Patient Guide: Understanding and Managing Shoulder Pain at Night

Experiencing shoulder pain at night can be a sign of a number of different shoulder conditions ranging from mild through to severe. Not only is dealing with shoulder pain at night uncomfortable, it can also rob you of sleep, which has negative flow on effects to your overall health and wellbeing.

This guide is designed to provide you with accurate and easy to understand information about the various causes of shoulder pain at night, how to manage it, and when to see a shoulder specialist for help.

Let’s take a closer look at the causes of shoulder pain at night and treatment options to help find relief.

What Are the Causes of Shoulder Pain at Night?

Before considering how best to treat your shoulder pain at night, you first need to know what is causing it. Shoulder pain at night is caused by a range of issues, each with their own challenges. Among the most common causes are:

1. Shoulder Impingement:

Shoulder impingement is a condition that occurs when the tendons of the rotator cuff and the bursa (a fluid-filled sac) become compressed between the acromion (part of the shoulder blade) and the head of the upper arm bone. People with this condition usually experience pain over the side of the shoulder, especially when the arm is raised over head. Additionally, people with this condition also have a lot of shoulder pain at night and have trouble sleeping on the affected side. Shoulder impingement is commonly caused by repeated overhead motions such as throwing. It’s also frequently seen in people who do a lot of heavy lifting or overhead for their work, such as carpenters, painters and construction workers.

2. Bursitis:

Bursitis is the inflammation of the bursa which is often caused by repetitive motions or overuse of the shoulder joint. When the bursa becomes inflamed it can cause pain, tenderness, and swelling over the side and front of the shoulder.

Often people with this condition report a feeling of warmth in the shoulder, as well as sensations of pain, pinching or stiffness when they lift their arms overhead. Some people also experience pain when they lower their arm from an overhead position. Once the condition has progressed, people with bursitis commonly report experiencing shoulder pain at night, especially when lying on the affected shoulder.

3. Tendon Damage (Tendinopathy or Tendinitis) or Tear (Rotator Cuff Tears):

Shoulder pain at night can also indicate that there is damage to the tendon, known as tendinopathy or tendinitis. This is where tendons around the rotator cuff become damaged, or in some cases even tear, known as a rotator cuff tear. Tendon damage is most commonly caused by wear and tear, sport injuries or accidents involving sudden movements. Tendonitis of the shoulder often causes pain which worsens when reaching overhead or lifting the arm, as well as an aching pain at night-time especially when lying on the affected side.

4. Shoulder Arthritis:

Arthritis of the shoulder is another relatively common cause of shoulder pain at night. As we get older the quality of tendons and cartilage in the shoulder may degenerate leading to pain, stiffness and weakness of the shoulder joint. Shoulder arthritis generally begins with inflammation of the shoulder joint, but worsens over time, causing damage to the structures within the shoulder. It commonly leads to loss of cartilage and narrowing of joint space. Not only does this cause issues carrying out your day-to-day activities such as brushing your teeth and hair, it can also cause a lot of pain at night.  

Why Does My Shoulder Pain Get Worse at Night?

There are a number of reasons why shoulder pain happens at night. Some of the most common factors include: Several factors contribute to increased shoulder pain at night:

Sleeping position: Often those who sleep on their side – especially the side of the affected shoulder – experience the most pain at night. This is because lying on your side compresses the inflamed and damaged structures in your shoulder, which intensifies the pain.

Reduction in blood flow: When you’re asleep, your body is generally still, leading to decreased blood flow to the shoulder (and other extremities). While this decrease in blood flow is essential, allowing your body to focus on other essential and restorative functions, it can also lead to increased pain and discomfort in an injured shoulder. 

Muscle Stiffness: Muscle stiffness is a common cause of shoulder pain at night. When you are sleeping, your body is resting in the one position for an extended period of time. As a result, this can cause your muscles to stiffen leading to pain and discomfort.

How Should You Sleep if Your Shoulder Hurts?

You may be surprised to hear that good sleep posture is just as important as maintaining good posture throughout the day. Preferred sleeping position varies from person to person, however, here are some tips that will help you maintain the best possible posture irrespective of whether you’re a back or side sleeper:

Back Sleeping: Lie on your back with a pillow placed beneath your head and another pillow placed under the affected arm to support it.

Side Sleeping: If you prefer to sleep on your side, place a pillow between your knees and a second pillow to support your upper arm. This will help you keep your shoulder in a neutral position.

It is recommended that you avoid sleeping on your stomach as this can cause a lot of strain to your neck and back, as well as exacerbating pain in your affected shoulder. 

Easy at-home exercises to help shoulder pain at night:

Performing some simple exercises can go a long way in reducing shoulder pain and improve mobility. As shoulder pain at night can sometimes be caused by a serious underlying issue, it’s important that you always consult a medical professional before starting an exercise routine. Provided you have engaged a medical professional, you can try the following three exercises: 

Wall Climbs: Stand facing a wall so your fingertips are just touching it. Use your fingertips on the affected arm to slowly walk your fingers up the wall as high as you can go, before slowly walking them back down. You should feel a gentle stretch in your shoulder as your arm walks higher. 

Pendulum Swings: Lean forward slightly and secure your non injured arm on a table of chair for balance. Meanwhile, allow your injured arm to hang down in front of you. Slowly swing your arm in small circles, gradually getting bigger provided you don’t feel too much pain. The arm movement should mimic that of a pendulum, swinging back and forth. Pendulum swings are an excellent way to promote movement and flexibility.

Shoulder Blade Squeezes: Sit or stand upright and make sure your shoulders are relaxed, with your arms hanging freely by your sides. Now, gently squeeze your shoulder blades together, hold the position for a few seconds, and then release.  Shoulder blade squeezes are a simple but effective way to strengthen the muscles around your shoulders and alleviate pain in the area. 

When should you Seek Treatment for Shoulder Pain?

In some cases, shoulder pain can be managed with conservative treatments, including rest and at home remedies. However for more severe cases, especially where the pain is described as moderate to severe it’s is crucial to consult a shoulder specialist for a proper diagnosis and treatment. 

If you’re dealing with shoulder pain, but you’re not sure whether it’s time to consult a medical professional, ask yourself the following questions:

  • Has the pain persisted or worsened over time?.
  • Does the pain prevent you from sleeping or performing daily activities?
  • Is there swelling, redness, or a change in the appearance of your shoulder?
  • Are you experiencing weakness or loss of function in your arm?

If you have answered yes to any of these questions it is crucial that you see a shoulder specialist. For specialised care, Dr. Sushil Pant, leading Sydney shoulder surgeon in Sydney can diagnose the underlying cause of your shoulder pain and recommend a treatment plan tailored to your unique needs.

Taking action to cure your shoulder pain

Shoulder pain which flares up at night-time is not something you should ignore. If you are experiencing persistent or worsening pain at night, or upon waking, it’s crucial that you see a shoulder specialist who can determine what’s causing the pain. A specialist, such as Dr. Pant will be able to diagnose (or rule out) some of the most common shoulder problems such as bursitis, arthritis, shoulder impingement, and more. 

A shoulder specialist will not only identify the underlying cause of your shoulder problem, but will help you take the essential steps toward reducing your pain and getting a good nights sleep.

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