Chapter 2 — The Classic Pattern: Shoulders, Hips, and Morning Stiffness
One of the most recognizable features of polymyalgia rheumatica is the distribution of the pain.
The shoulders are particularly common sites of symptoms. A person may experience aching across both shoulders and upper arms, sometimes making it difficult to raise the arms above the head.
Simple activities can suddenly become challenging.
Putting on a jacket, washing or brushing the hair, reaching into a cupboard, or fastening clothing may require considerably more effort than usual.
The hips and upper thighs can also become painful and stiff.
Someone may find it difficult to rise from a chair, climb stairs, get out of bed, or walk after sitting for a long period.
The stiffness is often most pronounced after periods of inactivity, especially in the morning.
This can be an important clue.
For example, ordinary muscle soreness after exercise typically improves as the body warms up and the muscles move. PMR-related stiffness can instead feel particularly intense after waking or resting.
Some people experience symptoms in the neck as well.
The pain is often bilateral, meaning both sides of the body are affected, although symptoms do not necessarily have exactly the same intensity on each side.
Another important characteristic is the age group.
PMR is extremely uncommon in people younger than 50 and becomes much more common with increasing age.
However, age alone does not establish a diagnosis.
Several other conditions can produce shoulder and hip pain in older adults, including osteoarthritis, rheumatoid arthritis, rotator cuff problems, thyroid disorders, inflammatory muscle diseases, and other rheumatic conditions.
This is why the overall symptom pattern matters.
A person who suddenly develops significant stiffness in both shoulders and hips, particularly with prolonged morning stiffness, should discuss the symptoms with a healthcare professional rather than simply assuming they are caused by aging.
Early assessment can help distinguish inflammatory conditions from mechanical or degenerative problems.
Image 2 — Suggested placement: