Rotator Cuff Tear and Frozen Shoulder - How Are the Two Different?

Most of us do not realize how often we use our shoulders until we feel pain or cannot move it at all. Shoulder conditions lead to pain, stiffness, and reduced range of motion. Two of the most common shoulder conditions that orthopaedic surgeons treat every day are frozen shoulder and rotator cuff tear.

It's important to understand the differences between a frozen shoulder vs rotator cuff tears because they can often be mistaken for one another.

What is a Rotator Cuff Tear?

The shoulder joint is bounded by a group of muscles called the rotator cuff. These muscles work in tandem with tendons to make the shoulder joint stable so that you can move your arms easily. In other words, they are extremely crucial for the proper functioning of the shoulder joint.

A tear in the rotator cuff can happen in two ways:

• Partial Tear: In partial tear, the tendon is partially damaged.
• Complete Tear: In complete tear, the tendon is pulled off the bone completely, causing severe damage to the shoulder.

Rotator Cuff Tear Causes

Rotator cuff tear may result from an acute injury, say a fall, in adults. It can also be caused by age-related wear and tear, resulting in the degeneration of the tendon. Initially, you will experience pain in the front of your shoulder, which travels down your arm. If you indulge in activities like lifting, the pain may worsen.

Also, it may aggravate if you try sleeping on the affected side. Consequently, you may note weakness in your arm and difficulty accomplishing daily tasks like combing your hair or reaching behind your back.

Rotator Cuff Tear Symptoms

In the beginning, you may not observe the prominent rotator cuff tear symptoms except the pain while using the arm or pain during the night, which could interrupt your good night’s sleep. In case the tear is insignificant, your arm may still fully function. But when it becomes significant, you may not be able to lift your arm(s) at all. In rare cases, it may lead to a condition called shoulder arthritis.

Rotator Cuff Tear Diagnosis

At first, the doctor performs the clinical examination of the shoulder joint treatment. An X-ray is also taken into account, followed by an MRI scan. MRI is done to determine the extent of the tear and calculate the amount of retraction and fatty degeneration in the rotator cuff.

Rotator Cuff Tear Treatment

Arthroscopic tendon repair is one of the best arthroscopy treatment options available for rotator cuff tear. Several keyholes are made around the shoulder, and the surgery is performed through these keyholes with the help of a camera and other instruments. Suppose the rotator cuff is in its early stages.

In that case, the bony spur is removed from underneath the acromion to make space for the rotator cuff and reduce the amount of rubbing, which may further degrade the muscle. The treatment is called subacromial decompression. In case of an extensive tear, surgery is needed, in which sutures are employed to repair the tear.

What is a Frozen Shoulder?

Also known as adhesive capsulitis, frozen shoulder is a condition that develops when your shoulder joint is compromised. It also affects the shoulder capsule – a tissue that encircles the shoulder joint. When you start developing a frozen shoulder, the shoulder capsule becomes thick and stiff. As a result, you find moving your arm or shoulder difficult. Also, it results in the loss of synovial fluid, which helps keep the joint lubricated for smooth movement.

Frozen Shoulder Causes

Shoulders are made up of three bones (Humerus, scapula, and clavicle) to form a ball-and-socket joint. Around the shoulder joint are tissues, known as capsules, to hold up everything.

When you have a frozen shoulder, the capsule becomes too thick and hard to move. It causes extreme pain and discomfort, and it limits the movement of the shoulders. Some medical conditions like diabetes, Parkinson’s disease, heart disease, stroke, and thyroid can also be responsible for developing a frozen shoulder. In addition, prolonged stress also exposes an individual to inflammation which also can be the main cause of frozen shoulder.

Frozen Shoulder Symptoms

The firstsymptom of a frozen shoulder is excruciating pain in the shoulder. This pain limits the area of free movement of the shoulder and arms. People with this condition also experience dull pain in one shoulder while performing usual tasks. For better diagnosis, physicians suggest a frozen shoulder test to people. The pain keeps increasing if not treated. It causes discomfort and limits the movement of the shoulders. Often the pain becomes worse during the night.

The frozen shoulder gradually occurs in three stages:

• Freezing stage: You start developing more and more pain every time you move your shoulders. The pain becomes more problem at night and you feel losing your range of motion.
• Frozen stage: Although the pain is reduced, the problem gets worse and it becomes very difficult to perform regular activities. Even lifting small objects becomes challenging; therefore, it affects you both physically and mentally.
• Thawing stage:You can consider this stage as the healing phase. After all the struggle, your pain starts improving and you gain a close to normal, or sometimes, a complete return to normal situation.

Frozen Shoulder Diagnosis

Doctors perform two types of physical tests to diagnose frozen shoulders.

• Active test: In this test, patients need to move their shoulders by themselves.
• Passive test: In this test, doctors assist patients during shoulder movement to note the difference.

Sometimes, doctors also recommend an X-ray, MRI, or ultrasound for a frozen shoulder test.

Frozen Shoulder Treatment

Frozen shoulders get healed over time with a careful resting period, but, it is not smart to avoid it for long. Sometimes the condition is not improved through conservative methods; then, it is important to discuss it with your doctor and undergo surgical treatment.

Therapy for Frozen Shoulder Treatment

Therapies are often effective in these types of injuries. Certain exercises are beneficial in improving the condition but you should do it under expert guidance. In severe conditions, a therapy session needs medical intervention too.

Corticosteroid injection

To reduce pain and improve the condition, doctors inject a powerful anti-inflammatory medicine- Cortisone. It is injected directly into the shoulder to reduce inflammation and pain.

Joint distension by injecting sterile water

This process is known as Hydrodilatation. In this treatment, doctors gently inject sterile fluid into the shoulder joint which improves the condition of the capsule. The process is conducted by a radiologist who ensures the right placement of the fluid.

Surgery using thin pencil-sized tools

A thin pencil-sized surgical tool, known as an arthroscope which has a camera and light on its tip, is inserted into the shoulders. It transmits the images on the monitor. Depending on these images, further surgical actions are performed.

Physical therapy

Physical therapy or rehabilitation consists of specific exercises and stretches. Initially, your therapist assists you in this, but as your condition improves, you start doing it on your own. Regular gentle massage is also a beneficial way to ease tightness and restore mobility. This is one of the fastest and safest ways to get rid of a frozen shoulder.

Shoulder manipulation

When other treatment options do not work, doctors put you on sleep through anaesthesia and manipulate your shoulder movements. They forcibly move shoulders to losen up capsule tissue.

Non-surgical and Home Remedies for Frozen Shoulder Treatment

Although, you should not avoid frozen shoulders and better consult it with a professional doctor. But, in some cases, a few home remedies are also effective.

• Start with warming up to ensure adequate blood flow so that you do not encounter any further injury during the process. Taking a bath with warm water is recommended. You can add Epsom salt to maximize the results.
• Besides this, you should also avoid processed foods, carbonated beverages, frozen food, and alcohol.

Alternative Medicine to Treat Frozen Shoulder

Acupuncture

You can treat frozen shoulders through natural remedies like acupuncture. There are certain points (Zhongping, LI 14, and Ashi Point) around your shoulders that are targeted in the acupuncture sessions to improve blood flow and movability.

Nerve stimulation

There are also electrotherapy modalities to bring instant relief. These are Transcutaneous Electrical Nerve Stimulation (TENS) and Interferential Therapy (IFT). In this process, electrical lights are employed in the affected area to bring relief to the patient.

Who is At Risk for Developing Frozen Shoulder?

Frozen shoulder occurs mostly in adults between the ages of 40 and 60, but it can occur at any stage under certain conditions. Researches tell us that women are more prone to this condition due to menopause. Besides this, those who have gone through an injury or surgery can develop the symptoms. In addition, the following health conditions can also be a risk factor:

• Thyroid
• Breast cancer
• Lung diseases
• Cardiovascular diseases
• Heart surgery
• Polymyalgia rheumatica
• Parkinson’s disease

Frozen Shoulder vs Rotator Cuff

A frozen shoulder is often confused with the rotator cuff. However, both conditions have a significant difference. Rotator cuff patients can lift their shoulders without assistance. In contrast, with frozen shoulders, patients face difficulty in raising their shoulders by themselves.

Conclusion

A lot of times, people confuse frozen shoulder with rotator cuff tear. However, the frozen shouldersymptoms are different from rotator cuff tear. The arm’s range of motion may be limited with a rotator cuff tear, but you can still lift it yourself. In contrast, a frozen shoulder is characterized by an aching pain and majorly follows stable immobilization.

If you look at the medical statistics about frozen shoulder, you will find that women are affected by this condition more than men. Also, it is more common in people in their 50’s and 60’s. However, the condition can improve significantly with proper treatment, which includes the intake of non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen that help relieve pain.

Other treatment options like joint distension and surgery are considered if the symptoms are severe. Rotator cuff and frozen shoulder cause severe pain to the patients and limit free shoulder movement. However, they both have different treatment options. Frozen shoulder can be treated with counter medications, while surgery is the best treatment option for the rotator cuff.

Frequently Asked Questions

1. Can a torn rotator cuff be misdiagnosed as a frozen shoulder?

A proper physical frozen shoulder test is enough to perform the correct diagnosis of the disease. Although both conditions concern shoulder movement, in frozen shoulders, patients can not increase their range of motion even with external assistance.

2. Is a frozen shoulder worse than rotator cuff?

In the rotator cuff, patients experience shoulder pain, but they can perform the movement without assistance. However, patients with frozen shoulders face extreme difficulty performing regular tasks, even with help.

3. How does it feel in a partially torn rotator cuff?

In a partially torn rotator cuff, patients experience shoulder pain while lifting objects. They feel a popping sensation or clicking sound while moving their arms. The shoulder pain increases while a patient sleeps or rests.

4. How do you tell if the rotator cuff is torn or strained?

Both conditions limit the arm's free movement by causing severe pain. However, in rotator cuff tearing, the tendon completely separates from the shoulder bone, forming a hole. The tendon stretches but remains attached to the bone in a strained rotator cuff.

5. Does a torn rotator cuff hurt all the time?

A torn rotator cuff does not hurt all the time. However, people generally feel sharp pain while sleeping, performing specific arm movements, or lifting objects.

6. Can you see the frozen shoulder on MRI?

Magnetic Resonance Imaging, commonly known as MRI, is a method to diagnose tumors, torn ligaments, gallstones, etc. This diagnosis method provides an excellent way to diagnose frozen shoulders.

7. What vitamin is good for frozen shoulder?

However, physical therapy and other treatment methods are effective. But, omega-3 fatty acids and supplements like glucosamine are beneficial. Along with this, Vitamin D is good for frozen shoulders.