Teresa’s TCM Clinical Reflections (14)Why Can’t I Lift My Arm? Is It Frozen Shoulder or a Rotator Cuff Injury?

By Teresa Shen, BHSc (Acupuncture), ACC Registered Treatment Provider, Registered Chinese Medicine Practitioner (NZ)

“Teresa, I can’t lift my arm. Is it frozen shoulder, or have I torn my rotator cuff?”

This is one of the most common questions I hear from patients with shoulder pain.

Many people experience similar symptoms. Their shoulder hurts, reaching overhead becomes difficult, getting dressed is uncomfortable, brushing their hair is almost impossible, and sleeping on the affected side becomes painful.

Because the symptoms overlap, many patients assume frozen shoulder and rotator cuff injuries are the same condition.

In reality, they are two very different problems.

Although both can cause pain and restricted movement, they develop differently, require different treatment approaches, and may have very different recovery timelines.

For me, the most important question is not:

“What is the name of this condition?”

It is:

“Why can’t this patient lift their arm?”

Finding the answer to that question is often the key to choosing the right treatment.

I Always Begin with the Patient’s Story

The first thing I want to understand is how the problem started.

I often ask:

“Did your shoulder gradually become stiff, or did the pain begin after an injury?”

Frozen shoulder usually develops slowly.

Many patients cannot remember a specific injury. Instead, they notice that the shoulder becomes progressively stiffer over several months until even simple daily activities become difficult.

Rotator cuff injuries are different.

They often occur after lifting something heavy, falling, sporting injuries, or years of repetitive overhead work. Some patients remember the exact moment the pain began, while others develop tendon damage gradually through repeated strain.

The history alone often provides valuable clues before I even begin the physical examination.

“I Can’t Lift My Arm” Does Not Always Mean the Same Thing

Many patients describe exactly the same symptom.

“I can’t lift my arm.”

But clinically, I want to understand how they cannot lift it.

With frozen shoulder, the entire shoulder joint gradually loses movement.

Reaching forwards, sideways and behind the back all become restricted. Even if someone else tries to lift the arm, the movement remains limited because the joint itself has become stiff.

A rotator cuff injury usually behaves differently.

Movement is often limited by pain rather than stiffness.

Certain movements—such as lifting the arm overhead, lowering it under control or rotating the shoulder—may be particularly painful, while other directions remain relatively normal.

Although both patients say they cannot lift their arm, the underlying reasons may be completely different.

Clinical Examination Often Provides the Answer

Pain alone is rarely enough to make an accurate diagnosis.

I pay close attention to shoulder movement, muscle strength and the patient’s functional limitations.

Special clinical tests, such as the Empty Can Test, Hawkins Test and Neer Test, can help identify signs of rotator cuff involvement.

Sometimes further imaging is also appropriate.

Ultrasound or MRI may show tendon inflammation, partial tears or full-thickness tears that cannot be confirmed through examination alone.

On the other hand, frozen shoulder usually does not involve a significant tendon tear. Instead, the joint capsule gradually becomes thickened and stiff, leading to global restriction of movement.

Imaging is not ordered simply because a patient has shoulder pain.

It is recommended when the results are likely to change the diagnosis or influence treatment decisions.

How Does Traditional Chinese Medicine View These Conditions?

Although Traditional Chinese Medicine does not use terms such as frozen shoulder or rotator cuff injury, it approaches both conditions through pattern differentiation.

Patients with frozen shoulder often present with patterns involving Cold-Damp obstruction, reduced circulation or long-standing blockage within the channels. Besides local acupuncture, I may combine treatment with moxibustion and techniques that promote circulation and improve overall recovery.

Rotator cuff injuries are more commonly understood as tendon injuries with local Blood Stasis.

Treatment focuses on supporting tissue healing, improving local circulation and reducing further strain while the tendon recovers.

The symptoms may appear similar, but the treatment strategy is not necessarily the same.

Treatment Should Follow the Diagnosis

One principle guides my clinical thinking:

Treatment should follow the diagnosis—not simply the symptom.

If I believe the problem is frozen shoulder, restoring shoulder mobility becomes a major priority.

If I believe the patient has a significant rotator cuff injury, I also consider the severity of the tendon damage.

Some patients respond well to conservative treatment, including acupuncture and rehabilitation exercises.

Others, particularly those with larger tears or significant weakness, may require further orthopaedic assessment and, in some cases, surgical repair.

My role is not simply to reduce pain.

It is to help patients understand why they cannot lift their arm and guide them towards the most appropriate treatment pathway.

When patients ask me,

“Teresa, is this frozen shoulder or a rotator cuff injury?”

I do not try to label the condition as quickly as possible.

Instead, I first ask:

“Why can’t this shoulder move normally?”

Because once the underlying cause becomes clear, the right treatment usually becomes much clearer as well.

For me, the difference between frozen shoulder and a rotator cuff injury is not simply the diagnosis.

It is recognising that each condition requires its own clinical reasoning, its own treatment strategy and its own path to recovery