Persistent shoulder pain and restricted movement are often attributed to frozen shoulder, but medical experts warn that not every stiff or aching shoulder is caused by this condition. True frozen shoulder, medically known as adhesive capsulitis, affects approximately 2 to 5 per cent of the general population. Since shoulder pain is considerably more common, some people diagnosed with frozen shoulder may have other underlying conditions that require a different approach to treatment. Accurate assessment is therefore important to identify the source of the discomfort and determine the most appropriate care. Dr Naman Wahal, Senior Consultant and Unit Head of Orthopaedics at Fortis Escorts in New Delhi and Director of StepUp Joints, New Delhi, highlighted the distinction between frozen shoulder and other causes of stiffness in an interview with HT Lifestyle.

The key concern is that the term frozen shoulder is sometimes used as a general description of restricted shoulder movement without a detailed examination. However, stiffness is a symptom rather than a diagnosis, and several conditions affecting the shoulder joint, surrounding tendons or other structures can produce similar complaints. Frozen shoulder, or adhesive capsulitis, develops when the capsule surrounding the shoulder joint becomes inflamed and thickened, restricting movement. People with the condition typically experience pain and progressive stiffness that can make routine activities difficult, including reaching overhead, dressing or moving the arm behind the back. The restriction can affect both active movement, when a person moves the arm independently, and passive movement, when another person or an examiner moves the relaxed arm.

Assessing these movement patterns can help clinicians distinguish frozen shoulder from other shoulder disorders. Several other conditions can cause persistent shoulder pain or limited movement. Rotator cuff disorders, including tendon inflammation and tears, can cause pain when lifting or rotating the arm. These problems may produce weakness and difficulty performing overhead activities, although the pattern of movement restriction can differ from that seen in adhesive capsulitis. Shoulder impingement-related symptoms and inflammation of the structures surrounding the joint can also cause discomfort during particular movements. Arthritis may lead to pain, stiffness and reduced function, particularly when the joint itself is affected. Each condition has different characteristics, making an individual assessment essential.

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The distinction between pain-related restriction and true joint stiffness is particularly important during a clinical examination. A person may avoid moving the shoulder because movement hurts, even when the joint retains a relatively greater range of motion than someone with adhesive capsulitis. In other cases, the shoulder capsule or joint structures may physically restrict movement. Comparing active and passive range of motion, assessing strength and examining where the pain occurs can help a healthcare professional identify the likely cause. The patient's history, including how symptoms began, how long they have persisted and whether there was an injury, can also provide useful diagnostic information.

Persistent shoulder symptoms should not automatically be dismissed as frozen shoulder, especially when the pain is worsening, follows an injury or is accompanied by significant weakness. A medical assessment can help determine whether further investigations, such as imaging, are appropriate. Treatment depends on the underlying cause and may involve activity modification, physiotherapy, pain management or other interventions recommended by a qualified clinician. Exercises that are suitable for one shoulder condition may not be appropriate for another, so a treatment plan should be based on the diagnosis rather than the symptom alone. Shoulder pain can also occasionally be associated with problems outside the joint. Pain referred from the neck, for example, may extend into the shoulder or arm and can occur alongside tingling, numbness or other neurological symptoms.

In some cases, shoulder or arm discomfort accompanied by chest pain, breathlessness, sweating or nausea may indicate a medical emergency rather than an orthopaedic problem. Such symptoms require urgent medical attention. Recognising these warning signs helps prevent potentially serious conditions from being overlooked. The central message is that a stiff, painful shoulder does not necessarily mean frozen shoulder. Although adhesive capsulitis is a recognised cause of persistent pain and restricted movement, rotator cuff problems, arthritis, other joint conditions and referred pain can produce overlapping symptoms. Identifying the underlying cause through a proper clinical assessment is essential for choosing appropriate treatment and avoiding unnecessary delays in care. People experiencing persistent or progressively worsening shoulder pain should seek medical advice rather than relying on a general label or attempting treatment without understanding what is causing the problem.

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