’40-year-old shoulder’ is an informal term sometimes used to describe the development of frozen shoulder (adhesive capsulitis). Although the phrase has come back in recent years, it actually has its roots in China and Japan, where it is sometimes referred to as the ’50-year shoulder’.
Bethany Tomlinson, musculoskeletal clinical service manager, AXA Health, UK, explains that ’40-year-old shoulder’ is more of a nickname than a clinical term – and she doesn’t personally use it.
However, they noted that there is a significant increase in shoulder complaints in women over the age of 35. As a result, this phrase is often used as an umbrella term covering many possible causes of shoulder pain and stiffness in midlife.
Sometimes, frozen shoulder occurs for no apparent reason. But it can also develop when the tissue around your shoulder joint has become weaker or less flexible.
“This means that the tissues – such as rotator cuff muscles, tendons or cartilage – are not as flexible as they used to be,” Tomlinson explains. “They may not stretch or lengthen enough to allow full movement of the shoulder.
“As a result, your range of motion becomes limited or restricted.”
In frozen shoulder, the joint capsule – the flexible tissue surrounding your shoulder – may become thick and stiff. This, along with inflammation, makes the joint less flexible and can make movements painful, limiting both how far and how easily you can move your shoulder.
Symptoms of Frozen Shoulder
In simple words, the main symptom of frozen shoulder is pain in your shoulder. This pain can interfere with your daily activities – including sleeping, when it often feels worse. You may also notice that your shoulder has become very stiff, making it harder to move than before.
“People typically notice a new feeling of stiffness in their shoulders when performing everyday tasks, such as reaching back to fasten a seat belt, tying a shirt, or even tying a bra,” says Tomlinson.
She explains that these activities involve rotating the shoulder in and out, which is often affected early on. Typically, external rotation – turning your arm outward – becomes limited at first, although many people can still manage day-to-day tasks at this level.
However, she notes that when internal rotation – moving your arm inward – or reaching behind your back becomes difficult or painful, it often prompts people to seek help.
“A simple exercise, such as checking your shoulder flexibility by trying to reach backward, can help you notice early signs of stiffness,” she suggests. “If you notice that your external rotation is becoming stiff, you should seek medical attention quickly to prevent the condition from getting worse.”
Bethany Tomlinson, Musculoskeletal Clinical Services Manager, AXA Health
If your age is between 40 and 70, your chances of getting a frozen shoulder increase. You are also more likely to have this if you have had an injury to your shoulder that has left it immobilized for a period of time. Other factors that increase your chances include health conditions such as diabetes or thyroid problems, or having had surgery around your shoulders or chest.
Tomlinson says that during midlife, many people who have never had shoulder problems begin to notice symptoms such as pain and stiffness, even if their shoulder looks normal on an MRI or X-ray scan.
She further adds that hormonal imbalance can also play an important role in the development of frozen shoulder.
“Conditions such as menopause, hypothyroidism, and insulin resistance are associated with a greater likelihood of developing frozen shoulder,” she explains.
“During menopause, your estrogen, testosterone, and progesterone levels decrease. There is some evidence to suggest that this hormonal change during menopause can cause the synovial fluid within the joint to thicken and the soft tissues to become less adaptable and elastic.”
Tomlinson says this loss of tissue elasticity can limit the range of motion of your shoulder. In response, the body triggers inflammation, which can cause the joint capsule to thicken or adhesions to develop – commonly known as frozen shoulder.
frozen shoulder stages
Frozen shoulder goes through several stages and can persist for a long time, so if you get one, don’t expect a quick recovery. Pain and stiffness in your shoulder can change over time, both in how severe it feels and how it affects your movement.
Tomlinson outlined three main stages:
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to solidify – Lasts between 2 and 9 months, with pain usually being the most prominent symptom. Movements become more painful, especially with certain movements, and your shoulder may begin to feel tender.
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frozen -Can last for 4 to 12 months, during which stiffness becomes the main issue. Your shoulder becomes very stiff, and motion becomes quite limited, but the pain often begins to subside during this phase.
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Thawing – May last 12 months or longer, as your shoulder gradually begins to regain movement. The pain is decreasing, and range of motion is improving, although there may be some fluctuations in pain as your shoulder heals. Full recovery may take a year or more depending on the severity and treatment.
There are several treatments for frozen shoulder, depending on how it affects you. These may include over-the-counter pain relief, heat or ice therapy, physiotherapy, and – in more severe cases – medical or surgical intervention.
“The first step in treatment usually involves physiotherapy,” says Tomlinson. “A physiotherapist can guide you through exercises that help reduce pain, stiffness and improve your range of motion.
“Usually a six-week course of physiotherapy is recommended, with an additional six weeks if necessary and progress monitored.”
She suggests that if your pain is severe and physiotherapy is limited, the pharmacist may suggest pain-relief options such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs). NICE guidelines usually recommend starting with paracetamol, and if this is not sufficient, moving on to an NSAID.
If physiotherapy does not improve or your shoulder gets worse, other treatments may be considered. These may include steroid injections into the joint or referral to an orthopedic specialist.
“In some cases, invasive procedures such as subradial decompression (SAD) or manipulation under anesthesia are performed,” says Tomlinson. “These procedures have similar results when evaluated approximately 18 months after treatment.”
In the early stages of frozen shoulder, you can try to manage your symptoms at home. This usually involves using over-the-counter pain relievers, applying heat or ice, or adjusting your sleeping position to avoid lying on the affected shoulder. Light exercise, such as the suggested exercises British Elbow and Shoulder Society (BESS) May also help maintain motion and reduce stiffness.
Tomlinson explains that exercise is a great evidence-based way to help improve your symptoms.
“Make sure you tailor the exercise to the state of your symptoms,” she advises. “With early detection and treatment, simple postural advice, strengthening exercises and advice on pain relief from your pharmacist may be sufficient.”
However, she adds that if a hormone-related frozen shoulder is suspected that won’t resolve, it may be worth discussing it with your women’s health specialist.
If your symptoms are preventing you from doing your normal daily activities, Tomlinson recommends talking to a physical therapist.
“You may not need to see them regularly, but they can offer advice tailored to your specific issues at that time,” she says. “If pain is keeping you from sleeping, it is also advisable to contact a medical professional.”
Tomlinson emphasizes the importance of sharing any relevant medical history, including cancer, tuberculosis, diabetes, or thyroid conditions, with the physician evaluating you.
“Shoulder pain and neck pain are often linked,” she adds. “So if you’re experiencing pain, tingling and numbness in the neck, be sure to mention it.”
Tomlinson concluded that prevention is better than cure when it comes to shoulder stiffness.
Keeping your shoulders balanced, strong, and maintaining their range of motion can help reduce the chance of it developing. And if it does develop, getting an early diagnosis and starting treatment right away can make a big difference in your recovery.
