Shoulder pain affects millions every year, but the same problem does not always cause it. In fact, two of the most common culprits, the frozen shoulder and rotator cuff injuries, share overlapping symptoms that can easily be mistaken for one another. A correct diagnosis is the key to lasting relief and full recovery.
At Interventional Pain & Spine Center in Wexford, PA, triple board–certified pain specialist and neurologist Dr. Mohammad Ali leads a comprehensive, patient-first team. We evaluate shoulder injury types, coordinate imaging, and deliver evidence-based pain treatments, from targeted injections to advanced neurodiagnostic testing.
Now that we've framed the problem and how we help, let's define the two most common culprits and why they happen.
What’s Behind Your Shoulder Pain?
Shoulder Pain can have many causes, but two of the most common are frozen shoulder and rotator cuff injuries. Knowing the difference helps you take the right steps toward relief.
What Is Frozen Shoulder (Adhesive Capsulitis)?
Frozen shoulder occurs when the capsule around your shoulder joint becomes thick, tight, and inflamed. This limits your shoulder's ability to move freely. Over time, scar-like tissue called adhesions forms, which causes stiffness and pain.
It usually happens after the shoulder has been immobilized for a while, like after surgery or an injury. People with diabetes or thyroid problems are also at higher risk. Symptoms develop slowly and often move through three stages: freezing, frozen, and thawing.
What Is a Rotator Cuff Tear?
Your rotator cuff is a group of four muscles and tendons that help lift and rotate your shoulder. A tear can range from small fraying to a full tear of the tendon.
Rotator cuff injuries often happen due to aging, repetitive overhead movements, or a sudden injury, like lifting something heavy or falling. Common symptoms include pain during activity and shoulder weakness, especially when reaching overhead or away from the body.
Now that you understand the causes, let's look at how each condition feels.
How Do the Symptoms Compare?
Signs of Frozen Shoulder
- Stiffness comes first, followed by growing pain that lasts for months.
- Severely limited range of motion, you may not be able to lift your arm overhead or behind your back.
- Both active (you move it) and passive (someone moves it for you) motion are restricted.
- Nighttime pain is common, along with trouble getting dressed or reaching behind you.
Signs of a Rotator Cuff Problem
- Localized pain on the outside of your upper arm or shoulder.
- Weakness when lifting or rotating the arm.
- Pain during specific movements—like reaching overhead or behind you.
- Passive motion is often okay, but active motion can cause discomfort or weakness.
- Clicking or popping may occur when moving the arm.
Quick Tip: If your shoulder feels stiff no matter who tries to move it, frozen shoulder may be the issue. If you're weak but someone else can move your arm freely, it could be a rotator cuff injury.
How Doctors Tell the Difference
What to Expect During a Physical Exam
- Frozen Shoulder: Your doctor will assess your arm's range of motion, noting that both active and passive movements are limited. This is a key part of the diagnosis.
- Rotator Cuff Tear: Your doctor will ask you to resist certain movements (like lifting your arm with your thumb down). If that causes pain or weakness, it may point to a rotator cuff tear. Passive motion usually remains normal.
What Imaging Tests May Be Used
- X-rays rule out other issues like arthritis or bone spurs.
- Ultrasound or MRI can show tendon tears, inflammation, and other soft tissue problems.
- Diagnostic injections (a numbing shot) may help clarify whether the issue is weakness or just pain.
- Nerve tests (EMG/NCS) are used if nerve problems from the neck are suspected.
At Interventional Pain & Spine Center, to ensure an accurate diagnosis, we coordinate all necessary imaging and provide in-house EMG & EEG Testing Services when nerve involvement is suspected. For expert evaluation and guidance,Dr. Mohammad Ali is ready to support your recovery every step of the way.
Treatments That Match the Cause
How We Treat Frozen Shoulder
- Gentle physical therapy is the first line of treatment. Stretching exercises help improve motion over time.
- Anti-inflammatory medications and steroid injections can reduce pain and make therapy more effective.
- Hydrodilatation (injecting fluid into the joint) may help loosen the shoulder.
- In tough cases, surgery or manipulation under anesthesia may be recommended.
We offer targeted procedures like image-guided injections and nerve blocks to help manage pain while you work on regaining motion.
How We Treat Rotator Cuff Tears
- Rest and physical therapy are effective for partial tears or tendon inflammation. Therapy focuses on shoulder strength and coordination.
- Steroid injections may be used to reduce pain and help you progress with therapy.
- Surgical repair may be needed for large tears, recent injuries, or if rehab doesn't work.
We’ll help guide you through a conservative treatment plan first. If surgery becomes necessary, we coordinate orthopedic referrals and continue pain management before and after surgery.
What Does Recovery Look Like?
Frozen Shoulder Recovery Timeline
- Freezing stage (2–9 months): Pain increases, and motion becomes more limited.
- Frozen stage (4–12 months): Pain may improve, but stiffness remains.
- Thawing stage (5–24 months): Gradual improvement in movement.
Most patients improve significantly with stretching, consistent therapy, and time.
Rotator Cuff Recovery Timeline
- Partial tears or inflammation: 6–12 weeks of structured physical therapy can greatly improve symptoms.
- After surgery: Patients wear a sling at first, then start rehab in phases. Recovery takes about 6–12 months, depending on the injury.
Get the Right Diagnosis, Get the Right Treatment
Shoulder pain can disrupt work, sleep, and daily life, but knowing whether it's a frozen shoulder or a rotator cuff injury is the first step toward lasting relief. At Interventional Pain & Spine Center, we combine expert diagnosis with advanced treatments to restore mobility and reduce pain, helping you get back to the activities you enjoy.
Call us at (724) 965-8946 or set an appointment to start your recovery today.
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Frequently Asked Questions
Can frozen shoulders heal without treatment?
Yes, but it can take years. Treatment speeds recovery and reduces pain.
Do rotator cuff tears always require surgery?
No. Many partial tears heal with rest, therapy, and non-surgical care.
How can I tell if my shoulder pain is serious?
If pain persists beyond a week, limits daily activities, or follows an injury, see a specialist.
What are the main shoulder injury types?
Common conditions include frozen shoulder, rotator cuff tears, tendonitis, bursitis, and arthritis.
