Frozen shoulder has become the default label for almost any stiff, aching shoulder in an adult. It is often applied without anyone checking how the relaxed arm moves. True frozen shoulder that is medically called adhesive capsulitis, affects only around 2 to 5 percent of the general population. Persistent shoulder pain is far more common than that. Hence, a good number of people carrying the label have something else going on. In an interview with HT Lifestyle, Dr Naman Wahal, Senior Consultant and Unit Head, Orthopaedics at Fortis Escorts, New Delhi and Director of StepUp Joints, New Delhi, shared the difference between frozen shoulder and stiffness.
Also read | Waking up with stiff fingers? Orthopaedic doctor reveals when it could be a sign of arthritis
Dr Naman highlighted that the distinction matters because the treatments can take us in opposite directions. Frozen shoulders need patience and controlled movements that are gentle. A shoulder with a rotator cuff problem can be made worse by the same stretching.
The one-minute check
The most useful test needs no scan. It compares active movement, that is, where the patient lifts their own arm, with passive movement, where the examiner lifts the relaxed arm. In true frozen shoulders, both are restricted. Especially when he is turning the arm outward and lifting it forward. The capsule around the joint has tightened.
Hence, the arm meets a firm wall irrespective of who is doing the lifting. “If only internal rotation is reduced while outward rotation is normal, another diagnosis is possible. Pain at the very end of outward rotation, without clear restriction, may point to an early frozen shoulder and is worth reassessing in a few weeks,” said Dr Naman.
According to Dr Naman, a weak shoulder is different. In pseudoparalysis, the patient cannot lift the arm, yet the examiner can raise it much further. The joint is not frozen. The mechanism that powers the lift has failed, classically because of a major rotator cuff problem. Before reaching that conclusion, pain-related inhibition and nerve weakness have to be ruled out.
The explanation given to patients is simple: in frozen shoulders, even the doctor cannot fully move the relaxed arm. In pseudoparalysis, the doctor can lift it, but the patient cannot lift or hold it alone.
Primary and secondary stiffness
Frozen shoulder is broadly divided into two kinds. Primary frozen shoulder has no clear cause. In one specialist clinic, nearly 80 percent of these patients are perimenopausal women. However, that is a clinical observation and not a population figure.
Secondary stiffness follows an injury, surgery or a period of immobilisation, or comes with another problem in the shoulder such as a cuff, labral or biceps condition. It is spread much more evenly between men and women. Diabetes and thyroid disease also need to be considered, and the combination matters in India, where diabetes is common. A stiff shoulder in a diabetic patient is easily put down to frozen shoulder, while a tendon problem may be sitting alongside it.
What else can cause persistent shoulder pain?
● Rotator cuff disease, where active movement is much worse than passive movement
● Arthritis of the shoulder joint, where both movements are limited, and a basic X-ray usually shows the cause
● Calcific tendinitis, with sudden and severe pain, often without any real injury
● A nerve problem in the neck, with shooting pain, numbness, or symptoms linked to neck movement
● Labral injury or instability, with clicking, slipping or apprehension after trauma or overhead activity
● Pain from the AC joint, felt on top of the shoulder and worse when reaching across the body
● A fracture or dislocation after an injury
● Infection or inflammatory disease, suggested by fever, redness, swelling, or long morning stiffness in both shoulders
Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.
