Frozen shoulder or complex regional pain syndrome(CRPS)?

Frozen shoulder is a common source of shoulder pain.

While frozen shoulder is commonly missed or confused with a Complex Regional Pain Syndrome (CRPS) or rotator cuff injury, it has a distinct pattern of symptoms resulting in severe shoulder pain, loss of shoulder function and eventually stiffness so it is important to get an accurate diagnosis. There are a large number of people that have been seen with the “tag” Frozen shoulder that actually were something else entirely.

Is Frozen shoulder and Complex Regional Pain Syndrome (CRPS) the same?

Complex regional pain syndrome (CRPS) is an autoimmune condition in which a person develops a persistent pain, usually after a minor injury. The pain is out of all proportion to what you would normally expect. The skin of the affected body part can become extremely sensitive, even the slightest touch or change in temperature can cause intense pain. This is not unlike a frozen shoulder in onset, cause and sensitivity.

Symptoms of CRPS

Physiological view on that links to CRPS are as follows:

  • Trigger points (specific sore spots) on both sides

  • Pain pressure threshold is decreased (low tolerance of pressure).

  • Thermal pain threshold is reduced (low tolerence of heat).

  • Inconsistent pain levels that don’t match the action or provocation

  • Abnormal distribution of pain and sensation (not following an expected pattern)


This is all very complicated but it does show that CPRS it is driven by pain for the sake of pain.

Then, what is a Frozen shoulder?

Frozen shoulder syndrome, or clinicaly known as Adhesive Capsulitis isn’t an injury, it is more of an autoimmune response. What makes it different from CRPS is that the autoimmune response causes the tissues around the joint to stiffen, form scar tissue, and shoulder movements become difficult and painful. Frozen shoulder comes on gradually and takes between 18 to 35 months to resolve.

So what causes a frozen shoulder?

There is no cause that has been found but you are at higher risk with the following:

  • After surgery or injury.

  • Most often in people 40 to 70 years old.

  • More often in women, especially post menopause.

  • Most often in people with chronic diseases, especially diabetes and stroke.

It is considered to have 3 phases:

  • Phase 1:

    • This is where pain is the predominant factor. Essentially pain limits the movement. If you were unconscious then you would have good movement. However because the pain is so high the joint starts to stiffen up. This phase can last for 6 months to a year.

  • Phase 2:

    • This is when the acute pain begins to reduce and leaves a severely restricted shoulder joint. This phase can remain up until 1 year to 18 months from onset.

  • Phase 3:

    • This is the final phase and is basically the gradual restoration of the movement in the joint to normal range of movement.

What are the symptoms?

  • Pain is localised to the shoulder area usually on the deltoid muscle.

  • There is usually very limited movement

  • Pain is both at rest and during movement and it is also painful to lie on the affected shoulder.

Common issues for frozen shoulder include:

  • Unable to reach above shoulder height

  • Unable to throw a ball

  • Unable to quickly reach for something

  • Unable to reach behind your back eg bra or tuck shirt

  • Unable to reach out to your side and behind. eg reach for seat belt

  • Unable to sleep on your side.

If you are having shoulder problems seeking physiotherapy early can help to reduce the effects and get you on your way to optimal recovery. At Physio Savvy, have a physiotherapist assess you and correctly diagnose CRPS or frozen shoulder- they require very different plans of treatment!

The following two tabs change content below.
Afiq Muhammad

Afiq Muhammad

Physiotherapist at Physio Savvy
Afiq Graduated with BSc (Hons) in Physiotherapy from MARA University of Technology. His past work experience involves varied cases in various fields, making his patient care hollistic and patient based. He is most interested and experienced in the fields of musculoskeletal conditions and sporting injuries.
Afiq Muhammad

Latest posts by Afiq Muhammad (see all)

Posted in Musculoskeletal Disorders.