Do I Have Frozen Shoulder? How to Tell What’s Causing Your Shoulder Pain
Your shoulder hurts. Sleeping on that side is uncomfortable. Reaching overhead or behind your back has become a project.
Is it frozen shoulder? A rotator cuff problem? Could it actually be coming from your neck?
These problems can feel surprisingly similar, but they often need different treatment. At Summit Physical Therapy, our first job is to figure out what is driving your symptoms so your treatment makes sense for you.
What does frozen shoulder feel like?
Frozen shoulder, also called adhesive capsulitis, affects the capsule surrounding the shoulder joint. The capsule becomes irritated and stiff, gradually limiting how far the shoulder can move.
You may notice increasing difficulty getting dressed, washing your hair, reaching a shelf, or putting on a coat. Pain can be especially frustrating at night.
The biggest clue is a progressive loss of movement—even when someone else gently helps move your arm. Turning the arm outward with your elbow at your side is often particularly limited.
That distinction matters. A shoulder that hurts when you lift it is not automatically a frozen shoulder.
Frozen shoulder is more common between ages 40 and 60, particularly in women and people with diabetes or thyroid conditions. However, those risk factors alone do not establish the diagnosis. AAOS
How is frozen shoulder different from a rotator cuff problem?
The rotator cuff is a group of muscles and tendons that helps move and stabilize your shoulder. Rotator cuff problems include tendinopathy and partial or full-thickness tears.
Common symptoms include pain along the outside of the shoulder or upper arm, discomfort lifting or lowering the arm, and pain or weakness with reaching and carrying. Sleeping on the affected side can hurt, too.
With a rotator cuff problem, moving the arm yourself may be more painful or difficult than having your therapist help move it. The joint may still have substantially more available motion than you can comfortably use on your own.
Frozen shoulder typically restricts both types of movement:
Active motion: You move your arm yourself.
Passive motion: Your therapist moves your relaxed arm.
This is a useful clue, not a diagnosis by itself. Pain can cause guarding, rotator cuff problems can coexist with stiffness, and shoulder arthritis can also limit both active and passive movement. Your therapist needs to put the whole picture together. AAOS
Could my shoulder pain actually be coming from my neck?
Yes. The joints, discs, and nerves in your neck can produce pain felt around the shoulder, shoulder blade, or arm. Sometimes the shoulder is where you feel the problem even though your neck does not seem particularly painful.
This is common enough that a thorough shoulder evaluation should include the neck.
One observational study reported a cervical contribution in 50% of its shoulder-pain sample, defined as at least a 30% change in shoulder pain following a neck screening procedure. That does not mean half of all shoulder pain comes entirely from the neck. It does show why checking the neck can meaningfully change the treatment plan. ScienceDirect
Clues that the neck may be involved include:
Shoulder or arm pain that changes when you turn or position your neck.
Symptoms extending below the elbow.
Tingling, numbness, or changes in arm strength.
Shoulder symptoms that are difficult to consistently reproduce with shoulder testing.
You do not need every symptom on that list. Neck-related referred pain can occur without numbness or tingling, and neck and shoulder problems can exist together.
Treating only the shoulder when the neck is contributing may leave an important part of the problem unaddressed. PMC
How does a physical therapist figure out the difference?
Physical therapists are trained to evaluate muscles, joints, nerves, and movement. A skilled examination goes well beyond finding a tender spot or performing one shoulder test.
At Summit Physical Therapy, we look at:
Your symptom history. Did this begin after an injury or develop gradually? Is the shoulder becoming progressively stiffer? Which activities aggravate it, and what helps?
Active and passive movement. We compare how far you can move with how far the joint moves when we assist.
Strength and tolerance to loading. We assess how your shoulder responds when the rotator cuff and surrounding muscles work.
Your neck and nervous system. We examine whether neck movement changes your shoulder symptoms and check sensation, reflexes, and nerve-related strength when indicated.
Your response to treatment. We retest meaningful movements to see whether the treatment is helping. Your diagnosis and plan can be refined as we learn how your symptoms behave.
No single test tells us everything. The value is in interpreting the findings together and recognizing when imaging or another medical evaluation is appropriate. doi.org
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Why the diagnosis changes your treatment
Giving everyone with shoulder pain the same stretches and resistance band exercises misses the point. The right treatment depends on what is limiting you.
If you have frozen shoulder
Early treatment often emphasizes managing pain, adjusting aggravating activities, improving sleep positioning, and maintaining tolerable movement. Hands-on treatment and appropriately dosed mobility exercises may help.
More stretching is not always better. Forcing an irritable shoulder can make symptoms worse. As it becomes less sensitive, we progress mobility, strength, and functional use. We can also coordinate with your physician when options such as a corticosteroid injection may help you participate in rehabilitation.
Recovery often takes months and sometimes longer. Your plan should reflect your symptoms and progress rather than a promise of a quick fix. AAOS
If you have a rotator cuff problem
Treatment usually centers on gradually rebuilding what the shoulder can tolerate. We adjust painful activities, address relevant mobility limitations, and progressively strengthen the rotator cuff and surrounding muscles. doi.org
Then we train the movements you actually need: lifting groceries, pressing overhead, playing tennis, or picking up your child. When appropriate, VALD strength testing helps us measure deficits and track improvement.
If your neck is contributing
Your plan may include neck movement exercises, hands-on treatment, and progressive neck, shoulder, and upper-back strengthening. Nerve-related exercises may be appropriate for some people.
We use your examination and response to treatment to decide which approaches belong in your program.
Feeling better is the beginning
Once pain and movement improve, we build coordination, strength, and tolerance for repeated activity. For people returning to sports or demanding exercise, that may include faster movements, power, and sport-specific loading.
The goal is a shoulder you trust throughout your day—not just one that feels better during an appointment.
As one patient shared:
“Expert service and very professional. Be sure to ask for Larissa. She is very knowledgeable and patient.”
Get answers about your shoulder pain in Summit, NJ
You do not need to know your diagnosis before scheduling an evaluation. Figuring that out is part of what we do.
Summit Physical Therapy serves patients from Summit, Short Hills, Millburn, Maplewood, Chatham, Florham Park, New Providence, Springfield, and South Orange.
If shoulder pain is affecting your sleep, work, exercise, or daily routine, we can help you understand what is going on and build a treatment plan around your needs.
Seek prompt medical evaluation for sudden major weakness after an injury, progressive arm weakness or numbness, or a hot, swollen shoulder with fever. Shoulder pain accompanied by chest pressure, shortness of breath, or sweating requires emergency care.