Frozen Shoulder vs Rotator Cuff Tear: Understanding the Difference

Shoulder pain can be frustrating, limiting your movement, sleep, and ability to carry out everyday activities. Two of the most common causes of shoulder pain in adults are frozen shoulder (also called adhesive capsulitis) and rotator cuff tears. While they can feel similar, these are quite different conditions that require different approaches to treatment. In this article, we’ll explain what each condition is, how to spot the difference, how they’re treated medically, and what to expect from physiotherapy and rehabilitation.

What is Frozen Shoulder?

Frozen shoulder is a condition where the capsule that surrounds your shoulder joint becomes inflamed, tight, and thickened. This causes pain and a progressive loss of movement.

It often develops gradually and can last many months or even years. It is more common in people between 40 and 60 years of age and is more frequent in women. It is also linked with diabetes, thyroid disorders, and following shoulder immobilisation after injury or surgery [1].

Common Symptoms

A slow onset of shoulder pain, often without a clear injury
Stiffness develops over time, especially with movements like reaching overhead or behind your back
Pain is often worse at night
Movement becomes restricted both actively and passively (even when someone else moves your arm)

Frozen shoulder typically goes through three phases:

Freezing phase – increasing pain and loss of movement (2–9 months)
Frozen phase – pain may settle, but stiffness remains (4–12 months)
Thawing phase – gradual return of movement (6–24 months)

"Frozen shoulder is characterised by progressive shoulder stiffness and pain in the absence of significant trauma, with limitation of both active and passive movements" [1].

What is a Rotator Cuff Tear?

The rotator cuff is a group of four muscles and their tendons that stabilise your shoulder and help you lift and rotate your arm. A tear happens when one or more of these tendons become damaged, either from injury (trauma) or gradual wear and tear.

Rotator cuff tears become more common with age. Many adults over 60 may have a tear even without symptoms [2]

Common Symptoms

Pain with certain movements, especially overhead or reaching behind
Weakness when lifting or rotating the arm
Pain often felt on the side of the shoulder, especially when lying on it
In partial tears, you may still have good movement
In large or full-thickness tears, you may struggle to lift the arm

“Rotator cuff tears typically cause weakness and pain during overhead activities, but unlike frozen shoulder, they don’t usually limit passive motion” [2].

Medical Diagnosis and Imaging

Physiotherapists can usually identify the likely cause based on your history and movement tests. In some cases, your doctor or physiotherapist may request imaging such as:

Ultrasound – helpful for identifying rotator cuff tears
MRI – provides detailed images, useful for confirming tear size or excluding other causes
X-rays – not useful for soft tissue, but may show bone changes or rule out arthritis

Imaging is not always needed. Frozen shoulder is usually diagnosed based on your symptoms and loss of motion. For rotator cuff tears, imaging may be used if symptoms are severe, not improving, or if surgery is being considered.

Treatment and Management

Frozen Shoulder

Most cases resolve over time without surgery. Treatment is focused on managing pain and maintaining as much movement as possible.

Medical treatments:

Pain relief – paracetamol or anti-inflammatories
Corticosteroid injections – can reduce inflammation and pain in early stages [3]
Hydrodilatation – a guided injection to stretch the joint capsule
Surgery – rarely required, used only in severe, long-lasting cases

Physiotherapy approach:

Early phase: Gentle range-of-motion exercises to reduce pain
Middle phase: Manual therapy and stretching to maintain movement
Late phase: Strengthening and return to normal function as movement improves

Exercise must be matched to the phase of the condition. Overstretching in early stages may worsen symptoms.

"Physiotherapy tailored to the phase of frozen shoulder can significantly reduce recovery time and improve long-term outcomes" [3].

Rotator Cuff Tear

Small and medium tears often improve with physiotherapy. Larger or full-thickness tears may need a surgical opinion, especially in active individuals.

Medical treatments:

Anti-inflammatory medications
Corticosteroid injections – can reduce pain to allow rehab
Surgery – considered if weakness is severe or function does not improve after rehab [4]

Physiotherapy approach:

Early: Pain reduction and gentle activation exercises
Mid-stage: Strengthening rotator cuff and surrounding muscles
Later: Functional and sport-specific rehab if needed

"Exercise therapy is effective in managing most rotator cuff tears, especially when focused on shoulder stability and motor control" [4].

What Exercises Are Used?

While each person’s rehab is tailored, common exercises include:

Frozen Shoulder:

Pendulum swings
Wall slides
Passive arm raises with stick or pulley
Gentle capsular stretches
Isometric rotator cuff activation in later phases

Rotator Cuff Tear:

Scapular setting and shoulder blade control
Resistance band external rotations
Arm lifts with light weights
Prone shoulder retractions
Progression to overhead strength work

Progression is gradual and based on your symptoms. Your physiotherapist will guide you to avoid aggravating the area while promoting recovery.

When to Seek Help

If you have shoulder pain that is affecting your movement, sleep, or daily life for more than a few weeks, it’s time to speak to a physiotherapist.

Early assessment helps clarify the cause and build a plan. With the right approach, most shoulder problems improve without surgery.

References

Zreik NH, Malik RA, Charalambous CP. Adhesive capsulitis of the shoulder and diabetes: a meta-analysis of prevalence. Bone Joint J. 2016;98-B(1):85–91.
Yamamoto A, Takagishi K, Osawa T, et al. Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg. 2010;19(1):116–120.
Page MJ, Green S, Kramer S, Johnston RV, McBain B, Buchbinder R. Manual therapy and exercise for adhesive capsulitis (frozen shoulder). Cochrane Database Syst Rev. 2014;(8):CD011275.
Kuhn JE. Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol. J Shoulder Elbow Surg. 2009;18(1):138–160.

Disclaimer:

This content is for general informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with any questions you may have about your health or a medical condition. Never disregard professional advice or delay seeking it because of something you have read or seen here. The creators of this content accept no responsibility for any injury, loss, or damage arising from reliance on the information provided.

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