Common, a little more so in women, with the same main causesEmerging evidence
Estimates of how many people have shoulder pain vary widely (6.9% to 26% at any one time, across 18 studies), and about 2.4% of UK adults see a GP about it each year, with new cases peaking around 50. It is a little commoner in women: in Dutch general practice, it was commonest in women and at 45 to 64; 65% of 526 people consulting for the first time were women; and in a UK survey of 9,696 working-age adults, shoulder tendon problems were found in 6.1% of women and 4.5% of men.
The causes are mostly the same in women and men. In 766 people at a Norwegian hospital clinic, few differences were seen between the sexes, though women under 60 had a little more muscle pain, and women over 70 more shoulder arthritis (41% against 17%).
Sources 1, 2, 3, 4, 5, 6
The muscles, tendons and jointsEmerging evidence
Rotator cuff related pain (often called impingement) is the commonest diagnosis (36% in the Norwegian clinic): pain on the outside of the shoulder and upper arm, a painful arc as you lift the arm out to the side, and pain lying on it. An NHS physiotherapy booklet says it affects men and women equally. Muscle pain across the top of the shoulder and neck came next (17%), more often in women under 60, and strength training cut that kind of pain in trials in women.
Calcium deposits in a rotator cuff tendon (calcific tendinitis) bring sudden, severe pain, often at night; they were found in 42.5% of people with shoulder pain in one Dutch study, and being female went with them (odds ratio 1.5). Rotator cuff tears get commoner with age in both sexes, and so do scan findings in shoulders that don't hurt. Loose shoulders without an injury mostly affect people under 25, and hypermobility disorders (very flexible joints with symptoms) were diagnosed far more often in women (70% of 6,021 in Wales); 4 in 5 people with them have shoulder symptoms. Pain felt in the shoulder can also come from the neck, NHS inform says.
Sources 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
Frozen shoulder: who gets itStrong evidence
A frozen shoulder brings a deep ache, worse at night, and stiffness in every direction, especially turning the arm outwards (doing up a coat or reaching a back pocket). It affects 2% to 5% of people. It is most common between 40 and 65, the range our frozen shoulder guide gives from a US physiotherapy guideline, with a peak in women in their 50s: the UK care pathway from the British Elbow and Shoulder Society puts the peak at 56, and in 223 people followed over the years there were 1.6 women for every man.
Diabetes is the strongest link, with about 5 times the odds (10.8% of people with diabetes against 2.3% without, in the pathway's figures), then thyroid disease (odds ratio 1.87). NHS inform also lists Dupuytren's contracture, Parkinson's disease, heart disease, high cholesterol, smoking and being inactive.
Sources 16, 17, 18, 19, 20, 21, 22
The menopause and frozen shoulder: linked in time, not shown to cause itMixed evidence
Frozen shoulder peaks in the menopause years, and NHS inform lists being peri-menopausal or menopausal among its risk factors, but the UK care pathway says "a causal link has not been identified". In 310 women seen for shoulder pain at one Korean clinic, frozen shoulder was as common before the menopause as around it (31.8% and 35.4%), and a 2025 review's theory about falling oestrogen hasn't been tested.
Hormone replacement therapy (HRT) hasn't been shown to prevent or treat it: in the records of 1,952 women aged 40 to 60, frozen shoulder was recorded in 3.95% of the 152 on hormone therapy and 7.65% of those not, a difference that could be chance, and the authors call it a pilot. No trial has tested it. Muscle and joint aches are commoner around the menopause: across 37 studies of 93,021 women they were reported by 40% before it and 57% to 59% around and after it, and shoulder pain was a little commoner in menopausal women in a Chinese survey (20.4% against 15.5%).
Sources 21, 16, 23, 24, 25, 26, 27, 28
Feeding, carrying and very flexible jointsEmerging evidence
Shoulder pain was reported by 34.3% of 216 breastfeeding mothers in a Turkish clinic survey, more often with the cross-cradle hold and rocking the baby in the arms, and less often with help at home; in an online survey of 471 mothers in Arabic-speaking countries, 36.8% had arm or shoulder pain, and support such as pillows and a good chair went with less. These are snapshots that may not apply everywhere.
Carrying a baby in a well-fitting front or back carrier changed the wearer's body less than carrying in the arms, in 14 small studies, and badly fitting carriers went with discomfort and, rarely, danger to the baby. No study has looked at handbags or shoulder bags, and one snapshot study of 339 women found more shoulder and neck pain in the larger-cup group.
Sources 29, 30, 31, 32, 33
After breast cancer treatmentStrong evidence
Surgery to the armpit and radiotherapy can leave the shoulder stiff and painful, with arm swelling (lymphoedema) or tight cords down the arm (cording): up to a third of women have restricted movement, long-lasting pain or lymphoedema. Across 72 studies, arm lymphoedema followed in 16.6% (19.9% after removing the armpit lymph nodes, 5.6% after a sentinel node biopsy), and the NHS lists frozen shoulder among the possible effects of a mastectomy.
Radiotherapy went with a little more frozen shoulder in insurance records of 1.67 million women (odds ratio 1.29), and nearly half of women taking aromatase inhibitors, the hormone tablets used after some breast cancers, report joint pain (47% of 200).
Sources 34, 35, 36, 37, 38, 39
Later lifeStrong evidence
Polymyalgia rheumatica (pain and stiffness in both shoulders, often the neck and hips too, with more than 45 minutes of stiffness each morning) is commoner in women, mostly over 65, and very rare under 50. Women lose bone quickly in the first years after the menopause, and a broken upper arm after a fall is commonest in older women, with about 2 women for every man. Shoulder arthritis was the commonest diagnosis in women over 70 at the Norwegian clinic.
Sources 40, 41, 42, 43, 6
Causes outside the muscles and jointsStrong evidence
The heart: heart attack pain is usually tight or squeezing in the chest and can spread to the arm, neck or jaw. The British Heart Foundation says women sometimes have the less well-known symptoms rather than chest pain, including pain that spreads to either arm, the neck, jaw, upper back or stomach. Across 27 studies, women having a heart attack more often had pain between the shoulder blades (about 2.2 times the odds), in the neck or jaw, felt sick or were breathless, while left arm or shoulder pain was as common as in men (38% and 37%) and chest pain was still the commonest symptom in women (74%). In a US registry of 1,143,513 people, 42.0% of women and 30.7% of men had no chest pain. Angina is chest, neck, shoulder, jaw or arm pain brought on by exertion that eases with rest.
Other causes: a clot in the lungs (sudden breathlessness with chest or upper back pain), which is more likely after surgery, in pregnancy and after a birth, and with contraception or HRT that contains oestrogen; an ectopic pregnancy, where shoulder tip pain (where the shoulder ends and the arm begins) with tummy pain, bleeding or dizziness can mean bleeding inside; shoulder pain after keyhole surgery on the tummy, from the gas used, which is common and settles; and gallstones, commoner in women and over 40, where pain under the right ribs for more than 30 minutes can spread to the right shoulder blade (NHS inform). Rarely, the UK pathway notes, a tumour can be mistaken for a frozen shoulder in people over 40.
Sources 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 16
When a scan or test helpsStrong evidence
Rotator cuff pain and frozen shoulder are recognised from the story and an examination: frozen shoulder is a clinical diagnosis, and routine X-rays rarely find anything else. Scans show rotator cuff changes in many shoulders that don't hurt, more with age (from 9.7% at 20 and under to 62% at 80 and over), so a scan finding doesn't always explain the pain.
Tests answer specific questions: an X-ray after a fall, or to look for arthritis; an ultrasound or magnetic resonance imaging (MRI) scan when a tear is suspected after an injury; an electrocardiogram (ECG) and blood tests for a suspected heart attack; a pregnancy test, then an ultrasound scan and blood tests, for a suspected ectopic pregnancy; tests to rule out conditions such as rheumatoid arthritis before polymyalgia rheumatica is diagnosed; a blood sugar check, since diabetes is so strongly linked with frozen shoulder (our suggestion); and a breast clinic for a new lump.
Sources 16, 7, 11, 44, 50, 40, 54
How it usually goesStrong evidence
Many shoulder problems begin to settle within 6 weeks, NHS inform says, though the NHS says shoulder pain can take 6 months or longer. Rotator cuff pain settles in about half of people in about 6 months, and rehabilitation takes about 3 to 6 months; every group improved substantially over a year in the largest trial. About 80% of loose shoulders respond to physiotherapy, which can take up to 6 months.
A frozen shoulder can take more than 2 years, recovery is slower with diabetes or thyroid problems, and some people keep slight stiffness that doesn't hold them back. In 223 people followed for an average of 4.4 years, 59% had normal or near-normal shoulders, and most of the rest had mild symptoms; most improvement comes early rather than in neat stages. After breast cancer surgery, exercise kept arm function better at a year. Menopause symptoms usually last 7 to 9 years. No one can promise a timescale.
Sources 15, 55, 7, 56, 21, 17, 57, 12, 34, 27
