Shoulder arthritis and frozen shoulder

«I can reach less and less with my arm and it hurts even when I keep still»

Progressive stiffness and constant pain that already limits daily life. Two different problems with one shared symptom, and why telling them apart matters.

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Treated by Dr. Ricardo Aveledo, shoulder subspecialist certified by the Royal College of Surgeons. Consultation and surgery in Tenerife · Hospital Quirónsalud View CV

Do any of these sound familiar?

If two or three sound familiar, this fits the picture.

Progressive loss of range: you can reach less and less
Difficulty fastening clothes behind you or reaching a back pocket
Pain that no longer comes only on movement, but at rest too
Marked stiffness on waking
Creaking or grating inside the joint (more typical of arthritis)
The shoulder stays stiff even when someone else tries to move it (more typical of frozen shoulder)

Worth having it assessed soon if you also notice

Loss of movement setting in over a few weeks with no preceding injury.
Shoulder stiffness after surgery or prolonged immobilisation.
Diabetes or a thyroid problem alongside progressive stiffness: these are known risk factors for frozen shoulder.

The glenohumeral joint is where the humeral head sits against the glenoid. Cartilage separates the two surfaces, and it is what wears away in arthritis.

Two different causes, one shared symptom: stiffness

Shoulder arthritis and frozen shoulder (adhesive capsulitis) bring patients to the same sentence: I can reach less and less and it hurts more. But something very different is happening inside in each case, and confusing them leads to the wrong treatment.

Shoulder arthritis. The cartilage covering the humeral head and the glenoid wears away. Without that cushion, bone rubs on bone: mechanical pain that worsens with use, creaking, and a progressive loss of range. It is a slow process, over years, and it does not reverse.

Frozen shoulder. The cartilage is intact. What happens is that the joint capsule — the fibrous envelope surrounding the joint — becomes inflamed and contracts, shrinking around the shoulder. The restriction is far more severe and, unlike arthritis, affects active and passive movement equally: neither you nor anyone else can move that shoulder past a certain point. It usually appears without an obvious cause, and is commonest between 40 and 60, in women, and in people with diabetes or thyroid problems.

The three phases of frozen shoulder

Understanding which phase you are in explains why treatment changes over time:

Painful phase (2 to 9 months). Pain dominates, even at rest and at night. Movement starts to be lost. Forcing stretches here is counterproductive: the priority is controlling pain and inflammation, and this is where injection makes most sense.

Stiff phase (4 to 12 months). Pain eases somewhat but the shoulder is frankly locked. This is the phase of patient, sustained stretching.

Thawing phase (5 to 24 months). Movement gradually returns. Rehabilitation accompanies and accelerates this process.

When a replacement is considered

In arthritis, the decision is not made by the X-ray but by the patient’s life. There are badly deteriorated X-rays in people who barely complain, and moderate wear that proves disabling. What tips the balance is sustained night pain, loss of independence in basic things — dressing, washing, driving — and having exhausted the conservative options.

At that point there are two routes. If the rotator cuff is intact, an anatomical replacement reproduces the original joint. If the cuff is massively and irreparably torn, that replacement would fail, and a reverse replacement is used instead, changing the geometry of the shoulder so the deltoid does the work.

How the diagnosis is confirmed

01
Active and passive movement

This is the key to telling the two apart. In frozen shoulder the restriction is the same whether you move it or the doctor does; in arthritis there is usually more passive range.
02
X-ray

Shows cartilage wear, narrowing of the joint space and osteophytes. In pure frozen shoulder the X-ray is normal, and that is information too.
03
MRI or blood tests

MRI rules out associated cuff pathology. Where frozen shoulder is suspected, checking blood glucose and thyroid function is considered, given the known association.

What can be done, and in what order

Surgery is not the starting point. It is proposed when it beats not operating, and the reasoning is explained.

First option

Treatment without surgery

This is the main treatment for frozen shoulder and the first line in arthritis. It requires persistence: results here are measured in months, not weeks.

When: Always in frozen shoulder, which resolves without surgery in most cases. In arthritis, while the pain is tolerable and function acceptable.

What it involves

Physiotherapy with progressive capsular stretching, sustained over time
Ultrasound-guided intra-articular injection, particularly useful in the painful phase of frozen shoulder so stretching can begin
Scheduled pain relief to allow sleep and tolerate rehabilitation
Control of diabetes and thyroid function where these are involved

If needed

Surgery

Two very different scenarios: releasing a contracted capsule, or replacing a worn joint.

When: Frozen shoulder that does not settle after many months of rehabilitation, or advanced arthritis with pain that is already affecting sleep and daily life.

What it involves

Arthroscopic capsular release in frozen shoulder that does not respond to prolonged conservative treatment
Anatomical shoulder replacement in advanced arthritis with an intact rotator cuff
Reverse replacement where arthritis is associated with a massive irreparable cuff tear
Prior planning with imaging to choose the type and size of implant

How long will this take?

These timings correspond to a shoulder replacement. Capsular release for frozen shoulder recovers faster but demands very intensive rehabilitation from day one so as not to lose the ground gained. These are approximate ranges.

Wk 0–4

Wk 4–12

Wk 12–24

Wk 24–52

Protection First 4 weeks

Sling and assisted passive movement. The aim is to protect the subscapularis in an anatomical replacement and let the implant integrate.
Active movement Weeks 4–12

Progressive active movement without resistance. Most people already notice a clear improvement in pain compared with before surgery, which is the main reason for operating.
Strength Weeks 12–24

Gentle strengthening and return to full daily activity: driving, cooking, dressing unaided.
Final result Weeks 24–52

Movement and strength continue improving throughout the first year. Low-impact activities are allowed: walking, gentle swimming, golf.

Frequently asked questions

What is the difference between arthritis and frozen shoulder?

In arthritis the problem is the cartilage: it has worn away and bone rubs on bone. In frozen shoulder the cartilage is fine, and what happens is that the capsule enveloping the joint becomes inflamed and contracts, as though the shoulder were inside a sleeve that has shrunk. They resemble each other in symptoms — stiffness and pain — but they are different things: frozen shoulder almost always resolves without surgery, and arthritis is not cured but managed.

Does frozen shoulder get better on its own?

It tends to resolve by itself, but it takes a long time: between one and three years, passing through three phases (painful, stiff and thawing). Treatment changes the final destination less than it changes the length and the misery of the journey, and it avoids being left with residual restriction.

How long does a shoulder replacement last?

Most published series show survival above 90 per cent at ten years. That figure weighs on the decision: in a younger person every alternative is exhausted first, because a replacement fitted at 50 will probably need revising at some point.

Will I get full movement back with a replacement?

You recover movement that works for daily life and, above all, the pain goes, which is usually the real reason for the consultation. You do not get back the shoulder you had at 20, and it is worth knowing that beforehand. Reverse replacement in particular gives very good elevation and less rotation.

I have diabetes — does that matter?

Yes. Frozen shoulder is considerably more common in people with diabetes, and in them it tends to be more stubborn and longer-lasting. Good glucose control is part of the treatment, not a separate detail.

Do anti-inflammatories help at all?

They help with pain in the acute phases and make sleep and rehabilitation possible, which is what actually changes things. They do not slow cartilage wear or undo capsular contraction, so they are not a definitive treatment.

Often confused with

An assessment with Dr. Aveledo

Consultations at Hospital Quirónsalud Tenerife, Vida Puerto de la Cruz and Quirónsalud Santa Cruz.

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