What Is Frozen Shoulder And How Do You Manage It?

I couldn’t spoon my partner, grab for toilet paper or pull a shirt over my head. For a while, I wasn’t even able to drive. The only way to relieve the excruciating night pain was by icing every two hours for an hour—a schedule reminiscent of my long-ago breastfeeding days.

The joke, however, was that the baby was my shoulder, aching and locked into place by a crippling malady called frozen shoulder syndrome.

It started with slight pain in my left arm. Then downward dog became impossible; lifting became difficult; until finally, I avoided using my left arm completely. Did I mention the pain?

When a physiotherapist diagnosed my frozen shoulder (the limited range of motion was an obvious marker) and said it might be because I was a middle-aged woman, I still thought this was my own private hell. But the more I shared stories with other women about my restricted movement, the more I understood that I was far from alone. Frozen shoulder is everywhere, and it seems to have much to do with age and gender.

Curious if you too have frozen shoulder? Here’s what I’ve learned about this frustrating condition—incredibly common in midlife women—and how to deal with it.

What exactly is frozen shoulder?

Frozen shoulder, or adhesive capsulitis, occurs when the capsule of connective tissue inside the shoulder joint thickens and tightens, restricting movement. 

It’s a life-altering condition that means things like undoing a bra strap or putting an arm out is incredibly painful. The pain is often worse at night. 

“Essentially, you have this deep, nagging pain, and it gets worse and worse,” says Dr. Sarah Naomi Shaw, chief medical officer of Lume Women + Health, a new multidisciplinary medical clinic for midlife women in Toronto.  

“It’s frozen, you have limited range of motion, and that pain can be severe,” she says. 

Who gets frozen shoulder?

Frozen shoulder affects two to five percent of the population over the course of their life (about 300 million people worldwide). Frozen shoulder tends to affect the non-dominant arm; about 70 percent of cases are in women and 84 percent are aged 40 to 59.

While diabetes, hyperthyroidism and injuries put one at higher risk, frozen shoulder can arrive seemingly out of nowhere.

“Women come in, and they say, I haven’t had an injury; I’m not doing overhead activities. What in the heck is going on?” says Shaw.

What are the symptoms of frozen shoulder?

Frozen shoulder has three stages: freezing, frozen, thaw. 

“It goes from purely pain and inflammation to capsular shrinkage,” says Dr. Vonda Wright, an orthopedic surgeon based in Orlando, Fla.,  who is a pioneer in research on mobility and musculoskeletal aging.

“It’s [typically] a two-year cycle, so unless you get in front of it, it can be years of your life without the use of your arm and sleepless nights because it’s so painful.”

The first stage is just a bit of bothersome shoulder pain, explains Dr. Allan Austin Oolo, founder of the World Frozen Shoulder Clinic in Toronto.

In the second stage, the range of motion is reasonably good, but the pain is horrific. “People can’t sleep at night, and then they start to get limitation in the range of motion,” he says. 

The third stage is a loss of range of motion, with a decrease in pain. Frozen shoulder usually takes two or three years to resolve on its own and, in some cases, can continue for five or even 10 years.

What role do hormones play in frozen shoulder?

Answers aren’t easy to find. “If you look at different sources, they all say they don’t really know what causes frozen shoulder,” says Oolo. “I think it’s a part of a triad of things—sort of a perfect storm.”

That perfect storm includes a hormone imbalance, some inflammation response in the shoulder, and often disc problems or compression of the nerves in the neck, he says. 

For women, the onset of perimenopause is another potential trigger. “In all circumstances, we become highly inflamed because of estrogen’s effect on inflammation in the immune system, and our glucose becomes dysregulated,” says Wright.

Researchers aren’t exactly sure why, but the shoulder capsule is incredibly sensitive to inflammation and high glucose levels. Add joint pain and a lack of desire to exercise and tada, it freezes up.

The problem is compounded by the general lack of focus on menopause in the medical community and the dearth of education in medical schools. Hoping to help fix this information void, Wright released a review paper last year which addresses total body pain, frozen shoulder, loss of muscle mass, osteoporosis and their relationship to the hormonal fluctuations of menopause. She also coined a new term to refer to these symptoms: the musculoskeletal syndrome of menopause. 

“This is a landmark day for you!” Wright told her 1.5 million Instagram followers on the day the paper was released. “You’re not falling apart, and you’re not going crazy. The musculoskeletal syndrome of menopause is real.”

“Dr. Wright’s article is so incredibly helpful,” says Shaw. “A lot of times, women have really been dismissed with their pain from frozen shoulder. Having new terminology gives us the power to recognize it, name it, and focus more research dollars on it.” 

How is frozen shoulder diagnosed?

Frozen shoulder is diagnosed through medical history, physical examination and X-rays, MRIs or ultrasounds. A limited range of motion in multiple directions is a crucial indicator, while imaging studies can help confirm the diagnosis.

Wright says that women with frozen shoulder are often told the condition is a part of getting old or an indicator that it’s time for antidepressants. (Read: they’re going crazy.)

“That’s the cop-out answer that women have received for a very long time,” says Wright. “Sometimes doctors don’t know. But we need to dig deeper.” 

She says that women should be encouraged to talk about where they’re at in the menopausal transition, what other symptoms they’re having and whether they’re doing all they can to stay healthy. 

Diet is critical. Are you eating a lot of sugar, which can make this worse? Are you eating enough protein (and building better bones)? Are you getting enough fibre (and helping decrease inflammation)? 

“In my office,” says Wright, “the conversation is not only what to do about your frozen shoulder, but have you made your [menopause] therapy decision? [More on this below.] I still treat your frozen shoulder, but not just because you’re a shoulder to me. Because if I don’t get in front of the other questions, it’ll come back.”

How is frozen shoulder treated?

It’s important to know what frozen shoulder is and to recognize it early, Wright says. “People always think that if something hurts, you shouldn’t move it.” But movement is essential when it comes to frozen shoulder.

Strategies for dealing with frozen shoulder include:

• Doing range-of-motion exercises at home, such as pendulum swings, wall crawls and towel stretches.
• Working with a physiotherapist who’s trained in treating frozen shoulder 
• Taking over-the-counter anti-inflammatories, like acetaminophen
• Icing and heating to relieve pain

In some cases, menopause hormone therapy might help, says Wright. However, it’s also crucial to decrease insulin resistance through diet (insulin resistance is linked to increased inflammation), and develop an exercise regimen that includes short bursts of high-intensity exercise and weight lifting. 

“Hormones are not a silver bullet,” says Wright. “It’s all the things. This is a lifestyle.” 

Some women get corticosteroid injections in the joint to help reduce inflammation and relieve pain. Medical procedures to help loosen the shoulder include hydrodilatation (in which corticosteroid, saline and anesthetic are injected to expand the shoulder joint capsule and stretch and break adhesions) and manipulation of the shoulder under anesthesia. Surgery may be an option if all other treatments have failed, writes Dr. Mary Claire Haver in the recently released The New Menopause. 

Can you prevent frozen shoulder?

“I think there are a lot of general things in terms of prevention,” says Shaw. This includes being physically active and having a healthy diet. 

An essential concept addressed in Wright’s paper is that, similar to how girls are prepared for puberty and women for pregnancy, women should be offered menopause preparedness sessions. 

“There are over 30 symptoms of menopause,” says Shaw. “It can take women years to pull together the pieces, and their physicians may miss it altogether if they haven’t proactively had extra training.”

“Imagine having the information and knowing that this is not only a normal part of aging, but there are treatment options available,” she adds. “Having that empowered medical literacy is very, very important.”

My frozen shoulder experience

Frozen shoulder hit me just before I set out on a five-week trip to Europe. Unfortunately, I didn’t have the time or smarts to keep moving it. The pain increased, my shoulder continued to freeze up, and one morning, in a little off-grid cabin on the Baltic Sea, I woke up with a scream.

Back in Toronto, a sports medicine doctor kick-started my recovery by loosening up my shoulder capsule with hydrodilatation. (The procedure was painful, but I experienced an immediate reduction in pain and improvement to my range of motion.)

I attended weekly physiotherapy sessions. I diligently followed an ever-expanding series of exercises and started swimming, initially with just one arm. Gradually, I started resuming normal daily activities. 

After such an intense, debilitating experience (the really bad part was a mere six months, ha ha), I still get flashbacks when I pull a shirt over my head. Fortunately, that’s now a reminder to keep healthy and fit and learn more about other changes in this stage of my life.