can see
the published fee for every treatment.
Not sure which stage describes your shoulder? That is the question worth asking before deciding anything.
There is no obligation to book.
Evidence and outcomes
Does an injection actually help?
For a meaningful proportion of people, yes, but not for everyone. The main value is short-term comfort during the painful stage. It does not cure frozen shoulder or change how long the condition lasts.
53.4%
met the success threshold at twelve weeks in one corticosteroid injection study
92.5%
accuracy with guidance, compared with 72.5% by feel
Short-term benefit
Steroid injection can improve short-term symptoms.
A 2020 systematic review found that a steroid injection into the shoulder joint gave better short-term results than other non-surgical treatments, with benefit lasting as long as six months in some patients.
What it cannot do
It does not change the course of frozen shoulder.
NHS patient guidance is direct on this point: an injection is not a cure, and it will not shorten how long a frozen shoulder lasts or restore movement on its own.
That changes what the treatment is for. The injection buys comfort during the painful stage, which is often the stage that disrupts sleep and makes normal movement difficult. Movement returns on its own timetable through use and exercise.
What success looked like
Just over half met the study threshold at twelve weeks.
One study of corticosteroid injection for frozen shoulder found 53.4 per cent of patients met the threshold for success at twelve weeks. That combined a clear drop in pain with at least twenty degrees of movement regained.
53.4%
met the study's success threshold at twelve weeks, based on pain
reduction plus at least twenty degrees of movement regained
Steroid or hydrodistension
Paying more does not guarantee a better result.
A Cochrane review comparing distension using steroid and saline against an ordinary steroid injection found it may make no difference to pain or disability. A head-to-head study of 108 people already in the frozen stage put the steroid injection ahead at twelve weeks on both measures.
Hydrodistension is not automatically the stronger choice, and a higher price does not buy a better result by default.
Steroid injection
simpler option discussed in the evidence above
Hydrodistension
not automatically superior for pain or disability
When treatment is not appropriate
When is an injection not the right step?
Sometimes the answer is no, and it is written into national guidance rather than left to preference. The NHS protocol names three situations where a steroid injection should not be offered:
Steroid injection should not be offered
Three situations named in the NHS protocol.
The shoulder is stiff but painless and settled
So there is little inflammation left to treat.
Diabetes is poorly controlled
Since steroid raises blood glucose for several days afterwards.
Three or more injections have already gone into that shoulder within the past year
Not offered at this clinic
Spinal injections, sciatica or nerve root pain
These are carried out in hospital under X-ray guidance.
Nerve blocks
These are not offered here.
Anyone aged sixteen or under
Injections are not given to this age group.
If the scan says no
The appointment still gives you an answer.
An injection is given when clinically appropriate, after examination and scan. Should those findings show it is not the right treatment, Rob will say so and will not inject. You are charged for the examination, scan and report rather than the treatment fee, and you leave with a written report and a clear answer about what is actually wrong.
Before you book
Questions about frozen shoulder injections
Clear answers about timing, discomfort, repeat injections, diabetes, referrals and what to expect afterwards.
How long does a frozen shoulder injection take to work?
Most people feel some relief on the day from the local anaesthetic, which then wears off within a few hours. Real improvement usually starts around day three, and the steroid builds towards full effect over one to two weeks.
Does the injection hurt?
Most patients find it well tolerated. Local anaesthetic goes in alongside the steroid, and the needle is watched on screen throughout rather than pushed in blind. A hydrodistension involves more fluid, so a feeling of pressure in the shoulder during the procedure is normal.
Will one injection be enough?
For many people, yes. If you have already had one that did nothing, that is worth investigating rather than repeating. An injection that misses the joint, or one given after the shoulder has stiffened and settled, has little to work on. So does an injection given for a rotator cuff problem that was mistaken for frozen shoulder. Seeing the joint on screen before deciding is how those three possibilities get separated. Where a first injection helped but not enough, a second is sometimes discussed. Repeats into the same shoulder are limited, and three or more within twelve months is the point at which NHS guidance advises against another.
Can I have an injection if I am diabetic?
Often yes, provided your diabetes is well controlled. A steroid injection raises blood glucose for several days, so you would need to monitor levels more closely than usual afterwards. Poorly controlled diabetes is a reason to hold off, and that gets discussed at the appointment rather than assumed.
Do I need a referral from my GP?
No. You can arrange the appointment directly. Rob is an independent prescriber, so the medicine used in the injection is prescribed in the room rather than needing a separate prescription from a GP or consultant first.
What should I do in the days afterwards?
Keep the shoulder moving gently and avoid heavy loading for the first two days. Be ready for it to feel worse before it feels better. A steroid can irritate the joint as it settles, and with frozen shoulder in particular that flare can last up to two weeks rather than a day or two. It is a normal reaction rather than a sign that something has gone wrong. Once the pain does ease, structured exercise is what turns short-term relief into recovered movement.