Frozen Shoulder or Rotator Cuff?

These are two of the most common shoulder problems we see in clinic, read on to find out more about what they are and what you can do to help your recovery……

What is a frozen shoulder?

A frozen shoulder is also known as adhesive capsulitis and is characterised by a tightening of the ligaments and capsule surrounding the ball and socket joint of the shoulder. The capsule becomes scarred and inflamed which causes pain and a progressive loss of movement in the shoulder. It affects women more than men.

A frozen shoulder can occur after the arm has been immobilised for a period of time or after a trauma, but more often than not it develops gradually with no obvious cause. It starts with pain in the shoulder, and then certain movements such as reaching overhead or putting your arm into a coat can become very restricted. It can cause pain at night and be particularly stiff on waking in the morning.

What is the rotator cuff?

The rotator cuff is a group of muscles that run from the back of the shoulder, forming a cord like tendon which wraps around the shoulder; very much like a cuff to support and stabilise the joint. The rotator cuff is important in many movements of the arm and shoulder particularly with reaching away from the body and overhead. Pain from rotator cuff injuries can be worse when you lift heavier objects in day-to-day life or when exercising.

Problems with the rotator cuff include tendinopathy; pain and irritation of the tendon causing pain at the front and outside of the shoulder that can radiate down the upper arm, often in movements with the arm away from the body. You can also tear the rotator cuff; this can happen traumatically or more gradually over a period of time. Rotator cuff tears can result in marked weakness with certain movements as well as severe pain in the shoulder. The risk of developing a rotator cuff tear increases with age and is most prevalent in people in their 60’s and 70’s.

A frozen shoulder can limit how far you can lift your arm.

The main difference between a frozen shoulder and a problem with the rotator cuff is the amount of movement you’re likely to have. As a general rule, if you have a frozen shoulder you will have pain and stiffness – so you won’t be able to move your arm freely in all directions, there will be a real block to the movement. If you have a rotator cuff tendinopathy then you will be able to move your shoulder, but it will be painful with some movements. Of course, there can be overlap in these symptoms, and the two conditions can sometimes occur together. It’s important to get a clear diagnosis which will guide your management and recovery. A Physiotherapist can perform specific tests on the shoulder to establish what the problem is and guide your treatment and rehabilitation.

How long does it take to recover?

Recovery times vary from one person to the next. A frozen shoulder is known as ‘self-limiting’, meaning eventually it will resolve itself. Unfortunately, this can take many months and, in some cases, more than a year.

Rotator cuff tendinopathy can settle more quickly but can also cause long term niggles around the shoulder if not addressed properly.

The recovery and prognosis for rotator cuff tears will depend on the extent of the injury, amongst other factors. It is essential to have a thorough assessment with a health professional to get you on the right pathway to optimise your recovery.

What on the treatment options?

Physiotherapy can be helpful, particularly with problems of the rotator cuff problems, treatment is likely to include exercises to improve the activation of the muscle which then helps the joint move more comfortably with less pain, leading to recovery. As well as exercises and hands-on treatment, your Physiotherapist can also assess any postural or ergonomic factors that might be contributing to the load and stress in the rotator cuff muscles and tendons.

Specific exercises play an important role in improving shoulder pain.

Physiotherapy can also be of benefit in some phases of a frozen shoulder to manage pain and optimise movement, though for some people medical interventions have been found to be more effective, so careful assessment is needed to establish what is best on a case-by-case basis.

There are several medical interventions that are available for a frozen shoulder; these include injection therapy (hydro-dilation where the joint is filled with fluid stretch it), or surgical options such manipulation under anaesthetic or arthroscopic debridement. A shoulder specialist is best placed to assess which of these treatments is most appropriate for you if more conservative options like Physiotherapy haven't been successful.

Rotator cuff tears can be surgically repaired but this isn’t the best course of treatment for everyone. It depends on several factors including the size and depth of the tear, how long you have had it and the extent of pain and disability it is causing. Physiotherapy plays an important role to ensure you can still use the shoulder effectively and can help in reducing and eliminate pain.

There are a number of other shoulder conditions which cause shoulder pain, we have just looked at a couple of the most common here. If you’re suffering with shoulder pain, get in touch here for a comprehensive assessment, diagnosis and treatment.