Part of Shoulder impingement
Shoulder impingement vs frozen shoulder: how to tell them apart
Warning signs, and when to get help
Shoulder impingement vs frozen shoulder: what is actually different?
Range of movement, not pain. That is the short answer, and it is the part most comparisons skim past.
Shoulder impingement is the older name for pain around the top and outer side of the shoulder that comes on when you use the arm. The Dutch Orthopaedic Association guideline calls this group subacromial pain syndrome, defines it as all non-traumatic, usually unilateral shoulder problems that cause pain, and puts bursitis, calcium deposits, supraspinatus tendinopathy, partial cuff tears and biceps tendinitis inside it (Diercks and colleagues, 2014). Lewis (2016) gathers the same group under one over-arching term, rotator cuff related shoulder pain, which takes in subacromial pain (impingement) syndrome, rotator cuff tendinopathy and symptomatic partial and full thickness cuff tears. Your letter may say any of impingement, subacromial pain, rotator cuff tendinopathy or rotator cuff related shoulder pain, and on this site the shoulder impingement program and the rotator cuff tendinopathy program are the same shoulder under two of those names. OrthoInfo describes the complaint as pain and tenderness at the front or side of the shoulder, pain and stiffness when you lift the arm and reach above your head, pain again on bringing the arm down, and pain that is typically at its worst at night.
Frozen shoulder is a problem of the lining of the joint. OrthoInfo describes the shoulder capsule thickening and becoming stiff and tight, with bands of tissue forming and less fluid inside the joint, so that over time the shoulder becomes very hard to move. One sentence from the same source does more work than any list of symptoms: people with frozen shoulder have limited range of motion both actively and passively. The arm stops in the same place whether you lift it yourself or a clinician lifts it for you.
Adhesive capsulitis is the other name on the letters, and it is on the way out. Brindisino and colleagues (2024) argue that it is inaccurate, because the adhesions it names are not consistently found, and they recommend keeping the plain term frozen shoulder.
So the real comparison is not painful against painless. Both hurt, both are often worse in bed, and OrthoInfo uses the word stiffness in its account of a cuff problem as well. What differs is whether the movement has gone.
What you can notice yourself, and what only an examination settles
There are a few things worth paying attention to before an appointment, and none of them is a test you run on yourself.
The first is what the end of the movement feels like. Pain that stops a lift usually gives a little: the arm goes further when you are warm, relaxed or taking some of its weight with the other hand. A capsule that has tightened gives a firm stop in much the same place every time, and being warm or relaxed does not move it.
The second is direction. A sore cuff tends to complain about one band of the lift and about work above shoulder height. A stiff shoulder loses movements that have nothing to do with lifting, including turning the forearm outward with the elbow tucked against your side. That one matters most in frozen shoulder: Date and Rahman (2020) call passive external rotation with the arm by the side the best way to assess the loss, and describe range as globally reduced both passively and actively.
The third is the order things happened in. Pain first with stiffness creeping in later is a different story from a shoulder that got tight and sore across the same few weeks, and it is one of the few pieces of evidence only you have.
What an examination adds is the comparison you cannot make on yourself. OrthoInfo describes the clinician moving the shoulder carefully in all directions and comparing what you can do with what they can do for you, pressing around the shoulder for a tender area and testing the strength of the arm. Date and Rahman note that in frozen shoulder those findings are often unremarkable, with no point tenderness and normal rotator cuff strength, which is itself informative. No single move settles it either way: the Dutch guideline says the diagnosis of subacromial pain syndrome can only be made using a combination of clinical tests, and that no single test is accurate enough on its own.
Please do not have anyone force your arm to see what happens, and do not grade your shoulder by how hard you can push it. A shoulder stirred up that way is sorer for days and no better understood.
Frozen shoulder or a rotator cuff problem?
More people ask this one than the question in the title of this page, and most of the time the two are the same question in different words. Rotator cuff problems and impingement belong to one group, as the Dutch guideline's definition above shows, so frozen shoulder against the rotator cuff is frozen shoulder against subacromial pain.
Four things separate them in practice. The trouble sits in a different place: a tendon that has become painful under load, against a capsule that has shortened around the joint. Pressing around a sore cuff usually finds a tender spot, and frozen shoulder often has none to find. Strength goes a different way too, because OrthoInfo lists loss of strength and motion as a cuff problem progresses, while frozen shoulder typically tests with normal cuff strength (Date and Rahman, 2020). Then there is the available range, which is the one that decides most cases.
A torn cuff is the exception that changes the route rather than the program. Weakness that arrived with a fall or a sudden pull belongs in front of a clinician within a day, not in front of a comparison page, and the exact wording for that is in the warning list at the foot of this page. For the longer version of the tear question, impingement, bursitis or a rotator cuff tear is the page that owns it.
Can shoulder impingement lead to frozen shoulder?
Nobody can show you that it does. Pages that state it outright are going further than the evidence goes, and it is the question most worth being careful with, because the person asking it is usually frightened of the answer.
Here is what the literature does say. Frozen shoulder is often split into primary, with no identifiable cause, and secondary, with a hypothesized cause, and the causes proposed inside the joint include tendonitis of the rotator cuff or biceps (Brindisino and colleagues, 2024). Read the word hypothesized carefully, because it is carrying that sentence. The same authors consider the split unhelpful and report that it lowers agreement between clinicians trying to apply it, while the ISAKOS upper extremity council recommends keeping the term for primary cases only. There is no settled position here to hand you.
Immobility has better support as a cause than any diagnosis does. OrthoInfo says frozen shoulder can follow a spell of immobilization from surgery, a fracture or another injury, and Date and Rahman list trauma, previous shoulder surgery and prolonged immobilization among secondary causes, alongside diabetes and thyroid disease.
That has a practical edge for anyone sitting with a sore shoulder. An arm that quietly stops being used is the one with something to lose, which is part of why treatment for a painful cuff is not strengthening alone: OrthoInfo says a physical therapist will focus on restoring motion to your shoulder, and that stretching exercises to improve motion are very helpful. If your shoulder has become stiffer rather than simply more painful over a few weeks, that is a reason to be looked at again, not a reason to work harder at the same exercises.
How long does each one take?
Different sources, different conditions, and the figures do not swap over. It is the first thing most people want to know, and the honest answer is not a comforting one.
For shoulder pain of the impingement type there is no clean figure to give you. The NHS says shoulder impingement usually gets better in a few weeks or months, and on its wider shoulder pain page says recovery from shoulder pain can take 6 months or longer. OrthoInfo, writing about treatment without an operation, says many patients improve gradually and return to function, although complete recovery may take several weeks to months. UK shoulder surgeons work in blocks instead of totals: about 6 weeks of physiotherapy, and a further 6 weeks if the first block is helping (Kulkarni and colleagues, 2015). The same OrthoInfo page does carry a tighter figure, 2 to 4 months for complete relief of pain and up to 1 year, but it gives that for rehabilitation after surgery, so it is not the timeline for a shoulder being treated without one.
Frozen shoulder is measured in a different unit. OrthoInfo gives the painful freezing stage 6 weeks to 9 months, the stiff frozen stage 4 to 6 months, and the thawing stage 6 months to 2 years for a complete return to normal or close to normal movement and strength, and says full recovery may take up to 3 years. How long frozen shoulder lasts goes through the long follow-up studies, and the three stages covers how to work out where you are, which is more useful than a total.
A range is not a prediction. Nothing in those numbers tells you whether your own freezing stage will be six weeks or most of a year. And a long timeline is not a reason to wait it out alone, because what you do in the meantime decides how usable the arm is while it lasts.
Do the exercises differ?
Yes, in emphasis, and that is the main practical reason the label is worth settling at all.
For subacromial pain the Dutch guideline wants exercise at low intensity and high frequency, kept within the pain threshold, combining eccentric work for the cuff with stabilization training for the shoulder blade (Diercks and colleagues, 2014). Load and control, in short. The shoulder impingement program and the rotator cuff tendinopathy program are built that way and carry the dose.
For frozen shoulder the emphasis shifts to movement itself. OrthoInfo calls physical therapy with a focus on shoulder flexibility the primary treatment recommendation, and says therapy includes stretching or range of motion exercises for the shoulder. How firm the stretch should be depends on how irritable the shoulder is that week, which is how frozen shoulder exercises by stage is organized. Your physio, or physical therapist, will set that level with you.
The two programs overlap more than people expect. Pendulum swings and the cross body shoulder stretch appear in both of them on this site. Injections, and the procedures a specialist may raise for a shoulder that stays stiff after months of good care, are covered in injections and other treatments rather than here.
Neither program is meant for the weeks after a manipulation under anesthesia or a capsular release, or for a shoulder that stiffened after a fracture or an operation. In those cases, follow the plan your surgeon and physio give you, and the warning signs that go with those weeks are listed in full on the frozen shoulder program.
The third possibility nobody mentions
There is a third common explanation for a stiff, painful shoulder, and it is arthritis in the joint itself.
OrthoInfo describes shoulder arthritis as pain that gets worse with activity and over time, with stiffness that can make it difficult to lift the arm, and limited range of motion as a common symptom. A grinding, clicking or snapping sound as the shoulder moves, which clinicians call crepitus, belongs to that picture more than to the other two. The NHS puts long-lasting pain and stiffness against both frozen shoulder and arthritis in the same row of its causes table. You are not going to separate those two from an armchair.
An X-ray does have a job here, in the hands of whoever orders it. OrthoInfo says X-rays are used in a stiff shoulder to rule out other causes such as arthritis, and that an arthritic shoulder shows a narrowed joint space and bone changes, which helps tell the forms of arthritis apart. The same source notes that some people have arthritis on an X-ray with few symptoms coming from it, so a film is read next to an examination and never instead of one. Whether you need one is a decision for the clinician who sees you, and do you need a scan for shoulder impingement goes through what a scan can and cannot settle.
One more cause is less common and much louder. A calcium deposit in a cuff tendon can produce an episode of shoulder pain severe enough that UK shoulder surgeons say it often mimics the pain of a malignancy (Kulkarni and colleagues, 2015), and a plain radiograph can show the deposit (Date and Rahman, 2020). That is the subject of our calcific tendinitis page. This site has no shoulder arthritis page yet, so for that one the route is your own clinician.
What to bring to an appointment
An accurate history beats a label, and most of it is yours to collect. Ten minutes with the notes app on your phone will do more for the appointment than another evening of reading.
- When it started, and whether anything started it: a fall, a pull, a new job, or a spell in a sling.
- Which came first, the pain or the loss of movement, and roughly how many weeks apart.
- Which movements have gone, including turning the arm outward with the elbow at your side, and whether the limit feels like pain or like a block.
- What the nights are like, and which positions you can and cannot lie in.
- Whether you have diabetes or a thyroid condition, both of which OrthoInfo links to frozen shoulder. Frozen shoulder and diabetes goes through why that changes things.
- What you need the arm back for, in your own words, because that is what the program gets built around.
Two of our symptom pages make good preparation. Shoulder pain when lifting your arm maps where in the lift the pain sits, and shoulder pain at night covers the sleep side for both conditions. If the nights are the worst part of a sore cuff, sleeping with shoulder impingement takes the positions further, and the rest of the shoulder pages cover the neighboring problems.
When a stiff or painful shoulder needs to be seen sooner
The NHS advises seeing a GP if shoulder pain is getting worse or has not improved after 2 weeks, or if it is very difficult to move your arm or shoulder. Both conditions on this page meet that description often enough, and neither is helped by spending six months deciding which one it is.
Some signs do not wait for the question this page answers. An injury the arm has been weak since, sudden severe pain or an arm you cannot lift at all, a hot and swollen shoulder with a fever, chest pain or tightness spreading to the arm, neck or jaw, a hand that turns cold, pale or blue, and numbness or pins and needles that will not go away all need attention sooner than an ordinary appointment. The list below gives each sign in full, with how soon to act on it, and some of them need emergency services straight away.
Related exercise programs
Warning signs
Get emergency help now
- Chest pain or tightness, which may spread to your arm, neck or jaw, or shoulder or arm pain that comes with shortness of breath, sweating or feeling sick. This can be a heart attack. Call emergency services straight away.
- The shoulder is hot, red and swollen, or you have a fever or feel unwell. This can be a joint infection, which needs treatment quickly. Go to an emergency department the same day, and call emergency services if you feel very unwell.
- The shoulder feels as if it has slipped out of place, looks a different shape or suddenly locks so you cannot move the arm, or the pain is severe after a fall or an injury. Go to an emergency department straight away, without driving yourself, and do not try to put the shoulder back in yourself.
- Your arm, hand or fingers turn cold, pale, blue or gray compared with the other side. Call emergency services or go to an emergency department straight away, and do not drive yourself. The blood supply to the arm may be blocked.
Get help today
- Sudden, very bad shoulder pain, or you suddenly cannot lift or move your arm at all. Get medical help the same day.
- The pain started after a fall, a pull or another injury, especially if the arm has been weak since, for example you cannot lift it out to the side or hold it up. This can be a broken bone or a torn tendon. Get medical advice the same day, and say how it happened and that the arm has been weak since, because UK shoulder surgeons advise urgent referral for a rotator cuff tear caused by an injury.
- Pins and needles or numbness in the arm that does not go away, no feeling in part of the arm, or weakness that is getting worse. Get medical advice the same day. For pain spreading down the arm from your neck, ask for an urgent appointment with your doctor. If one side of your face or body suddenly goes numb or weak, or your speech becomes slurred or muddled, call emergency services, even if it goes away.
- Severe pain in both shoulders that has come on recently. Get medical advice the same day.
- You are over 50 and have aching and stiffness in both shoulders, often in the neck or hips too, that is worst in the morning and lasts more than 45 minutes after you get up. This can be an inflammatory condition (polymyalgia rheumatica) rather than impingement or frozen shoulder. If you also get a new headache, pain or tenderness at your temples or on your scalp, or jaw pain when you eat or talk, get medical advice the same day, and if your vision changes, call emergency services. Even without those extra signs, see your doctor within a few days about the aching and stiffness.
- Pain at night or at rest that is constant, that no rest or change of position eases at all, and that keeps getting worse. If you are being treated for cancer now, contact your cancer team the same day.
Book an appointment
- New shoulder pain and you have had cancer, now or in the past, or you are losing weight without trying. See your doctor within a day or two and mention it.
- Pain at night or at rest that is constant, that no rest or change of position eases at all, and that keeps getting worse. If you have had cancer, now or in the past, or are losing weight without trying, see your doctor sooner, within a day or two, and mention it. This applies even if the pain is not getting worse.
- Night pain is common with this condition, but get checked within a few days if the pain is constant, no rest or change of position eases it at all, and it keeps getting worse.
Common questions
Is frozen shoulder worse than shoulder impingement?
Neither one is the bad one to have, and the comparison people are really making is about time and movement. Frozen shoulder usually costs more of both: OrthoInfo gives its stages 6 weeks to 9 months, then 4 to 6 months, then 6 months to 2 years for a complete return to normal or near normal movement and strength, and says full recovery may take up to 3 years. Impingement is not measured that way: the NHS says it usually gets better in a few weeks or months, and UK shoulder surgeons work in blocks of about 6 weeks of physiotherapy, with a further 6 if the first block is helping (Kulkarni and colleagues, 2015). A painful cuff also usually leaves you more movement to work with from the start, which matters for dressing, driving and sleeping. Set against that, a frozen shoulder is usually a condition that settles rather than one that keeps being provoked, so longer is not the same as worse in every way that counts.
Is frozen shoulder the same as impingement?
No, although the names around both are confusing enough to make it look that way. Impingement, subacromial pain syndrome and rotator cuff tendinopathy describe one group: the Dutch Orthopaedic Association guideline defines subacromial pain syndrome as all non-traumatic, usually unilateral shoulder problems causing pain, and puts bursitis, calcium deposits, supraspinatus tendinopathy, partial cuff tears and biceps tendinitis inside it (Diercks and colleagues, 2014). Frozen shoulder, still often written as adhesive capsulitis, is a problem of the joint capsule itself and sits outside that group. The place they genuinely blur is a cuff problem that has lost movement after months of guarding the arm, which is one of the things an examination is for.
Can you get shoulder impingement after a frozen shoulder?
We cannot answer that from the research we can read, and it is better to say so than to guess. The classification debate runs the other way round, listing tendonitis of the cuff or biceps among the hypothesized causes of a secondary frozen shoulder, and even that split is contested (Brindisino and colleagues, 2024). What is worth acting on is simpler. A shoulder that starts hurting on reaching again once a frozen shoulder has settled has more than one possible explanation, including a frozen shoulder that has not finished, so that is a reassessment rather than a new label you give yourself.
Can you have shoulder impingement and frozen shoulder at the same time?
Yes, and that overlap is part of why the labels are argued over. Secondary frozen shoulder exists as a category precisely because a stiff capsule sometimes turns up alongside another shoulder problem, with cuff and biceps tendonitis among the causes proposed for it, though the authors who reviewed that classification found the primary and secondary split reduced agreement between clinicians rather than improving it (Brindisino and colleagues, 2024). In practice the stiffness tends to set the plan while it is there, because range has to exist before the arm can be loaded through it, and the frozen shoulder guidance puts flexibility work at the center (OrthoInfo). That is a reason to be assessed rather than to run two programs at once.
Frozen shoulder vs rotator cuff tear: what is the difference?
A tear is damage in the tendon, and frozen shoulder is tightening of the capsule, so the thing that separates them is usually weakness against stiffness. A torn cuff can leave the arm able to move but unable to hold or lift, and a tear that happened in a moment, during a fall or a sudden pull, is the version that changes what happens next. Frozen shoulder takes the movement away in every direction instead, and Date and Rahman (2020) note that examination in frozen shoulder often finds no tender spot and normal rotator cuff strength. If a tear is what you are weighing up, impingement, bursitis or a rotator cuff tear is the page for it, and the warning sign about an injury the arm has been weak since is on the list at the foot of this page.
References
- American Academy of Orthopaedic Surgeons. Frozen shoulder. OrthoInfo. https://www.orthoinfo.org/en/diseases--conditions/frozen-shoulder/
- American Academy of Orthopaedic Surgeons. Shoulder impingement/rotator cuff tendinitis. OrthoInfo. https://www.orthoinfo.org/en/diseases--conditions/shoulder-impingementrotator-cuff-tendinitis/
- American Academy of Orthopaedic Surgeons. Arthritis of the shoulder. OrthoInfo. https://www.orthoinfo.org/en/diseases--conditions/arthritis-of-the-shoulder/
- NHS. Shoulder pain. Page last reviewed 22 May 2023. https://www.nhs.uk/symptoms/shoulder-pain/
- NHS. Shoulder impingement. Page last reviewed 26 November 2024. https://www.nhs.uk/conditions/shoulder-impingement-syndrome/
- Diercks R, Bron C, Dorrestijn O, et al. Guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the Dutch Orthopaedic Association. Acta Orthopaedica. 2014;85(3):314-322. https://doi.org/10.3109/17453674.2014.920991
- Lewis J. Rotator cuff related shoulder pain: assessment, management and uncertainties. Manual Therapy. 2016;23:57-68. https://doi.org/10.1016/j.math.2016.03.009
- Kulkarni R, Gibson J, Brownson P, Thomas M, Rangan A, Carr AJ, Rees JL. Subacromial shoulder pain. BESS/BOA Patient Care Pathways. Shoulder and Elbow. 2015;7(2):135-143. https://doi.org/10.1177/1758573215576456
- Brindisino F, Turgut E, Struyf F. Frozen shoulder: exploration of terminology and classification. Frontiers in Rehabilitation Sciences. 2024;5:1498263. https://doi.org/10.3389/fresc.2024.1498263
- Date A, Rahman L. Frozen shoulder: overview of clinical presentation and review of the current evidence base for management strategies. Future Science OA. 2020;6(10):FSO647. https://doi.org/10.2144/fsoa-2020-0145
Written and checked by the PocketPhysio editorial team. Last updated 2026-10-18.
This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.