Frozen shoulder, also known as adhesive capsulitis, is an inflammatory condition affecting the shoulder joint capsule. It affects around 5% of the population and is most common in women aged 40 to 60. Most cases develop without an obvious cause, although some follow a fall onto the shoulder, recent surgery, or medical conditions such as diabetes and thyroid disease.
For many people, the pain and stiffness become severe enough that exercises alone are not working. This is where a frozen shoulder injection — whether a cortisone shot for a frozen shoulder or, our preferred option, ultrasound-guided hydrodistension — can make a real difference. At Sport Doctor London, we perform frozen shoulder injections as a one-stop appointment: consultation, diagnostic ultrasound, and injection on the same day.
This guide explains how a steroid injection for frozen shoulder works, the difference between a simple cortisone injection and hydrodistension, what the evidence says, what the procedure involves, and what it costs in London.
How do I know I have a frozen shoulder?
A frozen shoulder usually presents with shoulder pain followed by progressive stiffness. At first, pain dominates — often severe and worse at night, disturbing sleep. Stiffness then sets in, making everyday movements such as brushing your hair, reaching behind your back, or removing a bra increasingly difficult.
Although the diagnosis is mostly clinical, it is essential to rule out other causes of a painful, stiff shoulder, such as shoulder arthritis or calcific tendonitis. An X-ray is often needed, and in more complex cases we use ultrasound or MRI.
Will a frozen shoulder get better on its own?
Most cases improve over 18 to 24 months. However, recent studies show that some people have symptoms for considerably longer — in some cases beyond two years, and occasionally up to ten. Given how disabling the condition can be, many patients understandably do not want to wait it out, which is why injection treatment is worth considering early.
What are the treatment options for frozen shoulder?
There is no single agreed best treatment for frozen shoulder. Tablets such as oral steroids or anti-inflammatories have no good evidence of lasting benefit. Physiotherapy, including stretching and strengthening, is an integral part of management and works well in milder cases, although there is no consensus on the most effective type of physiotherapy.
When pain is severe or progress has stalled, an injection is the next step. The main options are a simple steroid injection for frozen shoulder, hydrodistension (also called hydrodilatation), and in selected cases PRP or hyaluronic acid.
Steroid injection for frozen shoulder
A cortisone shot for a frozen shoulder is most helpful in the early, or “freezing,” stage, reducing pain and helping halt progression. Evidence shows that a frozen shoulder steroid injection can relieve pain for up to four months. To maximise accuracy, the injection should always be performed under ultrasound guidance.
Timing matters. A study on injections for frozen shoulder found that patients injected at stage 1 recovered within 2 to 6 weeks, whereas those treated at stage 2 took 7 to 12 weeks to resolve their symptoms. In other words, the earlier you are assessed and treated, the better the outcome.
Hydrodistension: our preferred frozen shoulder injection
Hydrodistension (hydrodilatation) is a specific injection technique in which a high volume of fluid, along with cortisone, is injected into the shoulder joint. The increased pressure stretches the tight joint capsule, leading to a faster “thawing” of the frozen shoulder.
Is hydrodistension better than a simple frozen shoulder steroid injection? We think so. While earlier high-level studies showed little difference between hydrodilatation and a simple cortisone injection, a more recent study found hydrodilatation to be more effective at improving both pain and range of motion.
Technique matters here too. We can inject a moderate volume (20–40 mL) or a high volume (over 40 mL), but very high volumes often rupture the capsule. One study found that stretching the capsule produces better pain relief and function than rupturing it, which is why we use a controlled, moderate-volume technique under ultrasound guidance.
Dr Masci has performed thousands of ultrasound-guided procedures and teaches these techniques to doctors across the UK and Europe. You can read more about his injection expertise here and about shoulder hydrodilatation in detail here.
PRP and hyaluronic acid for frozen shoulder
Platelet-rich plasma (PRP) injections are an emerging option. In a study comparing PRP with cortisone for frozen shoulder, PRP resulted in greater pain reduction and improved range of motion. More research is needed, but early results suggest PRP may be a useful alternative for patients who wish to avoid cortisone.
We sometimes use Hyaluronic acid, with one study reporting effects similar to those of corticosteroids.
Suprascapular nerve block
Another option for frozen shoulder is a suprascapular nerve block. The suprascapular nerve runs from the brachial plexus and runs behind the shoulder joint to supply the muscles surrounding the joint.
Studies suggest that blocking the nerve with local anaesthetic and cortisone can improve pain associated with frozen shoulder. Combining a suprascapular nerve block with a shoulder joint injection adds to the positive effect.
What happens on the day of your injection?
We offer frozen shoulder injections as a one-stop appointment at our London clinics. Dr Masci will take a history and examine your shoulder, perform a diagnostic ultrasound to confirm the diagnosis and exclude other causes, and then carry out the injection under ultrasound guidance in the same visit — typically using local anaesthetic to improve comfort. The whole appointment usually takes around 30 minutes.
Afterwards, we recommend taking the rest of the day off work and avoiding driving. Post-injection soreness is common for 24 to 48 hours, and the full benefit of cortisone typically builds over the following weeks. We combine injection treatment with a structured physiotherapy programme to restore movement as the shoulder thaws.
How much does a frozen shoulder injection cost?
For self-paying patients, our Chelsea clinic is consistently the most cost-effective option, with a consultation and injection for £400. Prices at our other clinics are higher. Full details are on our one-stop injection page, and you can find all our clinic locations here.
For insured patients, frozen shoulder injections are covered by all major private insurers, and our admin team can help with pre-authorisation.
Is surgery a good option for frozen shoulder?
Surgery, known as capsular release, is reserved for persistent cases that have failed injection therapy and physiotherapy. It carries real risks and is not always successful. A recent study found that surgical outcomes for frozen shoulder are comparable to physiotherapy, but with a higher rate of serious adverse effects (4–5%). The decision should never be taken lightly, and in our experience most patients avoid surgery with timely injection treatment.
Frequently asked questions about a cortisone shot for frozen shoulder
How long does a frozen shoulder injection last?
Evidence shows pain relief from a cortisone shot for frozen shoulder can last up to four months. With hydrodistension, the combination of cortisone and capsule stretching often produces longer-lasting improvement in both pain and movement, particularly when combined with physiotherapy.
Is a steroid injection for frozen shoulder painful?
It can be, particularly during the early freezing stage when the shoulder is most irritable. We use local anaesthetic and ultrasound guidance, which makes the procedure much more tolerable than a blind injection.
Is a frozen shoulder steroid injection more effective if done early?
Yes. One study found that early injection significantly reduced the time to complete resolution compared with later injection. If you suspect a frozen shoulder, early assessment leads to faster recovery.
Can an injection cause a frozen shoulder?
Yes. Immunisations in the upper arm can occasionally trigger frozen shoulder. During the COVID-19 vaccination programme, we saw an increase in cases, partly reflecting the higher vaccination rate.
Can a frozen shoulder show up on an MRI?
Yes. Although frozen shoulder is a clinical diagnosis, MRI can support it—typically showing swelling around the biceps tendon and thickening of the capsule at the inferior aspect of the joint. MRI also helps exclude other causes such as arthritis or calcific tendonitis.
Is a multi-site injection better than a single injection?
Possibly. One study found that a suprascapular nerve block combined with a steroid injection into the joint was more effective than a steroid injection alone, and another combined hydrodistension with a suprascapular nerve block in a single sitting. For resistant cases, we sometimes combine techniques.
Can you drive after a cortisone injection in your shoulder?
We advise against driving immediately afterwards. Most insurers do not cover accidents straight after a medical procedure, so take a taxi or public transport home.
Can I go to work after a frozen shoulder injection?
These injections often cause significant post-injection soreness, so we recommend taking the rest of the day off work and other activities.
Final word from Sport Doctor London
A frozen shoulder steroid injection — and in particular ultrasound-guided hydrodistension — is one of the most effective ways to relieve pain and accelerate recovery, especially when performed early. Most cases settle without surgery. The most important step is getting the diagnosis right, so see a doctor with expertise in shoulder conditions and extensive experience in ultrasound-guided injections.
To book a one-stop frozen shoulder injection appointment in London, contact us here or call +44 (0) 203 488 0350.
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