• Project led by Central London Community Healthcare.
  • Focused on physiotherapist-led treatment of frozen shoulder.
  • Aimed to speed up the treatment pathway for frozen shoulder, reduce the number of health care appointments needed and provide more cost-effective care.
  • Introduced a new service where specially-trained physiotherapists provided guided shoulder joint distension in primary care settings, enabling patients to have their assessment, interventions, follow-up and rehabilitation at a single location.

The Central London Community Healthcare team introduced a new service offering patients with 'frozen shoulder' guided shoulder joint distension in a primary care setting.

Guided intra-articular shoulder injections and shoulder joint distension has the potential to significantly reduce the impact and severity of frozen shoulder. The procedure takes around 15 minutes and the patient can return home immediately. Shoulder joint distension was previously only available in hospital, as the end point of a lengthy care pathway which took up to 18 weeks and often involved multiple hospital visits. The project team set out to:

  • speed up the treatment pathway
  • reduce the number of health care appointments needed
  • provide more cost-effective care.

The new service was provided by specially-trained physiotherapists and enabled patients to have their assessment, interventions including injections and guided shoulder joint distension, follow-up and rehabilitation at a single location.


  • 100% of patients felt that they had improved slightly or substantially.
  • Statistically significant mean improvements in outcome measures.
  • Clinically significant mean improvements in pain and range of motion.
  • Significant cost savings, with a cost per patient of £131 compared to £267 for the traditional treatment pathway.

Further reading

Learning report

Shine: Improving the value of local healthcare services

February 2014
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