Category: Treatments

Hydrodilatation is an ultrasound-guided treatment for frozen shoulder, also known as adhesive capsulitis. Fluid, usually combined with local anaesthetic and a steroid, is carefully injected into the shoulder joint to gently stretch the tight joint capsule.

A frozen shoulder takes over your daily life. Reaching a seat belt, fastening a bra, getting a coat on, sleeping on that side — all of it becomes difficult, and it often goes on for months.

Frozen shoulder does usually settle on its own eventually, but “eventually” can mean one to three years. Hydrodilatation is one of the ways to stop waiting.

You may also see the procedure called hydrodistension, or spelled hydrodilation. These all describe the same treatment.

What hydrodilatation is for

In a frozen shoulder, the capsule surrounding the joint becomes inflamed, thickened and contracted. The shoulder loses movement, and beyond a certain point exercise alone struggles to restore it, because there is not enough room in the joint to move into.

Hydrodilatation aims to reduce pain and improve movement by distending that capsule directly. It is most useful when stiffness rather than pain is limiting progress with rehabilitation.

How hydrodilatation is done

The injection is performed under live ultrasound guidance. Placement is important, because the fluid has to reach the glenohumeral joint itself rather than the space above it, and the two are not reliably distinguished by feel alone. Guidance means the needle and the fluid are watched onto the target throughout.

The appointment lasts a full hour, which allows time to reassess the shoulder, carry out the procedure and explain what happens next.

Does hydrodilatation hurt?

Less than most people expect. The area is numbed with local anaesthetic first, and most patients describe the procedure itself as similar to having blood taken.

If you are anxious about it, say so — we will talk you through what is happening as we go.

Is hydrodilatation right for me?

Not every frozen shoulder needs hydrodilatation. Whether it is appropriate depends on how stiff the shoulder is, how long the problem has been going on, how painful it currently is, and what has already been tried.

A stiff, painful shoulder is also not always a frozen shoulder. Rotator cuff problems, calcific tendinopathy and arthritis can present in similar ways, and more than one can be present at once. Assessment normally begins with examination and diagnostic ultrasound, so that the cause of the restriction is established before any procedure is considered.

Where pain rather than stiffness dominates, an ultrasound-guided steroid injection into the joint may be a more appropriate first step.

Afterwards

Movement usually improves straight away. Your shoulder is reassessed immediately after the procedure, so you and the physiotherapist can see what range has been gained before you leave the clinic.

Treatment is then followed by a programme of exercises to help restore and maintain that movement.

This part is not optional. Hydrodilatation creates a period in which the shoulder can move further than it could before, and rehabilitation is what turns that into a lasting change. Without it, the capsule can tighten again.

The clinician who assesses your shoulder, scans it and carries out the hydrodilatation is the same one who then works with you on restoring movement. The procedure and the rehabilitation that follows it are planned together, by the person who has seen how your shoulder actually moves.

How much does hydrodilatation cost?

Every appointment lasts a full hour. Where a diagnostic scan is needed, that appointment is charged at the scan rate, which replaces the standard consultation fee rather than being added to it.

Current prices are listed on the prices page.

Hydrodilatation in Weybridge

Meyer Physio provides ultrasound-guided hydrodilatation at its clinic on Baker Street in Weybridge, Surrey. You can come to us directly, with no GP referral and no waiting list.

Your first appointment is a full hour of assessment, with a diagnostic scan where that will help, so that the cause of the restriction is established. Where hydrodilatation is the right next step, we explain what it involves and what to expect, and arrange the procedure once you have had time to consider it. If you already have a confirmed diagnosis, it can often be arranged sooner.

Written by Suegnet Meyer, Advanced Practice Musculoskeletal Physiotherapist and MSK Sonographer. HCPC registered [PH55635]. Chartered Society of Physiotherapy member [66175]. Last reviewed: 9 September 2026.

If you’re living with the pain, swelling or stiffness of knee osteoarthritis, Cingal^® may offer the effective, non-surgical solution you’ve been looking for. Combining two trusted treatments – Steroid Injection Therapy and Hyaluronic Acid Injection Therapy, into a single injection. Cingal delivers both rapid and long-lasting relief — helping you move more comfortably and stay active.

What is Cingal^®?

Cingal^® is a powerful, dual-action injection therapy designed to relieve knee pain caused by osteoarthritis. It uniquely combines:

• Corticosteroid (Triamcinolone Hexacetonide): to reduce inflammation and provide rapid relief within days.
• Hyaluronic Acid (HA): a natural joint lubricant, formulated here in a highly purified, cross-linked form for long-lasting cushioning and support.

Cingal^® is the first and only CE-marked therapy to combine these two treatments in one injection, making it an ideal option for patients seeking convenience, speed, and sustained results.

Why Choose Cingal^®?

• Fast relief — noticeable reduction in pain often within the first week
• Long-lasting effects — up to 6 months of joint pain relief with one injection
• One simple appointment — performed in-clinic with no need for anaesthesia
• Proven safety — both HA and corticosteroids have decades of successful clinical use
• Delay or avoid surgery — ideal for those looking to postpone joint replacement

How Does Cingal^® Work?

Osteoarthritis causes a breakdown in the quality and quantity of hyaluronic acid in the joint — the substance that helps your joint fluid stay thick, elastic, and shock-absorbing. At the same time, inflammation builds up inside the joint, triggering pain and stiffness.

Cingal^® addresses both problems at once:

• The hyaluronic acid restores lubrication and cushioning within the joint, improving mobility and reducing friction.
• The corticosteroid calms inflammation, helping relieve pain quickly and reduce swelling.

Together, these components support better joint function — and better quality of life.

What to Expect During and After Treatment

The Procedure
Cingal^® is administered as a single injection directly into the knee joint. It takes just a few minutes and can be done during a routine clinic visit. No general anaesthesia is required.

After the Injection
You may feel slight swelling or tenderness around the joint for a day or two. It’s best to avoid intense activity for 48 hours, but you can usually resume light daily tasks immediately.

When Will I Feel Relief?
Most patients notice relief within a few days thanks to the corticosteroid. The HA component builds up over the following weeks, supporting ongoing comfort and joint movement.

How Long Will It Last?
Clinical studies show pain relief may last up to 6 months from a single injection.

When to use Cignal?

Cingal is particularly suitable for individuals with mild to moderate osteoarthritis of the knee who:

• Are no longer responding to over-the-counter pain relief
• Want to remain active without resorting to surgery
• Prefer a one-visit treatment with fast, noticeable benefits
• Cingal is suitable for patients managing multiple joint pain for example hips, shoulders, or knees.

How is Cingal different from standard joint injections?

Unlike standard HA or cortisone injections given separately, Cingal combines both in one injection — giving you immediate and sustained pain relief.

Is it safe?

Both components in Cingal (HA and corticosteroids) are clinically proven and have been used safely for decades. Side effects are generally mild and short-lived.

Can I have more than one injection?

Yes. If Cingal works well for you, it can be repeated after approximately six months, depending on your condition and clinician advice.

What joints can be treated?

Cingal is CE-mark approved for knee osteoarthritis, but the principles of viscosupplementation can be discussed for other joints such as hips or shoulders, based on your needs.

Where can I learn more about Cingal Injection Therapy?

If you want more detail about outcome measures, clinical studies, etc., please see the Cingal website. 

Cingal^® is a registered trademark, and the Cingal^® logo and images copyright of Anika Therapeutics, Inc. .

High-volume injection is an ultrasound-guided treatment sometimes used for persistent Achilles tendinopathy or patellar tendinopathy that has not improved with rehabilitation.

A stubborn tendon is a particular kind of frustrating. You have done the exercises, given it months, and it still hurts on the stairs or three minutes into a run. Progress stalls, starts, and stalls again.

A relatively large volume of fluid is carefully injected into the tissue plane alongside the tendon. The fluid is not injected into the tendon itself.

The aim is to mechanically separate the tendon from the surrounding tissues. The proposed mechanism also involves disrupting the small abnormal blood vessels and associated nerve fibres that can develop in a longstanding tendinopathy, although that mechanism is not established with certainty.

Who a high-volume injection is for

This is not a first-line treatment. It is considered when a tendinopathy has persisted despite a properly progressed loading programme, which means the first question is usually whether the rehabilitation itself was adequate and continued for long enough.

It is most often used for the Achilles and patellar tendons.

The evidence for high-volume injections

The evidence for high-volume injections is mixed, and they are not appropriate for every patient. We would rather say so at the outset than leave you to discover it afterwards.

In practice the decision rests on how long the problem has been present, what the tendon looks like on assessment, and what has already been tried. An ultrasound assessment helps establish whether the treatment is likely to be suitable, and whether the diagnosis is correct in the first place, since Achilles pain is not always tendinopathy.

What happens during a high-volume injection?

The procedure is performed using real-time ultrasound guidance, so the needle and the surrounding structures can be seen throughout.

After the skin is cleaned, a small amount of local anaesthetic is used to numb the area. The needle is then positioned under ultrasound guidance in the tissue plane next to the affected tendon, and a larger volume of fluid is introduced gradually into that space.

The exact solution and volume depend on which tendon is being treated and on your individual circumstances. The procedure is usually completed within a normal clinic appointment.

Does a high-volume injection hurt?

Most patients tolerate it well. The local anaesthetic reduces discomfort from the needle and the injection itself.

You may notice pressure, tightness or a feeling of fullness as the fluid goes in, and some temporary soreness afterwards once the anaesthetic wears off.

The injection is given slowly under ultrasound guidance, and you can tell us at any point if you are uncomfortable.

Recovery and aftercare

Plan for a relatively quiet period immediately afterwards. The treated area may feel numb for several hours because of the local anaesthetic, followed by some temporary soreness.

Avoid strenuous exercise and heavy loading of the treated tendon at first. Tendon loading is then reintroduced progressively.

When you restart strengthening, running or sport depends on which tendon was treated, your symptoms and what you need the tendon to do for work or sport. You will be given individual advice on this.

Rehabilitation is still the treatment

A high-volume injection is considered as part of a wider programme rather than instead of one. Progressive tendon loading remains the central part of recovery, and the injection is best understood as something that can create the conditions for that work.

Rehabilitation is planned alongside the procedure rather than afterwards. The clinician who scans the tendon and performs the injection is the same one who then builds and progresses the loading programme, so the two are designed together rather than handed between people. There is more on our approach to ultrasound-guided injections.

Not the same as hydrodilatation

Both procedures use ultrasound guidance and both involve injecting fluid, but they treat different problems. A high-volume injection is placed around a tendon. Hydrodilatation is placed inside the shoulder joint to stretch a contracted capsule in a frozen shoulder.

How much does a high-volume injection cost?

The price includes the prescribed medication. Current prices are listed on the prices page.

Assessment in Weybridge

Meyer Physio assesses and treats persistent tendon problems at its clinic on Baker Street in Weybridge, Surrey, combining diagnostic ultrasound, injection therapy and rehabilitation in one place. You can come to us directly, with no GP referral needed.

Your first appointment is a full hour of assessment, with a diagnostic scan where that will help. Where a high-volume injection is the right next step, we explain what it involves and what to expect, and arrange the procedure once you have had time to consider it.

Prior to proceeding with high-volume injection treatment you must provide consent by filling out the form: Informed Consent High Volume injections

Written by Suegnet Meyer, Advanced Practice Musculoskeletal Physiotherapist and MSK Sonographer. HCPC registered [PH55635]. Chartered Society of Physiotherapy member [66175].
Last reviewed: 10 September 2026.

Barbotage is an ultrasound-guided procedure that breaks down and removes the calcium deposits behind calcific tendinopathy, often called calcific tendonitis, most commonly in the shoulder.

Calcific shoulder pain can be severe. It can stop you sleeping on that side, lifting your arm above your head or getting through a day’s work, and it can arrive suddenly with no injury to explain it. Where the deposit is the problem and rehabilitation has not settled it, barbotage treats the calcium directly rather than working around it.

We provide barbotage at Meyer Physio in Weybridge, Surrey. You can come to us directly — you do not usually need a GP or consultant referral, and there is no waiting list. Your shoulder is assessed and scanned first, because whether barbotage will help depends on what the deposit actually looks like.

What is a barbotage procedure?

Barbotage is a minimally invasive procedure used to break down and remove calcium deposits in tendons, commonly in the shoulder. Using ultrasound guidance, a fine needle is inserted into the affected area to aspirate (remove) the calcium and flush the area with a saline solution.

The scan comes first: it shows where the deposit sits, how large it is and what it looks like, which is what determines whether barbotage is likely to help you.

Why is barbotage recommended?

Barbotage is recommended for patients with calcific tendinopathy who have persistent pain and reduced mobility despite other treatments like pain relief medications and physiotherapy. The procedure aims to:

• Reduce pain and inflammation
• Improve shoulder function
• Avoid the need for surgery

Your barbotage is carried out by the same clinician who assessed your shoulder and scanned the deposit, and who then guides your rehabilitation afterwards. Because the procedure is planned as one step in getting the shoulder moving again, what follows it is decided before it is done. See more on ultrasound-guided injections.

What happens during the barbotage procedure?

1. You will be positioned comfortably, and the skin over the affected area will be cleaned.
2. A local anaesthetic will be injected to numb the area.
3. Using ultrasound guidance, a thin needle will be inserted into the tendon to break up and remove the calcium deposit.
4. The area will be flushed with saline, and a small amount of steroid medication is injected to reduce inflammation.
5. A small dressing will be applied, and you will be monitored for a short period before going home.

What are the benefits of barbotage?

• Minimally invasive, avoiding surgery
• Short recovery time
• Can reduce pain and improve function in appropriately selected patients

What are the risks of barbotage?

As with any procedure, there are some risks, including:

• Mild pain or discomfort at the injection site
• Temporary swelling or bruising
• Infection (rare)
• Incomplete removal of calcium, requiring further treatment
• Temporary worsening of symptoms before improvement

Barbotage recovery time and aftercare

Most patients begin to notice improvement over the following three to four weeks. The shoulder can be uncomfortable for a short period immediately afterwards, so relative rest is advised at first, followed by a gradual return to movement.

• Rest the treated area for 24–48 hours.
• Apply an ice pack if needed to reduce swelling.
• Avoid strenuous activity for 1–2 weeks.
• You may be advised to do specific physiotherapy exercises.
• Pain relief medications like paracetamol or ibuprofen can be taken as needed.

How much does barbotage cost?

The fee covers the medication, the sterile consumables and delivery of the procedure under ultrasound guidance. Current fees are listed on our prices page.

When to seek medical attention

Seek medical advice if you develop increasing pain that does not begin to settle, increasing redness, warmth or swelling around the injection site, discharge from the injection site, fever, or if you feel systemically unwell. Contact Meyer Physio, your GP or NHS 111 for advice. If you become acutely unwell, seek urgent medical attention.

Informed Consent Form

If barbotage has been recommended for you, please read this page carefully and ask us any questions before giving your consent. To proceed with the treatment you must complete the form: Informed Consent Barbotage

Written by Suegnet Meyer, Advanced Practice Musculoskeletal Physiotherapist and MSK Sonographer. HCPC registered [PH55635]. Chartered Society of Physiotherapy member [66175].
Last reviewed: 10 September 2026.