Frozen Shoulder or Rotator Cuff??

Frozen Shoulder or Rotator Cuff??

Anyone who has experienced a long term shoulder injury will know that once you experience the sort of pain associated with adhesive capsulitis (frozen shoulder) or a chronic rotator cuff issue, it can have a really detrimental effect on your every day life as well as any sporting involvement. Although these two pathologies are often associated closely together, the reality is that they are very different in terms of their presentation, symptoms and eventual treatment. Therefore, it is really important to be able to differentiate between the two in order to provide the best possible care for an individual suffering with either pathology.


Kerstine and I have had multiple experiences of seeing individuals in clinic who have been diagnosed with one of these conditions without any real reason other than convenience and when assessed in detail, it becomes clear that some people are misdiagnosed, leading to incorrect management of the condition and potentially worsening or at least failing to improve an already difficult situation. In order to diagnose either frozen shoulder or an injury to the rotator cuff, a full subjective and objective assessment is required, allowing trained therapists such as ourselves to come to an accurate diagnosis by utilising our clinical reasoning skills.


But in summary, frozen shoulder involves the thickening of the capsule which surrounds the shoulder joint. Some key presenting symptoms of frozen shoulder would include significantly reduced range of motion, both actively and passively, meaning the individual is unable to move the shoulder through its full range by themselves or when done for them by us. Additionally, frozen shoulder is not so much associated repetitive load whereas rotator cuff injury often is. Often, individuals who have developed frozen shoulder have become immobilised either due to lifestyle choices or significant previous medical history. Lastly, frozen shoulder most commonly affects individuals over the age of 40 and females are more regularly affected than males.


In contrast, an injury to the rotator cuff, a group of four muscles deep in the shoulder joint can happen to anyone, with individuals who repetitively load their shoulder, particularly through overhead movements most commonly affected


This can be sportspeople but also people with active jobs such as labourers. Individuals with an injury to the rotator cuff are likely to have their range of movement limited by pain rather than restriction by a thickened capsule. This means that often passive range of motion will exceed active.  As mentioned before, where frozen shoulder will commonly affect older, less active individuals, rotator cuff injuries can affect anyone, with the most likely indicating factor hobbies or jobs which require overhead use of the shoulder.


So, now we know some of the key ways you can differentiate frozen shoulder from a rotator cuff injury, why is it important? Firstly it is important to get the correct diagnosis so that the affected individual is aware of their condition, the structures involved, the possible timelines and plans for improving their condition. This is vastly different for each of these pathologies and so it is vitally important for the diagnosis to be correct. After this has been established, the timeline, prescription and progression of exercises for each condition will again be very different, with a potentially progressed frozen shoulder likely to take an extended time to get back to full range, with early stage passive range exercises likely for instance. For someone with a rotator cuff injury, it’s likely that a period away from the cause of injury will be necessary, so again a very different initial management plan.

If you are suffering with shoulder pain which you feel could be either of these issues and would like to be assessed and set on your path to recovery, get in touch!

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