Shoulder Pain

Frozen shoulder: why women need to know this

Adhesive capsulitis (frozen shoulder) is more common in women, with the highest incidence between 40 and 60 (Li et al., 2026). If your shoulder symptoms started around the same time as changes in your cycle, that's a pattern worth noting and something I ask about at the first visit. Hormonal changes are thought to affect the shoulder capsule through changes in collagen synthesis and inflammatory response (Saltzman et al., 2023), which may explain why the capsule contracts more aggressively in this demographic. That connection is increasingly recognised even if the mechanism isn't fully understood.

The practical point is this: frozen shoulder caught early tends to respond better to conservative treatment than one that has progressed to severe capsular contracture. If your shoulder stiffness is progressive, affecting range in all directions (not just a painful arc), and worse at rest or at night, don't wait to see if it resolves on its own. Frozen shoulder typically follows a course of 1-3 years (Wong et al., 2017), and a subset of patients experience prolonged or incomplete resolution beyond that window. Conservative care in the early stage reduces pain and maintains function during that process (Pandey & Madi, 2021). For early frozen shoulder, a conversation with your GP about a corticosteroid injection is often worth having (Ramirez, 2019). Corticosteroid injection has strong short-term evidence for pain relief in the freezing phase (Wang et al., 2017). If you do end up having an injection, combining it with hands-on care tends to produce better results than either alone (Challoumas et al., 2020): the injection addresses the acute pain, the hands-on work maintains range.

The shoulder doesn't work in isolation. Thoracic spine mobility, scapular mechanics, and neck function all influence how the shoulder moves and loads. An assessment that only looks at the joint itself will miss upstream problems. This is why the first session always includes the thoracic spine and cervical region, not just the shoulder.

Common presentations

• Frozen shoulder (adhesive capsulitis): progressive stiffening of the shoulder capsule limiting all movements, not just specific arcs. Often worse at rest and at night. Natural history of 1-3 years or longer; early conservative care reduces pain and maintains function during the process. More common in women aged 40-60, particularly around perimenopause, and in people with diabetes or thyroid conditions. Waiting on this one tends to work against you.
• Asymmetric carrying patterns: consistently carrying a heavy bag on one shoulder, holding a child on one hip, or sitting with the body rotated creates a sustained loading imbalance across the shoulder girdle. This can affect how the scapula sits and moves, alters resting tension in the rotator cuff and upper trapezius, and contributes to both tendinopathy and impingement over time. It's one of the most common and most overlooked contributors to shoulder pain in women.
• Rotator cuff tendinopathy: degenerative or irritated tendon tissue, usually the supraspinatus. Pain with arm elevation and weakness with resisted movement. Partial thickness tears and tendinopathy respond well to conservative management with progressive loading and joint mobilization. Tendons need load to remodel.
• Shoulder impingement syndrome: tendons or bursa compressed in the subacromial space with certain arm positions. The classic sign is a painful arc of motion around 70-120 degrees of elevation. Thoracic mobility restriction and scapular mechanics are common upstream drivers.
• AC joint problems: pain at the top of the shoulder, often from direct trauma, repetitive overhead work, or heavy pressing. Usually reproduced by cross-body adduction of the arm.

Shoulder pain after breast cancer treatment

If you're dealing with shoulder restrictions during or after cancer treatment, it's one of the most underrecognised physical side effects of what you've been through. Post-mastectomy and post-lumpectomy shoulder problems are common and often undertreated. Surgery, lymph node removal, and radiotherapy each affect the shoulder girdle in distinct ways, and the problems don't always appear immediately. Some women experience gradual stiffening over months; others notice specific restrictions that develop as they return to activity.

Three presentations come up most often:

• Post-mastectomy frozen shoulder: Adhesive capsulitis occurs at a significantly higher rate following breast cancer surgery than in the general population (Yang et al., 2017). Scar tissue from the surgical site, guarding during recovery, and altered shoulder mechanics from lymph node removal all contribute. Treatment principles are the same as for primary frozen shoulder: gentle mobilisation to maintain range, exercise to preserve surrounding function, and honest timelines about what to expect. The main difference is that recovery often needs to account for ongoing oncology care and any ongoing radiotherapy effects on surrounding tissue.
• Axillary cording (axillary web syndrome): A tight, cord-like structure that appears in the axilla (armpit) and sometimes extends down the inner arm weeks to months after axillary surgery. It feels like a taut band under the skin that limits shoulder abduction and arm extension. It can be uncomfortable but is not dangerous. Manual therapy and specific stretching can meaningfully improve range of motion and reduce discomfort, particularly when started early (Gonzalez-Rubino et al., 2023). In my experience, addressing this early is preferable to waiting for the restriction to become more established.
• Lymphedema considerations: If arm swelling (lymphedema) is present or has previously occurred, shoulder treatment needs to be modified. Deep tissue work on the affected limb is avoided. General shoulder mobility work and cervicothoracic treatment are still appropriate. If you have lymphedema, or are at risk of it following nodal clearance, a physiotherapist with lymphedema training should be involved alongside any manual therapy, and I'll refer clearly if that's the case.

Breast cancer treatment affects more than the surgical site, and shoulder function is one of the most common areas where that shows up. If you're dealing with restricted movement, cording, or stiffness following breast cancer treatment, this is something I assess regularly and can help you understand what's manageable conservatively and what needs specialist input.

When to see someone urgently

Common questions