Frozen shoulder, also known as adhesive capsulitis, is a painful condition that restricts movement in the shoulder joint due to adhesion and inflammation in the joint capsule. While this condition can affect anyone, it is particularly common in women aged 40 to 60, with many cases coinciding with menopause.

What Is Frozen Shoulder?

Frozen shoulder is characterised by pain and stiffness in the shoulder joint. It progresses through two main stages: the painful stage, where movement becomes uncomfortable and often disrupts sleep, and the stiffness stage, where shoulder mobility is severely restricted. The exact cause isn’t always clear, but there are certain risk factors.

The Menopause Connection

Frozen shoulder tends to occur more frequently in women, especially during menopause. Hormonal changes, particularly declining oestrogen levels, can impact connective tissues, making them more prone to inflammation and stiffness. This hormonal shift may partly explain why women in midlife are at higher risk of developing the condition.

Signs and Symptoms

Key symptoms of frozen shoulder include:

• Pain: A deep, aching pain that worsens with movement. Night pain is common.
• Stiffness: As the condition progresses, shoulder movements become more restricted, making daily activities like dressing or reaching overhead challenging.
• Limited Range of Motion: Both active and passive movements are affected.

Risk Factors for Frozen Shoulder

• Age and Gender: Women between 40 and 60, especially those going through menopause, are at higher risk.
• Diabetes: Those with diabetes are more susceptible and often experience a more prolonged course of frozen shoulder.
• Thyroid Disorders: Hypothyroidism and other thyroid issues are linked to a higher likelihood of developing frozen shoulder.
• Immobilisation: Lack of movement after an injury or surgery can trigger the condition.

Treatment and Management Options

Physiotherapy: The Gold Standard

Physiotherapy is the cornerstone and is supported by the National Institute for Health and Care Excellence (NICE). It includes a combination of manual therapy, exercise, and education to relieve symptoms and improve shoulder function.

• Manual Therapy: Techniques like joint mobilisation and stretching are used to reduce stiffness and increase mobility.
• Exercise Therapy: A personalised exercise plan can help restore shoulder movement and build strength. Early in the painful stage, exercises are gentle, with intensity increasing as the shoulder improves.
• Patient Education: Understanding frozen shoulder, its natural progression, and expected recovery time is vital. Many patients worry about the severity of their pain, especially during menopause, but education can reassure them that frozen shoulder is manageable and temporary.

Injection Therapy: Corticosteroids and Hydrodilatation

For those whose pain severely limits rehabilitation, injection therapy can be an effective complement to physiotherapy.

• Corticosteroid Injections: These are most useful in the early painful stage, providing significant pain relief and reducing inflammation. This helps patients participate more actively in physiotherapy.
• Hydrodilatation: This procedure involves injecting a saline solution, often combined with a corticosteroid, into the joint capsule to stretch it and improve mobility. It’s typically used during the stiffness phase.

Can Frozen Shoulder Be Prevented?

While not always preventable, staying active and maintaining shoulder mobility can reduce the risk of developing frozen shoulder, particularly during menopause when hormonal changes increase vulnerability. If you experience early signs of stiffness or discomfort, seeking physiotherapy promptly can prevent the condition from worsening.

Role of Menopause in Frozen Shoulder Recovery

Due to hormonal changes, women going through menopause may experience a longer recovery time. However, with early intervention, including physiotherapy and, if necessary, injection therapy, most women see significant improvements within one to three years. Managing underlying conditions like diabetes or thyroid issues can also speed up recovery.

Conclusion

Frozen shoulder is a painful and limiting condition, but with the right treatment, particularly physiotherapy, most people can regain their shoulder mobility over time. For women experiencing menopause, the added risk makes it important to be proactive in addressing early symptoms. Whether through manual therapy, tailored exercises, or injection therapy, effective treatment can help you regain shoulder function and return to your regular activities.

Greater Trochanteric Pain Syndrome (GTPS) is a prevalent condition, particularly affecting peri- and post-menopausal women. It causes significant discomfort in the soft tissue on the outside of the hip and can severely limit mobility. This article discusses the signs, causes, and management of GTPS, with a focus on why it predominantly affects women undergoing hormonal changes.

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Luke Schembri is an Advanced Physiotherapy Practitioner working within the NHS, while also offering care to a limited number of private patients from his home. Born and raised in Epsom, he has always lived near Epsom Downs, which inspired his initial interest in the horseracing industry where he began his physiotherapy career. Luke is dedicated to delivering evidence-based, high-quality care to his local community. In addition, he authors a fortnightly blog that addresses health and wellbeing topics, particularly aimed at individuals over the age of 40.

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What is Greater Trochanteric Pain Syndrome?

GTPS is characterized by pain and tenderness over the greater trochanter, a bony area on the outside of the hip. The condition involves inflammation of the gluteal tendons or bursa, and although it was once called trochanteric bursitis, the term GTPS is now preferred as it covers a broader range of tendon-related disorders.

Signs and Symptoms

The primary symptom of GTPS is pain over the lateral hip, which can radiate down the outer thigh. Key symptoms include:

– Lateral Hip Pain: Often worsened by activities like lying on the affected side, walking, or sitting in low chairs.

– Tenderness Over the Greater Trochanter: Touching this area typically causes discomfort.

– Pain with Activity: Repetitive movements, such as climbing stairs, exacerbate the pain.

– Night Pain: Pain at night is common, particularly when lying on the affected side.

– Weakness or Stiffness: Some may experience hip weakness or stiffness, affecting their gait.

Why is GTPS Most Common in Peri- and Post-Menopausal Women?

GTPS disproportionately affects women in peri- and post-menopause due to hormonal changes and mechanical stress on the hip. Here are the primary reasons:

Hormonal Changes

The decline in oestrogen during menopause impacts the health of tendons, ligaments, and muscles. Oestrogen plays a critical role in maintaining soft tissue integrity, and reduced levels lead to:

– Decreased Collagen Production: Collagen is essential for tendon strength and elasticity, and its decline makes tendons more prone to injury.

– Increased Tendon Stiffness: Lower oestrogen increases tendon stiffness, contributing to gluteal tendinopathies.

– Altered Pain Perception: Hormonal changes during menopause can heighten sensitivity to pain, worsening GTPS symptoms.

Mechanical Load and Changes

Other factors contributing to GTPS in menopausal women include:

– Increased Load on the Hip: Weight gain during menopause places more stress on the hip joints and surrounding tissues.

– Reduced Physical Activity: Lower activity levels can cause muscle weakness, altering hip mechanics and increasing the likelihood of tendon injuries.

– Altered Gait: Pain-induced changes in walking patterns can further strain the hip and lead to GTPS.

Treatment and Management of GTPS

Treatment for GTPS involves conservative methods, physiotherapy, and sometimes more invasive procedures, following the National Institute for Health and Care Excellence (NICE) guidelines, which recommend starting with non-invasive options.

1. Conservative Management

   – Rest and Activity Modification: Reducing activities that worsen symptoms, such as standing for long periods or lying on the affected side, is crucial. Using a pillow between the knees when sleeping may help alleviate pressure on the hip.

   – Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): These medications can reduce pain and inflammation and are often recommended as initial treatment.

2. Physiotherapy

   Physiotherapy plays a key role in treating GTPS and involves:

   – Strengthening Exercises: Targeted exercises to strengthen the hip abductors, particularly the gluteus medius and minimus, improve hip stability and reduce strain on the tendons.

   – Manual Therapy: Techniques such as deep tissue massage and myofascial release can help relieve muscle tightness and provide short-term pain relief.

   – Education and Advice: Physiotherapists offer valuable guidance on managing activities and loading the hip joint to prevent further injury.

3. Shockwave Therapy

   Extracorporeal shockwave therapy (ESWT) is a non-invasive option that promotes healing by delivering shockwaves to the affected area. Some studies show positive outcomes for GTPS patients treated with ESWT.

4. Corticosteroid Injections

   For patients who do not respond to conservative treatments, corticosteroid injections may be used to reduce inflammation. However, repeated injections can weaken the tendons, so they are not a long-term solution.

5. Surgery

   Surgery is rare and reserved for severe cases where other treatments have failed. Options include removing the inflamed bursa or repairing the tendons.

Conclusion

Greater Trochanteric Pain Syndrome is a common condition that primarily affects peri- and post-menopausal women. Hormonal changes and mechanical stress on the hip contribute to its development. Effective treatment usually involves conservative management, physiotherapy, and sometimes shockwave therapy or injections. Early diagnosis and a tailored treatment plan can help alleviate symptoms, improve function, and enhance the quality of life for those affected by GTPS.