Frozen shoulder vs rotator cuff tear: stiff or weak?

The simplest way to think about it is stiff versus weak and sore on use. In frozen shoulder, the main problems the NHS lists are pain, which can be worse at night, and stiffness that makes the shoulder difficult to move. The Chartered Society of Physiotherapy (CSP) says it restricts movement in any direction. In a rotator cuff problem, the CSP says people typically find it painful to raise the arm overhead and the arm may feel weaker than usual.

Both are common in middle age, and the CSP lists rotator cuff tendon problems and frozen shoulder as the common causes of shoulder pain in that age group. They can overlap and a physiotherapist or doctor needs to examine the shoulder to say which one is more likely. The NHS says not to self-diagnose shoulder pain that does not improve after 2 weeks.

The NHS explains that frozen shoulder happens when the tissue around the shoulder joint becomes inflamed, then gets tighter and shrinks, which causes pain. It is often not clear why people get it. It can follow an injury or surgery that stops the arm moving normally, and it is linked with diabetes, which is why regular diabetes check-ups matter.

The rotator cuff is the group of tendons around the shoulder. The CSP says that in middle age people commonly experience pain from these tendons. It can start after strenuous activity or a fall but can also start for no reason at all, and it is known by various names, such as subacromial shoulder pain, rotator cuff tendinopathy and bursitis, which all describe the same symptoms. A rotator cuff tear is a more severe form in which a tendon is torn. The NHS lists a torn or ruptured tendon among causes of sudden very bad pain with difficulty moving the arm.

The table is built from the NHS frozen shoulder and shoulder pain pages and the CSP causes page.

The NHS says a health professional will examine you to work out what is causing your shoulder pain and may send you for tests such as an X-ray to check the cause. In many areas you may be able to refer yourself to NHS community musculoskeletal (MSK) services for help such as physiotherapy, without a GP referral. The treatment you need depends on the cause. The pages read for this comparison do not describe a specific test for frozen shoulder or for a rotator cuff tear, so treat the symptom patterns above as a guide to what to tell a clinician rather than as a way of diagnosing yourself.

The NHS says treatment for frozen shoulder works in three main steps: pain relief with paracetamol and, if appropriate, an anti-inflammatory such as ibuprofen; stronger pain relief including a steroid injection if needed; and getting movement back with gentle exercises and, if the pain continues, physiotherapy, which usually lasts at least 6 weeks. It says to keep the shoulder moving because keeping it still will make the pain worse, and not to make up your own strenuous exercises or use gym equipment.

For shoulder pain in general, the NHS suggests staying active and gently moving the shoulder, doing shoulder exercises for 6 to 8 weeks to stop pain returning, using good posture, and using painkillers, heat or cold packs. It says you usually need to do these for 2 weeks before pain starts to ease and that it can take 6 months or longer to recover. Depending on the cause, treatment can include stronger medicine or injections, physiotherapy or a specialist referral. The CSP notes that these problems can normally be managed in the first instance without attending hospital.

The NHS says to see a GP if shoulder pain is getting worse or does not improve after 2 weeks, or if it is very difficult to move the arm or shoulder. Ask for an urgent GP appointment or get help from NHS 111 if you have sudden or very bad shoulder pain, you cannot move your arm, your arm or shoulder has changed shape or is badly swollen, you have pins and needles that do not go away, there is no feeling in the arm or shoulder, the arm or shoulder is hot or cold to touch, the pain started after an injury or accident such as a fall, you have severe pain in both shoulders, or you feel feverish or unwell. The NHS says these can be signs of something serious, like a broken or dislocated bone or a torn or ruptured ligament or tendon.

The CSP adds that a lump or swelling on or around the shoulder, red skin and pain over the shoulder with fever, a sudden change in shape of the shoulder after an injury, and pain with difficulty raising the arm after an injury should be assessed more urgently.