Specialist Treatments

What is it?
Shoulder hydrodilatation is a treatment for frozen shoulder, a condition that causes pain and stiffness. The procedure usually takes about 15 minutes

How it works:

• A doctor uses an ultrasound or X-ray to guide a small needle into your shoulder joint

• A mixture of saline (salt water), steroid, and local anaesthetic is injected to gently stretch the tight joint capsule.

• This helps loosen the shoulder and break down sticky scar tissue, making movement easier and less painful.

Benefits:

• Reduces pain and improves shoulder movement, often within a few weeks

  What to expect:

• You may feel some pressure or mild discomfort, but the area is numbed first

• .Your shoulder might feel heavy or numb for a few hours.

• Rest your arm after the procedure and avoid driving for at least six hours.

  Risks:

• Mild pain during or after injection

• Rare risk of infection or bleeding

• Temporary increase in pain for a day or two

Aftercare:
Physiotherapy is usually recommended afterwards to help you get the best results

. If your shoulder becomes hot, swollen, or very painful after the procedure, seek medical advice pain.

What is it?
Tendon dry needling is a minimally invasive treatment for chronic tendon pain (tendinopathy). It’s used when symptoms haven’t improved with exercise and physiotherapy.

How does it work?

• A clinician uses ultrasound to find the damaged part of your tendon.

• After numbing the skin, a fine needle is passed in and out of the tendon several times.

• This process creates tiny injuries in the tissue, which helps to stimulate blood flow, trigger healing, and encourage the tendon to repair itself

What to expect:

• The procedure usually takes a few minutes.

• You may feel some discomfort or pressure, but the area is numbed first

• Afterward, your tendon may feel sore for a few days.

Benefits:

• Can reduce pain and improve function in tendons that haven’t responded to other treatments

• Most effective when combined with physiotherapy and a guided exercise program

Risks:

• Mild pain or soreness after the procedure

• Rare risk of infection or bleeding

Aftercare:

• Rest the area for a few days.

• Continue with physiotherapy and exercises to get the best results

Tendon dry needling is considered safe and promising for stubborn tendon problems, but it’s important to follow your clinician’s advice for rehabilitation and recovery

What is it?
Barbotage (also called needle lavage) is a minimally invasive procedure used to treat calcific tendinitis—a condition where calcium deposits build up in the rotator cuff tendons, causing severe shoulder pain and stiffness

How does it work?

• The procedure is done under ultrasound guidance to precisely locate the calcium deposit.

• After numbing the skin, a thin needle is inserted into the calcium deposit.

• The deposit is broken up and washed out (aspirated) using saline.

• A steroid and local anaesthetic are often injected at the end to reduce inflammation and pain

Benefits:

• Can provide significant pain relief and improve shoulder movement, often within days to weeks

• Avoids the need for surgery and has a faster recovery time

  What to expect:

• The procedure usually takes about 30 minutes and is done as an outpatient.

• You may feel some pressure or discomfort, but the area is numbed first.

• Afterward, your shoulder may feel bruised or sore for a few days.

• You’ll rest briefly after the procedure and should avoid driving immediately afterward

  Risks:

• Mild pain, bruising, or temporary soreness

• Rare risk of infection or skin changes at the injection site

• If the calcium deposit is large and cannot be fully removed, surgery may be considered

Aftercare:

• Continue with prescribed shoulder exercises and physiotherapy to restore strength and movement

• .

• If your shoulder becomes red, hot, swollen, or very painful, seek medical advice.

Barbotage is a safe and effective option for most people with painful calcific tendinitis of the shoulder, especially when other treatments haven’t worked

.

What is it?
High-volume tendon stripping (also called high-volume injection) is a minimally invasive treatment for chronic tendon pain, such as Achilles or patellar (knee) tendinopathy, especially when other treatments haven’t worked

How does it work ?

• Under ultrasound guidance, a large volume of sterile saline (salt water), sometimes mixed with local anaesthetic and/or a small amount of steroid, is injected into the space around the affected tendon—not into the tendon itself

• The fluid helps to “strip” away abnormal blood vessels and small nerves that develop around the painful tendon, which are thought to contribute to ongoing pain

• This process also helps break down scar tissue, reduce inflammation, and promote healing

What to expect:

The procedure usually takes about 15–30 minutes and is performed by a trained clinician using ultrasound for accuracy

• You may feel some pressure or discomfort, but local anaesthetic is used to numb the area.

• After the procedure, mild soreness or swelling is possible, but this usually settles within a few days

Benefits:

• Can reduce persistent tendon pain and improve mobility, often within a few weeks

• May help you return to normal activities and exercise sooner, especially when combined with a tailored rehabilitation program

Risks:

• Mild pain or swelling after the injection

• Rare risk of infection or tendon rupture

• Temporary numbness or bruising

Aftercare:

• Rest the treated area for 48 hours and avoid high-impact activities for a few days

• Follow your physiotherapist’s advice for rehabilitation exercises to get the best results

High-volume tendon stripping is considered safe and effective for chronic tendon problems that haven’t improved with rest, physiotherapy, or other conservative treatments

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What is it?
Nerve hydrodissection is a minimally invasive procedure used to treat nerve entrapments like carpal tunnel syndrome. It aims to relieve pressure on a nerve by gently separating it from surrounding tissues using a fluid injection.

How does it work?

• Under ultrasound guidance, a clinician inserts a thin needle near the affected nerve.

• A solution (usually saline, sometimes with anesthetic or dextrose) is slowly injected around the nerve.

• The fluid gently separates the nerve from ligaments, scar tissue, or other structures pressing on it, reducing compression and irritation

Benefits:

• Can quickly relieve symptoms like pain, tingling, or numbness in the hand or wrist.

• Minimally invasive and often performed in an outpatient setting.

• May help avoid or delay the need for surgery

What to expect:

• The procedure typically takes less than 30 minutes.

• You may feel pressure or mild discomfort during the injection, but the area is numbed first.

• Most people can return to normal activities shortly after.

Risks:

• Mild pain, bruising, or temporary numbness at the injection site.

• Rare risk of infection or nerve irritation

Aftercare:

• You may be advised to rest the hand for a short period.

• Symptoms often improve within days to weeks.

• Follow-up with your clinician and physiotherapy may be recommended for best results.

Nerve hydrodissection is considered safe and effective for conditions like carpal tunnel syndrome, especially when other treatments haven’t provided enough relief