Shoulder pain is frustrating enough, but not knowing what’s causing it makes it ten times worse. Many patients go through months of uncertainty, receiving conflicting advice about whether they have a frozen shoulder or a rotator cuff issue.
This article helps you recognise the fundamental differences between frozen shoulder vs rotator cuff injuries, explains what each feels like from a patient’s perspective, and shows when it’s time to see a physio for an accurate diagnosis.
What You’ll Learn in This Post
The key differences between frozen shoulder and rotator cuff tears
How patients describe these conditions in everyday language
Simple self-tests to distinguish stiffness from weakness
Common myths that delay treatment
When clinical assessment is preferable to imaging
Why Frozen Shoulder and Rotator Cuff Tears Get Confused
Both cause shoulder pain and restricted movement, making everyday tasks like getting dressed, lifting a kettle, or sleeping difficult. The term “frozen shoulder” can sometimes be used as a catch-all term for any shoulder pain, even when it’s clearly not.
Common misconceptions:
“All shoulder pain is either frozen shoulder or rotator cuff tear.” In truth, many other conditions exist, and pinpointing the cause requires specialist testing.
“An MRI will always give the right answer.” Imaging can be useful, but it sometimes misses small tears or even highlights changes in healthy people who aren’t experiencing any symptoms.
“Internet self-diagnosis is enough.” Differentiating these conditions often requires a hands-on assessment by a physiotherapist.
The Key Difference: Stiffness vs Weakness
Frozen shoulder is primarily a stiffness issue. The joint capsule becomes inflamed and contracted, restricting movement in all directions.
Rotator cuff tears are mainly about weakness and pain. Damage to muscles or tendons makes active lifting difficult, while passive movement often remains easier.
“When someone else tries to move your arm and it still won’t budge, that’s a classic frozen shoulder sign,” explains Paul Martin, lead shoulder physiotherapist. “In a rotator cuff tear, the arm moves passively, but often the patient struggles to do it themselves.”
How Patients Describe These Conditions
Frozen Shoulder: “Like My Shoulder Is Locked in a Vice”
Onset: “I woke up one morning and my arm was completely stuck. No injury, no warning.”
Pain quality: “A deep, constant ache that’s worse at night. I couldn’t find a position that didn’t hurt.”
Stiffness: “It feels like the joint’s wrapped in shrink-wrap. Even when my physio tries to move it, it simply won’t go.”
Daily impact: “It’s like wearing a T-shirt two sizes too small. Any movement pulls on the capsule.”
Emotional toll: “I did physiotherapy for nearly two years. It was hard, but it was the only way to get my motion back.”
Rotator Cuff Tear: “I Just Can’t Lift My Arm”
Onset: “I reached up for a box and felt a sharp pain. Since then, lifting my arm is impossible.”
Pain quality: “A dull ache at rest, but it becomes a stabbing pain if I reach overhead.”
Weakness: “My partner can lift my arm for me, but I simply can’t do it myself.”
Activity pattern: “It’s fine when my arm’s at rest, but as soon as I use it, the pain is unbearable.”
Sleep disturbance: “I can’t lie on that side. Even a slight roll wakes me in agony.”
“Some tears respond well to exercise, while others may need surgery,” notes Paul. “You can’t tell just from pain levels. Assessment of muscle strength and movement patterns is crucial.”
Key Joint Symptoms and Clinical Differences That Matter
Movement Patterns
Frozen Shoulder:
Active AND passive range severely limited
Restriction in all directions (external rotation most affected)
Feels “hard” at the end range, like hitting a wall
Rotator Cuff Tear:
Active range limited by weakness and pain
Passive range often close to normal
Certain directions (lifting overhead, out to the side) most painful
Pain Patterns
Frozen Shoulder: constant, deep ache; night pain even at rest
Rotator Cuff: activity-related sharp or stabbing pain; often eases with rest
Timeline & Phases of Frozen Shoulder
Frozen shoulder evolves through three phases over 12–24 months:
Freezing phase: increasing pain and gradual loss of movement
Frozen phase: pain stabilises, but stiffness is at its worst
Thawing phase: slow, steady return of motion
In contrast, rotator cuff tears have a more variable course. Some improve with rest and physiotherapy, others may require surgical input if conservative measures fail.
Simple Self-Tests
Passive Movement Test: Relax completely while someone lifts your arm. Much better movement suggests a rotator cuff issue.
External Rotation Test: With elbow by your side, try to turn your palm upwards. Severe restriction, even with assistance, points to frozen shoulder.
Sleep Test: Constant night pain in any position favours frozen shoulder; pain only when lying on the affected side suggests a rotator cuff tear.
When to Seek Expert Care for Shoulder Pain
If you’ve had shoulder pain and reduced movement for more than 2–3 weeks, book an assessment. A physio will:
Take your history and ask what eases or worsens symptoms
Perform targeted movement and strength tests
Advise whether imaging is necessary or whether conservative treatment is appropriate
Rule out other causes, such as neck-referred pain or other joint issues
“Early, accurate diagnosis saves months of frustration,” says Charlie Brahmbhatt, consultant physiotherapist. “I often see patients doing the wrong exercises for months because they were treating themselves for the wrong condition.”
Treatment Approaches: Why Diagnosis Shapes Therapy
Frozen Shoulder:
Manual therapy and joint mobilisation
Stretching and progressive mobility exercises
Corticosteroid injection for pain relief if needed
Recovery: slow but predictable over months
Rotator Cuff Tear:
Progressive strengthening of the rotator cuff and scapular stabilisers
Activity modification and ergonomic advice
Manual therapy to address muscle imbalances
Surgical referral only if conservative treatment fails
Red Flags: When to Seek Urgent Help
Seek immediate attention if you notice:
Rapid onset of severe weakness
Complete inability to move your arm
Uncontrolled pain despite analgesia
Signs of infection: fever, redness, warmth
Numbness or tingling down the arm
Frequently Asked Questions
What is the difference between frozen shoulder and rotator cuff tear?
The main difference is stiffness versus weakness. Frozen shoulder limits both active and passive movement. Your arm won’t move even when someone helps. Rotator cuff tears primarily limit active lifting; a helper can usually move your arm more easily.
Do I need an MRI to diagnose my shoulder problem?
Not usually. Most diagnoses are made through clinical assessment. MRI or ultrasound may be advised if conservative treatment isn’t working or if surgery is being considered.
Can frozen shoulder and rotator cuff tear occur together?
Yes. Coexisting conditions complicate the picture, which is why a thorough physio assessment is vital.
Which condition takes longer to recover from?
Frozen shoulder typically follows a 12–24-month timeline. Rotator cuff tears vary: some respond quickly to physiotherapy, while others may need longer management or surgery.
Shoulder Pain Recovery: Key Takeaways for Faster Results
Frozen shoulder and rotator cuff tears are distinct conditions requiring different treatments.
Frozen shoulder is about joint stiffness, following a predictable three-phase course.
Rotator cuff tears centre on muscle or tendon damage, with variable recovery paths.
Recognising the difference early by noting whether passive movement remains blocked guides you to the right treatment and a faster return to normal life.
If you’re unsure which condition you’re facing, our specialists are here to help. Book an assessment or get in touch to discuss whether physiotherapy could be right for you.
