I hadn’t heard of frozen shoulder syndrome until a few years ago, when I was suffering through acute pain. I certainly didn’t know it was connected to menopause. You would think somewhere along the way I would have learned about this, since I am a menopausal woman. But it’s just one of the aspects of this medical condition that is infuriating.
To explain, it helps to tell you a story of one snowy Christmas in Wisconsin:
I was surrounded by my boyfriend’s bustling family and the homey aromas of stew, melty cheese sauce, and his mom’s buttery homemade almond cookies that are one of my weaknesses. At Christmas time, this nice Jewish girl goes all in for Santa Claus and sweets. That’s me, in the corner, trying to stay out of the way of cooks and kids and eager dogs, wondering if just one more of those insanely yummy cookies would qualify as a reasonable lunch, butter being a legit protein source. I reach up for a mug—because a cup of coffee is the BFF of an almond cookie—and feel a twinge of pain in my right shoulder. I cannot recall an injury, so I move onward to the cookie tin and hope the pain will go away.
As the days pass, my right arm grows stiffer and weaker. I have to use my left arm to give my right arm a leg up, so to speak. By the time we get home to Brooklyn, the pain is a steady drone. No more yoga for me, but like busy women everywhere, I soldier on, working and organizing family life. Within a month, I am in sleepless excruciating pain, edging closer to 9 on the sad-face scale, even on a steady diet of Advil. I’ve been through childbirth, definitely a 10 on the pain scale, but at the end I had an adorable baby to show for my effort. This is relentless—24/7. No end, and no cute baby. I can barely hold a fork. I have to sign checks using my left hand to support my right.
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My Medical Mystery
I make the rounds of physical therapists and specialists who cater to the injuries of professional football and tennis players. Torn rotator cuff is the diagnosis. My shoulder is inspected and injected with cortisone, but the pain continues, reaching Code Red, like someone is jabbing an ice pick into my shoulder. I can’t focus on work. I need help dressing. I’ve never felt so helpless in my adult life. What the bleep is happening to me?
Then I remember that my brother had some kind of shoulder issue a few years earlier. He reminds me that our mother also had a bad shoulder and sends me to Dr. Vijay Vad, a physiatrist at New York City’s Hospital for Special Surgery. In the days prior to my appointment, I resort to more red wine than is good for me—it seems to dampen the pain more enjoyably than Advil—and re-read George Eliot’s Middlemarch, which at 800-plus pages keeps me distracted in the 19th Century. Dorothea’s marriage woes are definitely a super 10 sad face on the emotional pain scale.
My shoulder is inspected and injected with cortisone, but the pain continues, reaching Code Red.
When Dr. Vad examines my shoulder and asks me to perform a few simple arm movements, I can barely move the dangling appendage on my right side. “This is adhesive capsulitis,” he says. “Frozen shoulder.” He describes the disease as a spontaneous inflammation of the soft tissue surrounding the shoulder joint. “I see so many women your age with this condition. But don’t worry, we’re going to fix this.” I’m so relieved I do some bawling right there in his office and feel better already.
He identifies a number of risk factors for this disease: 5 percent of women overall, mostly in peri-menopause and menopause (that’s me, and probably you, Dear Reader), 20 percent of diabetics; people with autoimmune disorders including thyroid disease, cardiac patients, patients who’ve had upper body surgery, and and people with a family history (my brother and my mom). He says that the winter onset time of my frozen shoulder is also a hallmark of the disease. But the majority of his frozen shoulder patients are women, just about my age. And yes, decreasing hormones are to blame. Frozen shoulder is a midlife woman thing. Ask around. I guarantee that if you haven’t had this nasty business, one of your friends has.
Will My Shoulder Ever Un-Freeze?
Image: Tanja Heffner/Unsplash
Dr. Vad explains four distinct stages of the disease, each with an optimal treatment solution. His mantra is early diagnosis, but unfortunately that doesn’t always happen. Because the disease will eventually resolve itself, patients are often still told to “wait it out,” resulting in many months or even years of needless suffering.
In Stage One, which is where I was when I reached for a coffee cup and winced, a sonogram-guided cortisone injection into the shoulder joint can eliminate the pain and quickly restore mobility.
By now I was in Stage Two, with severe pain and stiffness. Most doctors will advise arthroscopic surgery for this stage, which is invasive and expensive and can result in chronic pain and…a refrozen shoulder.
In Stage Three, the shoulder is completely frozen stiff and pain subsides. For this stage, arthroscopic surgery is the only treatment option.
Stage Four is described as the “thawing” period.
Dr. Vad prefers to treat my Stage Two case with a brief, inexpensive procedure called capsule distension. After a local anesthetic is administered, the shoulder joint is injected with saline to flush out and expand the joint, which has shrunk. Dr. Vad describes the texture of the inflamed joint as something like a well-chewed piece of gum. Yuck. After the saline, in goes some cortisone. Nice. Fifteen minutes, no incision, done. An ice pack, and you can head home to binge watch seasons of 30 Rock.
Following my successful capsule distension, I worked with a physical therapist to regain strength and mobility. I am back to Plank Pose and Downward Dog. I have let go of headstands and Reverse Prayer for now, but I’ve got biceps again, and I can reach for coffee mugs, which is awesome.
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Frozen Shoulder Syndrome and Menopause: The Slap in the Face from Insurance
Unfortunately for all the wonderful women out there who will get frozen shoulder, there is no insurance code for capsule distension. No insurance code means insufficient reimbursement for physicians, which means that most would rather do the expensive, invasive procedure for which they have been well-trained and will be fully reimbursed, than a brief, inexpensive procedure that requires minimal recovery time.
If men developed frozen shoulder in similar numbers, you can be sure that this inexpensive procedure would be widely available.
I was covered for my procedure because it was conducted in a hospital operating room in the city where I lived. But most women who could benefit from capsule distension treatment will not have access to a doctor willing or able to perform it. Dr. Vad treats patients who fly in from all over the country and beyond. But this is obviously not an option for most of us, and that is just crazy.
This is why frozen shoulder is a feminist issue. Considering the impact this bad-ass disease has on our productivity and personal joy, we should all be banging on doors, lobbying for capsule distention. As with other medical situations women face—childbirth, for example, or abortion, for another—if men developed frozen shoulder in similar numbers, you can be sure that this inexpensive procedure would be widely available. Instead, even if you ask for capsule distension, your doctor might edge you towards arthroscopy. Our hardworking female shoulders carry enough burdens without the pain of recovery from needless major surgery.
Dr. Vad looks to ongoing research to identify the underlying causes of adhesive capsulitis and other issues that affect women in midlife. He recommends an anti-inflammatory diet, and he’s a big believer in turmeric and oral vitamin D, which can have a positive impact on back pain, depression, and arthritis. I can personally attest to the benefits of all these strategies in keeping my 40-plus body flexible and healthy.
Until a miracle pill comes along that will zap adhesive capsulitis after Stage One, Dr. Vad hopes to create an environment where women in midlife are more informed and empowered. “With early intervention, we can save you months or years of suffering,” he says, restating his mantra. “If you have pain in your shoulder and there was no trauma, and you are beginning to lose range of motion, you should get to a doctor immediately. If a few weeks of physical therapy do not bring good results, you should demand treatment for adhesive capsulitis. If you feel you might have a frozen shoulder, don’t sit and wait—take charge.”
Which sounds like good advice for all our life challenges.
Further Reading
Unlocking Frozen Shoulder: A New Paradigm of Treatment
Yve says
I had a capsule distension and a cortisone injection which unfortunately did not work. Can you tell me if your injection was done through the front or back of the shoulder? I’m in absolute agony with this pain.
Thanks
Yve
Julie Metz says
Hi Yve:
To be honest I cannot recall how the capsule distension was done as it has been some years now. Where did you have the procedure done?
Best
Julie
Doris says
I too had to deal with a frozen shoulder which after two years is still not 100%. Out of the blue in January 2019 I started experiencing the classic arm and shoulder pain and eventually my shoulder froze. I went to physical therapy a few months later and after about 5 months of therapy began regaining mobility back. It was still so painful to sleep on my side and I still to this day experience pain in my shoulder which I am convinced is tied to my hormonal cycle. I am 44 years old and have had perimenopause symptoms start around the time this all began. I never realized that my frozen shoulder could even be related to perimenopause or hormones until a friend had mentioned it to me. I am hoping that this discomfort will go away eventually. To other women experiencing this, you are not alone!
Kristen says
I started having discomfort in my bicep area in May 2020 and it wasn’t until Dec 2020 that my shoulder was completely immobilized. All the while I was being seen by my specialist (x-rays, cortisone shots, etc). Finally by the end of December and 2 MRI’s later and another specialist, I was diagnosed with frozen shoulder. This is the absolute worst pain! I’m up all night in pain and no one understands what I’m going through. The pain brings me to tears. I’m now in PT and I’m hoping to get some relief but any suggestions that got you through restless nights would be helpful.
Julie says
Apologies that I am just seeing this message now. This is such an undercovered condition and I understand what you are going through. The best thing is to seek care from a physiatrist. They understand pain management.
Claire says
Hi my name is Claire, I have been suffering with frozen shoulder for along time now, I have had 4 lots of steroid injections now, my Dr says he came keep giving me them every 3 mths, but sometimes the pain cones back so much sooner & I fine myself taking painkillers. I am in my early 50 & started menopause a few years ago, so not am I only awake through the night with pain I’m also up with hot sweats, I am at the end of my teather now, not knowing what to do. Please help.
Julie Metz says
Hello Claire:
I am so sorry to hear that you are suffering. I’ve been there. It seems that you are struggling with two issues at once so I will try to address them both here.
For the night sweats, you could talk to your gynecologist about getting some relief for the menopause symptoms. Not being able to sleep makes everything terrible and it’s hard to take care of yourself and be calm when you are so exhausted. Personally, I chose to take hormone replacement therapy when menopause began, in part because I am petite and at risk for osteoporosis. But I was also suffering from sleeplessness because of night sweats (really it was all day long!) and the hormones gave me immediate relief.
For your frozen shoulder: I am not sure where you live or what sort of health insurance you have. If the cortisone shots are not helping you in a permanent way, this might be because they are not sonogram-guided injections. This is very important. A sonogram-guided injection is not the most pleasant experience but it is effective. The injection goes right into the inflamed joint and you should experience longterm, hopefully permanent relief. For frozen shoulder, you should be seeing a physiatrist (a specialist in pain management/sports medicine) who will have the expertise and the equipment in their office. If you are still suffering years after the onset of pain, you might need some additional intervention, depending on how much range of motion you have in your shoulder. If you have insurance, your plan should allow you to see a physiatrist with a referral from your regular doctor. I would insist on seeing a specialist since you have been suffering for such a long time. I hope you will find relief soon.
Jenn says
Hello Julie,
I can’t tell you how relieved and overjoyed I am to find you and this article. I too am in menopause and suffering from frozen shoulder right not. I am scared and frustrated as I don’t understand what is going on with me and if things will get better. I am not sure what stage I am in however I can say that my pain has subsided and I am just starting to gain my range of motion back. I have many questions if you don’t mind. Did you gain full recovery in your range of motion? If so, how long did it take? Any advice you have, is greatly appreciated!!! Also, did a change in your diet help with the recovery of your frozen shoulder? Again, I am so grateful for finding this article!!!
Jenn
Julie Metz says
Hello Jenn:
If your pain is subsiding and you can move your arm again, you might have reached the “unfreezing” Stage Four. At this point you could seek out a physiatrist where you live and get a referral for a good physical therapist who has been trained in shoulder rehabilitation. I spent many months working with a physical therapist to rebuild strength in the weakened shoulder muscles, which is key to regaining range of motion. I would say I am about 85-90%. I cannot do Reverse Prayer pose but there are other more important things in life. Ditto Head Stands. I am careful and mindful when I lift objects and work in the garden. Some things I just don’t attempt. Your physical therapist will advise you.
I did modify my diet to include more green foods including green tea (anti-oxidants and anti-inflammatory) and this may have helped my shoulder but mostly it helped my overall health. This might be a good time to get a bone density scan and make sure you are getting enough Vitamin D. My doctor says we are all Vitamin D deprived from this quarantine period.
I wish you all the best. Don’t give up, you can get back to a better place.
Mary says
Hi Ladies, Feel your pain – as I had that as well, treated with Shock Wave Therapy -helped me in weeks to go back almost to normal. Was reading scientific information on this topic and that all in relation to Progesterone deficiency.
Julie Metz says
Hello Mary: I am glad to hear of new non-invasive treatments. Perhaps this is something like the treatment I recently received for Morton’s Neuroma, a painful nerve inflammation on the underside of the foot. I had a few treatments and the issue seems resolved. If only there were more research into the connection between inflammation and hormone changes! Thank you for posting.
Catherine says
Julie, Thank you so much for writing this article. I am going through FS right now – almost at 3rd month and this past month has been an incredible amount of pain around the clock. I’m so glad to hear of your successful recovery. It’s hard to believe there are not more practitioners offering this capsule distension treatment in the US. In researching this therapy it seems it is a very common and highly successful treatment in the UK. (Hydrodilatation Therapy ) I am 4-5 hours drive from Dr Vad and thinking I would gladly make the drive to end this painful nightmare but with Covid 19, it might just have to wait..
Incidentally, I too just hit “official” menopause a couple months before my frozen shoulder started.
Julie says
Hello Catherine:
If you can get an appointment now the procedure will work better and faster. I am sure the doctor’s office is using careful protocols. Three months is already a long time to suffer this way.
Let me know how it turns out.
Best
Julie
Jennifer says
I have it now and believe I am in stage 2. Physical therapy is not working. I hate getting dressed in the morning due to pain. Any doctors in California that perform this procedure?
Julie Metz says
Unfortunately I do not know of any. In a normal world I would invite you to contact Dr Vad’s office in NYC and ask for a referral…but I can imagine it is a busy time there so it might not be as fast as usual.
Renee Deubner says
I have experienced a frozen shoulder on the right AND the left. The right side locked down first and 2 years later, the left locked down. Both times, I did physical therapy to regain mobility in my arms. I was never offered shots or surgery. It was a long and painful process – at least 6 months of PT per shoulder. It’s frustrating that little is known about why and how frozen shoulders happen, especially to women in perimenopause.
Julie Metz says
Hi Renee:
Apologies for delayed reply. Yes, the healing can be long and so frustrating. As a reader pointed out today, there appears to be a connection between inflammatory conditions and hormone drop in midlife. Dr. Vad spoke to me about promising research into collagen treatments. Mary, above, seems to have had a new treatment that wasn’t available when I researched and wrote this article. While it is unlikely that you will have a repeat case, now that you recognize the symptoms you can get early treatment. And tell your friends to be aware of the early symptoms so that they can recover more easily.
ElKay says
I wish I’d had this article and the wise words of Dr. Vad three years ago. I got a frozen shoulder, yes, soon after menopause started–I blamed my new standing computer desk set up where I’d been holding my right arm unnaturally high. A friend first diagnosed my frozen shoulder (which I’d never heard of) when I yelped as I reached for the salt shaker out at lunch one day. Doctor sent me directly to physical therapy (no thought of “capsule distension treatment,” and it was 3 therapists and *many* months later before one day my arm was suddenly able to raise all the way up again. All that therapy was SO painful and seemed endless. Now I’ll pay attention to any twinges I feel again in the shoulder area (god forbid) and get right to the doctor with this article in hand.