What is 40-year-old shoulder?

Is ‘40-year-old shoulder’ a real medical condition?

‘40-year-old shoulder’ is an informal term sometimes used to describe the development of frozen shoulder (adhesive capsulitis). While the phrase has made a comeback in recent years, it actually has roots in China and Japan, where it is sometimes called ‘50-year-old 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 not one she personally uses.

However, she notes there is a marked increase in shoulder complaints among women over the age of 35. As a result, the phrase is often used as an umbrella term covering several possible causes of shoulder pain and stiffness in midlife.

Sometimes, frozen shoulder happens for no obvious reason. But it can also develop if the tissues around your shoulder joint have become weaker or less flexible.

“This means the tissues - such as the rotator cuff muscles, tendons, or cartilage - aren’t as elastic as they used to be,” explains Tomlinson. “They can’t 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 around your shoulder - can get thick and tight. This, along with inflammation, makes the joint less flexible and can make movements painful, limiting both how far and how smoothly you can move your shoulder.

Bethany Tomlinson, Musculoskeletal Clinical Service Manager, AXA Health

If you’re between 40 and 70, your chance of developing frozen shoulder goes up. You’re also more likely to get it if you’ve had a shoulder injury that left it immobile for a while. Other factors that increase your likelihood include health conditions such as diabetes or thyroid issues, or having had surgery around your shoulder or chest.

Tomlinson says that during midlife, many people who previously had no shoulder issues begin to notice symptoms such as pain and stiffness, even though their shoulder looks normal on MRI or X-ray scans.

She adds that hormonal imbalances may also play a significant 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 oestrogen, testosterone, and progesterone levels decrease. There is some evidence to suggest that this hormonal shift during menopause can lead to thickening of the synovial fluid within the joint and make the soft tissues less adaptable and elastic.”

Tomlinson notes that this loss of tissue flexibility can limit your shoulder’s range of movement. In response, the body triggers inflammation, which can cause the joint capsule to thicken or develop adhesions - leading to what’s commonly known as frozen shoulder.

There are several treatments for frozen shoulder, depending on how it affects you. These can include over-the-counter pain relief, heat or ice therapy, physiotherapy, and - in more severe cases - medical or surgical interventions.

“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 movement.

“A six-week course of physiotherapy is usually advised, with an additional six weeks if required, and progress is noted.”

She suggests that if your pain is severe and limits physiotherapy, a pharmacist can suggest pain-relief options such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs). NICE guidelines typically recommend starting with paracetamol, and if that isn’t enough, moving on to NSAIDs.

If physiotherapy doesn’t lead to improvement or your shoulder gets worse, other treatments may be considered. These can include steroid injections into the joint or a referral to an orthopaedic specialist.

“In some cases, invasive procedures such as a subracial decompression (SAD) or manipulation under anaesthesia are performed,” says Tomlinson. “These procedures tend to have similar outcomes when assessed around 18 months after treatment.”

In the early stages of frozen shoulder, you can try managing your symptoms at home. This usually involves using over-the-counter pain relief, applying heat or ice, or adjusting your sleeping position to avoid lying on the affected shoulder. Gentle exercises, such as those suggested by The British Elbow and Shoulder Society (BESS) can also help maintain movement and reduce stiffness.

Tomlinson explains that exercises are a great evidence-based method to help improve your symptoms.

“Make sure you match the exercise to the stage of symptoms,” she advises. “With early detection and treatment, simple postural advice, strengthening exercises, and advice on pain relief from your pharmacist can be enough.”

She adds, however, that if there is suspicion of a hormone-related non-resolving frozen shoulder, it may be worth discussing with your women’s health expert.

If your symptoms are preventing you from carrying out your usual daily activities, Tomlinson recommends speaking with a physiotherapist.

“You might not need to see them regularly, but they can give advice tailored to your specific issues at the time,” she says. “If the pain is stopping you from sleeping, it’s also worth reaching out to a medical professional.”

Tomlinson stresses the importance of sharing any relevant medical history, including cancer, tuberculosis, diabetes, or thyroid conditions, with your assessing clinician.

“Shoulder pain and neck pain are often connected,” she adds. “So if you’re experiencing any neck pain, pins and needles, or numbness, make sure to mention it.”