Stiffness vs. Frozen Shoulder: Knowing the Difference

Shoulder pain and stiffness that limit your range of motion can make daily life difficult. You may not be able to reach items in an upper kitchen cabinet or hold your hands up to wash your hair. 

Chronic shoulder stiffness is different from stiff muscles from a vigorous gym workout, which goes away after a day or two. 

Debilitating pain and lost range of motion mean it's time to see an orthopedic specialist. Our board-certified orthopedic surgeons with Peninsula Orthopedic Associates get to the root of your shoulder pain and develop a treatment plan. 

Your stiffness could be from a number of conditions. Your shoulder can be stiff from too much exercise, muscle spasm, arthritis, or a recent trauma in addition to frozen shoulder. 

Diagnosing stiffness from arthritis or a fracture

We take X-rays of your shoulder to rule out arthritis or a fracture. Tough tissue, or cartilage, surrounds your shoulder bones, providing a protective cushion between them. 

Sometimes the cartilage wears away from overuse or simply normal aging. You might even hear a grating sound when you move your arm a certain way. In that case, you could be almost bone-on-bone in your shoulder joint. 

If you have shoulder arthritis, you might have more stiffness in the morning when you get up that loosens during the day as you use your arm. 

Your X-rays show whether the cartilage is torn or depleted. Treatment for arthritis includes moist heat, cortisone injections, and physical therapy. When conservative treatment fails and you have no cushioning between your bones, we offer shoulder replacement. 

What is frozen shoulder? 

Your shoulder contains a capsule of fluid that helps it remain stable and enables complete range of motion. If the capsule becomes inflamed, it thickens and forms bands of scar tissue. You lose synovial fluid, a natural joint lubricator, and your shoulder becomes frozen. 

If your frozen shoulder occurs in the absence of a secondary health condition or trauma, it’s known as primary frozen shoulder. The exact cause is unidentified. 

Secondary frozen shoulder occurs as a reaction to a chronic condition like diabetes or thyroid disease, a shoulder injury, or a period of immobilization of your shoulder such as recovery from a stroke, a rotator cuff tear, or a fracture of your upper arm. 

When you don’t rotate your shoulder for an extended period of time, you’re more at risk for frozen shoulder. 

Frozen shoulder consists of three phases. First, your shoulder is very sore and painful, which signals inflammation. In the next stage, your shoulder becomes very stiff and difficult to move. In the final stage, the pain dissipates and you regain range of motion. 

Early treatment helps you recover faster. Untreated frozen shoulder can take up to two years to heal. 

Diagnosing stiffness from frozen shoulder

If your X-rays are negative, we look at other causes for your chronic shoulder stiffness. Part of a shoulder appointment includes passive and active movement of your shoulder to see the degree to which your movement is affected. 

Frozen shoulder is characterized by pain and stiffness with continued loss of motion over a period of time. You may try to compensate by bending to one side and lifting the side of your body upward when trying to raise your arm up.

We examine passive and active movement of your shoulder. Passive movement means that we hold your arm and move it in certain ways until you say stop or until your arm won’t move further. 

For example, we ask you to hold your forearm at a 90-degree angle facing forward. We hold your arm and try to move your lower arm toward the side of your body. A movement of less than 30 degrees usually signifies frozen shoulder. 

We test your active movement when we ask you to lift your arm yourself in different ways. For example, we may ask you to hold your arm straight out in front of your body and raise the arm all the way toward the ceiling, among a number of physical tests. 

Treatment for a frozen shoulder is similar to conservative treatment for arthritis. 

Call us at Peninsula Orthopedic Associates or book an appointment online today if your shoulder is stiff and painful. We have offices in Dade City, Menlo Park, and Los Gatos, California.