Emma Mapp’s Journey Through Frozen Shoulder

Initially, Emma Mapp, a 52-year-old lawyer from Twickenham, brushed off a dull ache in her left shoulder as just a result of a workout mishap. However, within a month, that minor discomfort escalated to a point where she could neither raise her arm nor turn her neck, making everyday tasks like dressing and washing herself incredibly difficult.

“I started avoiding social outings because I worried someone might bump into my shoulder, which would be really painful,” Emma recalled. “When I did go out, I’d wear a sling over my coat to signal to people that I was injured and to be careful.” 

Eventually, she received a diagnosis of frozen shoulder, a condition characterized by pain and stiffness, often stemming from an injury and can persist for months or even years. Surprisingly, a private physiotherapist introduced the possibility that Emma’s condition might be linked to the menopause.

At that time, she was grappling with typical menopausal symptoms like hot flashes and brain fog. “But I never realized that frozen shoulder could be related,” she confessed.

The connection might seem odd but research has found some evidence supporting it. Frozen shoulder, or adhesive capsulitis, impacts about a million people annually in the UK. This condition arises when the tissue surrounding the shoulder joint becomes inflamed and thickens.

Rajeev Sharma, an orthopaedic surgeon, explained that an inflamed capsule restricts shoulder movement, leading to the stiffness associated with frozen shoulder. Interestingly, some individuals may experience neck pain because the stiff shoulder forces the neck muscles to compensate for the lack of shoulder motion.

Although frozen shoulder commonly results from injuries, like falls or minor stretches, Mr. Sharma noted that it’s also more prevalent among those with diabetes. This is thought to be due to high blood sugar levels thickening the surrounding shoulder tissue. However, he highlighted that most patients are women aged 40 to 60, the typical age range for menopause.

Why is this age group particularly affected? Research suggests a correlation between declining estrogen levels during menopause and an increased susceptibility to frozen shoulder. A study from Duke University, which surveyed nearly 2,000 women, found that those not undergoing hormone replacement therapy (HRT) were 99 percent more likely to develop frozen shoulder compared to those on HRT.

Dr. Elise Dallas, a menopause specialist, further elaborated, explaining that estrogen plays several critical roles in musculoskeletal health. “It has anti-inflammatory effects and aids in bone growth, as well as connective tissue health,” she noted. When estrogen levels decrease during menopause, collagen—the connective tissue vital for muscle and joint health—can stiffen, limiting flexibility.

Additionally, the drop in estrogen is linked to an increase in cytokines, which can provoke inflammation in the shoulder joint. Dr. Dallas pointed out that this inflammation may lead to the classic symptoms of frozen shoulder.

Despite these findings, some experts remain skeptical, arguing that one study isn’t definitive proof that hormonal changes are the sole cause of frozen shoulder. Mr. Sharma reiterated that while there seems to be a correlation with menopause, a direct link remains unclear.

Currently, there’s no absolute cure, but treatment options aim to alleviate symptoms during the healing process. The most common approach is hydrodistension, which involves injecting a combination of saline, local anesthetic, and steroids into the joint capsule to reduce pain and improve movement.

Alongside this, physiotherapy can help maintain shoulder strength, though it may initially cause discomfort when the condition is at its peak. Emma explored various treatments, including physiotherapy, heat packs, massages, and painkillers, which provided temporary relief but didn’t eliminate the chronic pain. “Even relaxing to watch TV was painful,” Emma shared, detailing how she had to prop her arm to ease discomfort.

In severe instances, patients might require an MRI scan for confirmation, followed by a hydrocortisone injection to facilitate recovery. Emma’s journey took an unexpected turn when she fell before Christmas 2023, prompting an X-ray and MRI that later confirmed her diagnosis. The attending doctor observed that many women her age experienced similar conditions.

Following her diagnosis, she was referred for a hydrocortisone injection, which she received in January of the following year. Reflecting on the experience, Emma remarked, “I’ve never felt pain like it; it was excruciating.” Yet, within a week, she began to notice improvements in her shoulder’s mobility.

After some months, Emma managed to travel to Indonesia and Singapore with her partner, Stuart, where she discovered that they referred to frozen shoulder as “50s shoulder.” “They have a better awareness of the menopause connection,” Emma noted.

A year later, her shoulder mobility has significantly improved. “I’m at about 97 percent now, and although I can’t play tennis as I used to, I’m mostly back to normal,” she explained. Engaging in aqua aerobics several times a week has also helped her recovery.

Emma hopes to spread awareness, encouraging other women experiencing similar shoulder pain to seek medical advice sooner rather than later.