Shoulder pain has a way of arriving right as Colorado’s winter chores and winter sports start. The first ski weekends are here, snow shovels come out this month, and plenty of west Denver garages have a ladder and a string of holiday lights waiting. A shoulder that aches when you reach into a cabinet, or wakes you when you roll onto it, is one of the most common complaints a primary care or sports medicine doctor hears. The frustrating part is that three different problems produce almost the same first impression, and they are not treated the same way.
The three usual suspects
The National Institute of Arthritis and Musculoskeletal and Skin Diseases lists rotator cuff disease, torn rotator cuffs and frozen shoulder among the most common shoulder problems, and notes that most of them start when the soft tissues around the joint break down with repetitive motion, aging, heavy use or an injury from a fall or sport.
A rotator cuff problem means the tendons that hold the ball of the shoulder in its socket are irritated, partly torn or fully torn. The American Academy of Orthopaedic Surgeons says almost 2 million people in the U.S. see a doctor each year for rotator cuff tears, that most tears come from wear over time rather than one event, and that people over 40, painters, carpenters and anyone who does repeated overhead lifting are at higher risk. The telltale signs are pain at rest and at night, especially lying on that side, weakness when lifting or rotating the arm, and a crackling feeling in certain positions.
Impingement, sometimes called rotator cuff tendinitis or subacromial pain, is an irritation of the same tendons and the bursa above them without a true tear. The pattern is a painful arc: raising the arm out to the side hurts in the middle of the motion and often eases near the top, and overhead work such as painting, swimming or serving sets it off.
Frozen shoulder, or adhesive capsulitis, is different in kind. The joint capsule itself tightens, so the main problem is lost motion rather than pain. AAOS describes three stages: a freezing stage of growing pain and stiffness that lasts roughly six weeks to nine months, a frozen stage of four to six months when pain eases but stiffness stays, and a thawing stage in which motion slowly returns over six months to two years. It most often affects people between 40 and 60, women more than men, and it is much more common in people with diabetes or after a period when the arm was immobilized for surgery, a fracture or another injury.
How to tell them apart at home
Ridgeview Direct Care, a direct primary care and sports medicine practice on Wadsworth Boulevard in Wheat Ridge, published a plain-language guide this week that sorts the three by what the exam shows. Its shorthand: mostly weakness, pain reaching behind the back and night pain point toward the rotator cuff; pain in the middle of the arc with strength still intact points toward impingement; motion lost in every direction, even when someone else moves your arm for you, points toward frozen shoulder. The practice’s post on rotator cuff, impingement and frozen shoulder stresses that the conditions can overlap and that the exam, not the symptom list, settles it.
That passive-motion test is the one most people can try. Let your good arm, or a family member, lift the sore arm without any effort from the sore side. If it moves nearly normally and only your own lifting hurts, stiffness is probably not the issue. If the arm will not go, no matter who is moving it, a frozen shoulder moves up the list and the plan changes.
Why the label matters
The reason to sort them out is that the exercises that help one can aggravate another. Ridgeview’s guide puts a targeted exercise program first for all three, then activity changes, then injections only when pain is blocking the rehab work, with an orthopedic referral reserved for significant tears or a program that has not worked. It also warns that strengthening that helps a cuff problem can make a frozen shoulder worse during its painful phase, and that a program that is not working by six weeks should be changed rather than repeated.
The national guidance lines up with that. For rotator cuff tears, AAOS says nonsurgical treatment such as rest, activity modification, anti-inflammatory medicine, physical therapy and steroid injections relieves pain and improves function in about 80 to 85 percent of patients, and surgery is usually discussed when pain has not improved after six to twelve months, the tear is large or weakness is significant. For frozen shoulder, AAOS calls physical therapy focused on stretching the primary treatment, with cortisone injections, a fluid injection called hydrodilatation and, rarely, surgery during the frozen stage for people who do not improve. NIAMS lists the same tools and adds that doctors may use X-rays, ultrasound or MRI to confirm what they find on exam.
What a visit looks like
Expect the doctor to compare how far you can move the arm with how far it moves when they move it, test each cuff muscle for strength and watch how your shoulder blade travels. Ridgeview describes in-office diagnostic ultrasound as a way to see the tendons move and separate tendon irritation from a partial or full tear in the same visit, with MRI generally saved for cases where surgery is on the table. Its sports medicine page lists rotator cuff injuries, ultrasound evaluations and injection treatments among the problems it handles for members and for people who book a sports medicine visit without a membership.
Before the appointment, note three things: which motions hurt (reaching up, reaching back, lying on it), whether the arm feels weak or just painful, and whether there was a fall or a jerking lift that started it. For a brand-new strain with no red flags, NIAMS suggests resting the shoulder for 48 hours and icing it for 20 minutes several times a day. A sore shoulder that has not settled after a couple of weeks of that, or that is waking you at night, is worth an exam rather than another month of guessing.
When not to wait
Ridgeview’s guide lists the situations that call for prompt care, including urgent care or an emergency department if your own doctor cannot be reached: sudden significant weakness after a fall or injury, an obvious deformity or a shoulder that feels out of its socket, a red, hot and swollen shoulder with a fever, and numbness, tingling or weakness spreading down the arm. Shoulder pain that comes with chest pressure, shortness of breath, sweating or nausea can be a heart problem and needs emergency care right away.
Disclosure: Ridgeview Direct Care is a Holland Health Marketing client.
Sources
- American Academy of Orthopaedic Surgeons, OrthoInfo: Rotator Cuff Tears
- American Academy of Orthopaedic Surgeons, OrthoInfo: Frozen Shoulder
- National Institute of Arthritis and Musculoskeletal and Skin Diseases: Shoulder Problems
- Ridgeview Direct Care: Shoulder Pain That Will Not Quit: Rotator Cuff vs. Impingement vs. Frozen Shoulder (Oct. 29, 2026)
This is general information, not medical advice.
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