When there is inflammation in the subacromial bursa (a part of the shoulder joint), there is pain on elevation of the shoulder above the horizontal. This condition is variously called subacromial bursitis and shoulder impingement syndrome. If this condition is left untreated, eventually scar tissue will form in the shoulder joint. This scar tissue permanently restricts motion of the shoulder. This condition is called adhesive capsulitis, or frozen shoulder. Frozen shoulder is treated conservatively by physical therapy, but if that doesn't work the orthopedist has to do one of 2 things: violently wrench the shoulder to break up the scar tissue, or do surgery to go in and break up the scar tissue.