Unraveling the Difference Between Frozen Shoulder and Impingement

Understanding Shoulder Conditions

When it comes to shoulder conditions, understanding the differences between various potential issues is crucial for effective treatment. Two common conditions you might hear about include frozen shoulder and shoulder impingement. Both can cause significant discomfort, but they are distinct conditions with different causes, symptoms, and treatment approaches.

Differentiating Frozen Shoulder and Impingement

Frozen shoulder, also known as adhesive capsulitis, is is an inflammatory condition in which the body develops excessive scar tissue and inflammation in the shoulder joint, causing by pain and stiffness in the shoulder joint. This condition can cause significant pain, even when you're not moving your arm, and can occur unexpectedly. If you're dealing with a frozen shoulder, you might find our articles on how to sleep with a frozen shoulder and frozen shoulder exercises helpful.

On the other hand, shoulder impingement is a condition affecting the rotator cuff tendon. It's caused by the tendon swelling, thickening, or tearing, which can result in it rubbing against or catching in the acromion, located at the top edge of the shoulder blade. Unlike frozen shoulder, impingement doesn't cause stiffness but can cause pain that increases with movement, either suddenly or gradually.

Causes and Risk Factors

While both conditions can cause shoulder pain, they do have different risk factors and causes.

While the precise causes of adhesive capsulitis can vary, it is frequently associated with injury and/or surgery, prolonged immobilization, chronic overuse, as well as autoimmune responses and systemic conditions, such as diabetes or thyroid disorders (NCBI). Frozen shoulder is more common in women between the ages of 40 and 60, particularly in those who've had to keep their shoulder immobile for extended periods, such as after a surgery or a stroke. Individuals with reduced shoulder movement due to inflammation from conditions like rotator cuff tendinitis or bursitis are also at a higher risk (MayoClinic).

Meanwhile, shoulder impingement is the most common cause of shoulder pain, accounting for 44% to 65% of all shoulder complaints (NCBI). It's caused by a swollen, thickened, or torn rotator cuff tendon that rubs against or catches in the acromion. Shoulder imp9ngeknt are often caused by acute injury, repetitive stress injury, and degradation of the shoulder joint with aging.

Understanding the differences between frozen shoulder and impingement is essential in managing your symptoms and finding the most effective treatment. If you're looking for more information about adhesive capsulitis treatment, we have resources available to help you navigate your options.

Symptoms and Diagnosis

When dealing with shoulder pain, it can be challenging to identify the precise condition causing your discomfort. Both frozen shoulder and impingement have overlapping symptoms, but there are subtle differences that can aid in diagnosis.

Recognizing Adhesive Capsulitis Symptoms

Frozen shoulder, scientifically known as adhesive capsulitis, is a condition characterized by progressive pain and stiffness in the shoulder joint. This pain and stiffness gradually worsen over time, often disrupting sleep, and then improve.

This condition typically unfolds in three stages: the freezing stage, the frozen stage, and the thawing stage. The freezing stage is marked by a gradual increase in pain and stiffness leading to decreased movement. The frozen stage sees persistent stiffness, and can last from 4 to 12 months. Finally, the thawing stage, where movement gradually improves.

The onset of a frozen shoulder is usually slow and worsens at night, disrupting sleep. For more information on how to manage your sleep with a frozen shoulder, see our article how to sleep with a frozen shoulder.

Diagnosing Shoulder Impingement

On the other hand, shoulder impingement symptoms can start suddenly or gradually. Shoulder impingement is caused by a swollen, thickened, or torn rotator cuff tendon rubbing against or catching in the acromion, located at the top edge of the shoulder blade. While the pain increases with movement, it does not cause stiffness, distinguishing it from a frozen shoulder.

Diagnosis of shoulder impingement involves a medical history review, symptom assessment, mobility evaluation, and possibly x-rays or an MRI. Examination of the neck may also be done to rule out a pinched nerve.

Understanding the difference between frozen shoulder and impingement is the first step towards effective treatment.

Treatment Options

When it comes to the treatment of shoulder conditions like frozen shoulder and impingement, both nonsurgical and surgical options are available. The choice largely depends on the severity of your condition, your overall health, and your personal preferences.

Nonsurgical Interventions

For both shoulder impingement and adhesive capsulitis (frozen shoulder), nonsurgical treatments are typically the first line of defense. These treatments aim to manage pain, reduce inflammation, and restore range of motion.

According to the NHS, nonsurgical treatments for shoulder impingement include shoulder exercises, physiotherapist-diagnosed exercises to improve shoulder posture and muscle strength, and steroid injections for pain relief. While steroid injections can provide temporary relief, it's crucial to continue shoulder exercises for long-term improvement. More than two injections are generally not recommended to avoid potential long-term tendon damage.

For frozen shoulder, nonsurgical treatment typically involves over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen to relieve pain and inflammation, physical therapy, and in severe cases, corticosteroid injections. Exercises are particularly useful in improving range of motion and can be done at home or under the supervision of a physiotherapist. You can find a variety of targeted frozen shoulder exercises on our website.

Seek RELIEF®:

Both adhesive capsulitis and shoulder impingement syndrome are conditions that significantly impair shoulder mobility and function. Both conditions can be linked to abnormalities in the fascia, a connective tissue that surrounds and interconnects muscles, tendons, nerves, and joints.

In adhesive capsulitis, inflammation of the lining of the shoulder (the synovium) occurs. This inflammation can extend to the surrounding fascia, causing it to become thickened and stiff. As the condition progresses, chronic inflammation can lead to scar tissues, where excess collagen is deposited in the surrounding fascia, which add pressure on the joint and contribute to pain.^1,2

Similarly, shoulder impingement involves the compression of the rotator cuff tendons under the acromion, frequently exacerbated by fascial tightness and inflammation that restricts normal shoulder mechanics.³

The RELIEF® procedure is a scientifically-backed solution that combines ultrasound guidance and hydrodissection technique that may be beneficial for both conditions. By targeting damaged and tight fascia surrounding the shoulder joint, RELIEF® may help reduce inflammation and break down fascial adhesions, thereby restoring normal tissue elasticity and mobility. This can significantly alleviate pain and improve the range of motion in patients with adhesive capsulitis.

For those with shoulder impingement, RELIEF® can help by reducing fascial restrictions and improving the glide and movement of tendons and muscles around the shoulder, thus minimizing impingement and associated pain.^4,5,6

Surgical Procedures

If nonsurgical treatments do not provide relief, your healthcare professional may recommend surgical interventions. For shoulder impingement, surgery like subacromial decompression can be considered. This procedure involves widening the space around the rotator cuff tendon to prevent it from rubbing or catching on nearby structures. The operation is usually performed through keyhole surgery (arthroscopy) under general anaesthetic, with most individuals able to resume normal shoulder use after a few weeks (NHS).

In the case of frozen shoulder, surgical options may include manipulation under anesthesia and arthroscopic capsular release to loosen the joint capsule for improved movement. However, surgery is typically the last resort and is reserved for severe cases when all other treatment options have proven ineffective. Check out our article on frozen shoulder surgery for more detailed information fo these procedures.

Ultimately, the best course of treatment for you will depend on the specifics of your condition and your overall health. It's important to have open discussions with your healthcare provider to understand your options and make an informed decision. Keep in mind that regardless of the treatment method, recovery will take time and patience.

After seeking treatment for conditions such as frozen shoulder or impingement, the focus then shifts to recovery and prevention of recurrence. This involves a series of rehabilitation exercises and lifestyle changes.

Rehabilitation Exercises

To aid in the recovery process for both frozen shoulder and impingement, range-of-motion exercises are often recommended. These exercises are designed to restore flexibility and strength to your shoulder, helping to improve movement and reduce pain. Examples of these exercises can be found in our article on frozen shoulder exercises.

In addition to these exercises, physical therapy may also be beneficial. A physical therapist can provide you with a personalized exercise routine to help restore function to your shoulder. If you're experiencing discomfort at night, check out our guide on how to sleep with a frozen shoulder for tips on finding a comfortable sleeping position.

Preventing Recurrence

Recurrence of these conditions, particularly frozen shoulder, is unusual, but it can develop in the other shoulder within five years. To help prevent recurrence, it's important to maintain regular movement of your shoulder, especially during recovery from an injury or surgery.

Regularly performing the exercises recommended by your physical therapist can help to keep your shoulder flexible and strong. It's also important to maintain a healthy lifestyle, including a balanced diet and regular exercise. In some cases, your doctor may recommend anti-inflammatory medications or corticosteroids to help manage inflammation and prevent recurrence.

If you're at a higher risk for developing frozen shoulder, such as being a woman between the ages of 40 and 60 or having a medical condition that restricts shoulder movement, it's especially important to take preventive measures. For more tips on preventing frozen shoulder, check out our article on how to prevent frozen shoulder.

By following these guidelines and working closely with your healthcare provider, you can effectively manage your shoulder condition and prevent future issues.

For more information on how RELIEF® can help with adhesive capsulitis or shoulder impingement, without the need for steroids, surgery, anesthesia, or post-procedure immobilization, contact us today to schedule a free consultation.