Why Is My Shoulder Stiff? Is It Frozen Shoulder?
Short Answer
Shoulder stiffness can be caused by frozen shoulder (adhesive capsulitis), pain-related guarding, tendon irritation, or joint inflammation. Frozen shoulder is characterized by progressive loss of movement due to capsular tightening and adhesions. Proper assessment helps determine whether stiffness is due to true capsular restriction or other contributors.
What “Shoulder Stiffness” Usually Means
People often describe stiffness as:
- “I can’t reach behind my back.”
- “I can’t lift my arm fully.”
- “It feels tight and stuck.”
- “I can’t put on a bra / reach a seatbelt.”
- “It’s worse at night.”
Stiffness can have different causes, so identifying the pattern matters.
What Is Frozen Shoulder?
Frozen shoulder (adhesive capsulitis) involves:
- Inflammation of the joint capsule
- Thickening of the capsule
- Adhesions (scar-like tightening)
- Progressive restriction of movement
Typical features include:
- Pain that may be worse at night
- Gradual increasing stiffness
- Difficulty with daily movements (reaching overhead, behind back)
- Restriction of both active AND passive range of motion
This is different from weakness-based conditions.
Frozen Shoulder vs Rotator Cuff Problems
Frozen Shoulder
- Main problem: stiffness and restricted movement
- Both active and passive motion limited
- Pain may be deep and aching
- Weakness often secondary (because movement is restricted)
Rotator Cuff Irritation or Tear
- Main problem: pain and weakness during lifting
- Passive motion often less restricted early
- Painful arc can occur
- Weakness may be more prominent than stiffness
Both conditions can coexist, which is why assessment is important.
Frozen Shoulder vs Calcific Tendinitis
Calcific tendinitis may cause:
- Sudden severe pain
- Night pain
- Pain during lifting
It can also lead to temporary stiffness from guarding.
However, true frozen shoulder involves capsular tightening and adhesions.
X-ray or ultrasound can sometimes identify calcification, while clinical testing helps clarify capsular restriction.
Why Stiffness Happens Even Without Frozen Shoulder
Stiffness may also be due to:
- Pain-related muscle guarding
- Subacromial inflammation (bursitis)
- Rotator cuff irritation
- Reduced scapular control
- Posture-related movement restriction
Some of these improve as pain reduces and movement is re-trained.
When Is Imaging Helpful?
Imaging may be considered when:
- Diagnosis is unclear
- Trauma occurred
- Weakness is significant
- Calcification is suspected
- Symptoms persist
MRI or ultrasound may help identify:
- Rotator cuff tears
- Bursitis
- Tendon degeneration
- Calcific deposits
Frozen shoulder is often diagnosed clinically, though imaging can help exclude other structural contributors.
Where Shockwave May Fit In
Shockwave therapy may be considered in selected scenarios such as:
- Calcific tendinitis contributing to pain and movement limitation
- Chronic tendon irritation alongside stiffness
Shockwave is generally used as an adjunct within a broader plan that focuses on:
- Restoring range of motion
- Improving shoulder blade control
- Gradual strengthening
- Load management
Shockwave does not replace mobility-focused rehabilitation for capsular adhesions.
Suitability depends on the diagnosis.
The Four-Layer Integrated Shoulder Model™
Our clinic uses a coordinated outpatient framework.
Layer 1 — Medical Pathology Assessment
A doctor evaluates whether stiffness reflects capsular adhesions, inflammation, tendon pathology, or mixed contributors.
Layer 2 — Imaging Clarity (Where Appropriate)
Imaging is interpreted medically to identify rotator cuff tears, calcification, or other causes.
Layer 3 — Biomechanical & Mobility Evaluation
A licensed physiotherapist assesses:
- Range of motion restriction pattern
- Capsular tightness
- Scapular control
- Rotator cuff strength
- Functional limitations
Layer 4 — Targeted Non-Invasive Medical Technology
Where suitable, modalities may complement rehabilitation planning.
Doctor and physiotherapist discuss findings face-to-face within the same clinic to align the plan.
When Should You Seek Assessment?
Consider evaluation if:
- Stiffness is progressively worsening
- You cannot reach overhead or behind your back
- Night pain persists
- Symptoms last beyond several weeks
- Function is significantly limited
Early clarification helps prevent prolonged limitation.
Conclusion
Shoulder stiffness may be caused by:
- Frozen shoulder (capsular adhesions)
- Pain-related guarding
- Rotator cuff irritation
- Calcific tendinitis
- Inflammation
Frozen shoulder is defined by progressive capsular tightening and restricted movement.
Structured assessment helps determine whether the primary issue is stiffness, tendon pathology, or a combination.
1️⃣ How do I know if I have frozen shoulder?
Frozen shoulder typically causes progressive stiffness with restriction of both active and passive movement, often with night pain.
2️⃣ Can rotator cuff problems cause stiffness?
Yes. Pain-related guarding may reduce movement, but true frozen shoulder involves capsular tightening and adhesions.
3️⃣ What is the difference between calcific tendinitis and frozen shoulder?
Calcific tendinitis involves calcium deposits in tendons and can cause severe pain, while frozen shoulder involves capsular thickening and adhesions causing progressive stiffness.
4️⃣ Do I need an MRI for frozen shoulder?
Frozen shoulder is often diagnosed clinically. Imaging may be used when the diagnosis is unclear or to assess for other contributors.
5️⃣ Can shockwave help shoulder stiffness?
Shockwave may be considered if calcification or tendon irritation is contributing. Mobility-focused rehabilitation is usually central when capsular adhesions are present.
What To Expect When I Visit The Pain Relief Clinic
A typical visit will involve our doctor first understanding your medical history, concerns and previous experience with other pain treatments.
For patients who have consulted many people but have yet to receive a clear diagnosis, selecting an affordable imaging scan might be recommended to confirm the cause of your pain..
Some patients have already done scans with other doctors for their pain condition but are still not clearly told what they suffer from.
Dr Terence Tan is happy to offer you a second opinion and recommend how best to manage your condition.
We also see patients who already have a confirmed diagnosis from specialist pain doctors, but are "stuck” because treatment options offered are not practical or acceptable.
We can help by discussing options that you might have potentially never been told of.
A common experience is when a patient has already consulted a specialist doctor for pain management and is told to consider orthopaedic surgery which they find too aggressive.
Or they may have seen doctors for their pain and were prescribed painkillers with potential side effects which made them feel uncomfortable.
Many of our patients have also first tried complementary treatments or acupuncture with traditional Chinese pain doctors.
They look for a second opinion after finding any relief experienced from other treatments to be temporary or requiring repetitive treatments, which add up to time and cost.
Especially in such situations, we emphasize using non-invasive medical technology you likely have not been told about .
This can make a big difference to your results.
Ask Dr Tan a Question about your problem
Find out how your pain can be more effectively treated.
For enquiries, Call +65 6732 2397
THE PAIN RELIEF CLINIC
You May Qualify For Cashless Scans & Treatments
We believe that access to medical services should be stress-free.
Singaporeans, permanent residents, and some international patients may be eligible for cashless services.
This can remove the need to pay cash upfront, solving a potential problem even for patients with insurance coverage.
You should be focused on getting answers and starting correct treatment, not worrying about large upfront bills.
To check your eligibility, send us a message.
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