Episode 18 | Patient Story | Guest: Frank, patient at LBSM
Frank is 66, active all his life – rugby and basketball giving way to running, gym work, and Tai Chi as the years passed. He has ridden motorcycles for 50 years and Harleys for 30, touring across America, up towards the Arctic, through Eastern Europe and down to Morocco. His wife comes on the trips. It is, in his words, a major hobby.
So when his left shoulder began to limit what he could do – reaching across the handlebars, lifting his arm, even holding a knife and fork at the dinner table – it was impossible to ignore. Eventually.
A problem that had been building for decades
Frank is disarmingly honest about how long he put up with it. The shoulder had been causing problems, on and off, for the best part of 20 years – pain and stiffness that would flare, ease back, and never quite return to normal. He compensated. He adapted. Changing a lightbulb meant an extra step on the ladder. Reaching for a drink at the bar on his left side was simply not an option.
“You just compensate for it,” he says. “You work around it.”
But in the year before he finally sought help, things changed. The limitation became far greater. Pain set in with a vengeance. At its worst, he could move his arm no more than ten degrees away from his body. Sleep became a cycle of exhaustion and waking – lean on the shoulder and the pain would jolt him awake. He was taking painkillers just to get through the working day.
“That’s the stage I came to,” he says. “You just don’t sleep. You sleep for a couple of hours and wake up. It’s constant pain.”
What is frozen shoulder?
Dr Ajai Seth, who treated Frank at LBSM, describes frozen shoulder as one of the body’s more curious protective responses. The shoulder is the most mobile joint in the body – a golf ball sitting on a tee, as he puts it. When something upsets the joint, whether through injury, trauma, repetitive strain, or certain underlying conditions, the body’s instinct is to freeze it: to stiffen the surrounding tissues and restrict movement, keeping the arm close to the body and preventing further insult.
The condition progresses through three recognisable phases: a freezing phase (stiffening and pain), a frozen phase (the shoulder is stuck), and eventually a thawing phase (slow release). Without intervention, that cycle can take months or years to complete – and in Frank’s case, the shoulder had been cycling through variations of this pattern for two decades without fully resolving.
Frozen shoulder is also something of a mimic. Its pain can travel – down the arm, up into the neck, causing tension headaches via the trapezius muscle. It can look like a rotator cuff tear, a trapped nerve from the neck, or a joint problem. One of the key tasks at the initial consultation was ruling those out: a thorough history, a physical examination, an ultrasound scan of the tendons and joint, and an X-ray to check for any structural trauma.
The procedure: hydrodistension
Given that Frank had been through multiple cycles of stiffness and partial recovery over the years, Dr Seth felt a more definitive intervention was warranted rather than physiotherapy alone. The procedure offered was a hydrodistension – or hydrodilatation – carried out under ultrasound guidance at the London Bridge Clinic at the Shard.
The process involves guiding a needle into the shoulder joint under ultrasound, administering local anaesthetic, and then injecting 20 to 30ml of saline to expand the joint capsule and break down the adhesions that have caused the freezing. The whole process is visible in real time on the ultrasound screen – something Frank found unexpectedly captivating.
“You could actually watch the whole thing on screen,” he says. “You could see what was going on – the needle going in, watching it pumping, pumping the fluid. And then when you see it free, you feel it. It was great.” He describes the sensation as similar to a balloon being inflated from the inside – noticeable but not painful. His comparison for the overall procedure: no more painful than a tattoo. Given that Frank has a full sleeve, that is a considered and authoritative benchmark.
He stood up afterwards with approximately 80% of normal shoulder movement immediately restored. The pain, which had been his constant companion, was gone.
“I left bouncing down the road, getting the train home. It was unbelievable.”
Recovery: the role of physiotherapy
Frank is emphatic that the procedure was not a one-stop fix – and equally emphatic about how transformative the combination of injection and physiotherapy proved to be. He started physio three to four days after the hydrodistension and committed fully to it.
“To get to where I am now, you just have to commit to the physio – which, again, there’s another quantum leap.” Three weeks in, he had, as he puts it, around 110% range of movement – doing things with his shoulder he hadn’t been able to do for ten years. The focus had shifted from treating the frozen shoulder to rehabilitating the surrounding muscles and tendons that had been dormant and weakened over the years of restricted movement.
“We’re not treating the shoulder now, actually. We’re rehabilitating the upper body. Which is great.”
Dr Seth also highlighted the importance of understanding why the shoulder froze in the first place – and addressing those factors. For Frank, the likely contributors included a history of motorcycle accidents and the biomechanics of his riding position. For others, it might be a desk setup, a habitual posture, or an underlying health condition. The procedure restores range of movement; addressing the cause is what prevents recurrence.
Frank’s advice
Asked what he would say to anyone sitting on a shoulder problem, Frank does not hesitate:
“Don’t just put Voltarol on it and think it will go away. If you’ve got an issue, do what I didn’t do for ages – just phone your health provider, go to a physio, get an opinion on it, get the X-ray, get the ultrasound, find out what it is.”
He reflects, with characteristic frankness, on the two decades he spent compensating and adapting rather than seeking help. “I could have done this 20 years ago and I would have had a totally different life. It would have changed a lot and made life a lot easier.”
Less than three months after walking into the clinic, Frank has more shoulder movement than he has had in a decade, no painkillers, uninterrupted sleep, and the open road ahead.
Frozen shoulder is a common but frequently undertreated condition. If you are managing persistent shoulder pain or stiffness – however long you’ve been putting up with it – the team at London Bridge Sports Medicine can assess, diagnose, and treat it.
Book an appointment at lbsm.co.uk/booking
Listen to the full episode below ↓
