Written By: Chloe Wilson BSc (Hons) Physiotherapy
Shoulder pain at night is a common problem. It may be that you have pain during the day that gets worse in the evening, or it may be that you only notice your shoulder pain at night.
It doesn’t take much pain to affect sleep. You might struggle to get comfy making it hard to drift off, or the pain may wake you up. Whatever is going on, chances are you’re not waking up feeling rested and refreshed.
But the good news is, there are some simple things you can do to help. Here we are going to look at the common causes of shoulder pain at night and then go on to look at what you can do to help you get a good night’s sleep.
The term “Painsomnia” is becoming an increasingly popular term to describe the vicious cycle of pain and sleep deprivation. But why is shoulder pain worse at night? There are a few possibilities:
Shoulder pain at night is usually caused by either:
There may even be a combination of the two! There are also some medical conditions that tend to cause more pain at night e.g. rheumatoid arthritis and cancer, but these are rare and would usually be accompanied by other symptoms such as widespread pain, feeling unwell and unexplained weight-loss.
Let’s have a look at the most common causes of shoulder pain that get worse at night.
Shoulder bursitis is a common cause of shoulder pain at night. Bursa are small fluid-filled sacs that sit between two structures e.g. bones and tendons. They provide cushioning and a smooth, friction-free surface to allow the shoulder to move freely.
There are a number of different bursa located around the shoulder and any one of them may become irritated and inflamed. The two most common types are subacromial bursitis that causes pain at the top and front of the shoulder, and scapulotharacic bursitis which is a common cause of shoulder blade pain at night.
Bursitis usually develops after a shoulder injury or from repetitive friction/ pressure over the area from activities such as racket sports or throwing.
During the day, shoulder bursitis usually causes a dull, aching pain in the shoulder that gets worse when you lift your arm. But at night time, the pain often feels much more intense. Many people with shoulder bursitis get a lot of pain if they try and lie on their side as it squashes the inflamed bursa. Others are quite comfortable lying on their side but the moment they roll over and the pressure comes off the bursa, there is intense pain as the bursa rapidly expands.
You can find out all about the causes, symptoms, diagnosis and treatment options in the Shoulder Bursitis section.
Tendons are thick bands of connective tissue that form the junction between muscles and bones.
Shoulder tendonitis develops when there is inflammation and degeneration of one or more of the tendons, which usually develops gradually from overuse or repetitive friction.
Shoulder tendonitis typically causes a deep, aching, burning pain in the shoulder at rest and a sharp pain when reaching the arm out or lifting things. The arm often feels weak and range of movement may well be limited. Tendonitis can also cause nasty shoulder pain at night when lying on your side due to the pressure on the inflamed tendon, particularly with supraspinatus tendonitis.
Shoulder pain at night that is accompanied by restricted shoulder movement during the day could well be due to a frozen shoulder, particularly if you are over the age of 40. Also known as adhesive capsulitis, a frozen shoulder is when there is thickening and tightening of the joint capsule.
Arm movements get progressively more limited as the capsule tightens up, making activities such as reaching behind your back or your head difficult and painful. A frozen shoulder usually affects the non-dominant arm.
Intense shoulder pain at night is common with a frozen shoulder as the pressure in the already tight joint increases. After a few weeks or months, the pain should actually start to reduce but at the same time, the stiffness will get progressively worse. Early intervention is key with a frozen shoulder and in some cases surgery is required.
You can find out more about the causes, symptoms, diagnosis and treatment options in the Frozen Shoulder section.
Another possible cause of shoulder and arm pain at night is shoulder impingement syndrome. This is when there is narrowing of the bony gap at the top of the shoulder which causing pinching and friction on the soft tissues.
Shoulder impingement typically affects those who are frequently using their arm above head height e.g. sports such as swimming or tennis and occupations such as building and decorating. Impingement also increases in frequency as we age due to bones become more brittle and less smooth.
Typical symptoms of impingement syndrome are a sharp pain or toothache type sensation in the shoulder which may extend down the arm to the elbow. There tends to be an arc of pain as you lift your arm and overhead activities and heavy lifting often cause pain. In the early stages, there tends to only be pain when you are using your arm, but as the conditions worsens there may also be pain at rest and people often complain that their shoulder aches at night, and it may be painful to lie on that side.
There are a number of different treatment options – have a look at the shoulder impingement syndrome article to find out more.
The rotator cuff is the main group of muscles that control shoulder movements. There are four rotator cuff muscles that collectively surround the shoulder joint and work together to move and stabilise the shoulder.
Damage to the rotator cuff is a common shoulder problem that can develop from gradual, repetitive wear and tear or an acute injury such as a fall or heavy lifting.
Common symptoms of a torn rotator cuff include a deep, dull aching in the shoulder that gets worse when twisting or lifting your arm, weakness in the arm and shoulder and cracking or grinding in the shoulder. There is often also shoulder pain at night, particularly when there is any pressure through the damaged tendon.
Treatment for a rotator cuff tear includes medication, rest, physical therapy, rotator cuff exercises and in some cases steroid injections – find out more about treatment for a torn rotator cuff. It can take a number of weeks or even months for the pain to fully settle down, but there are some simple things you can do to reduce the shoulder pain at night.
There are a few simple things you can do to help you sleep better if you get shoulder pain at night:
Healthy sleep patterns can really help you to get a better night’s sleep. Try to have a consistent bed time (and wake up time) and think about your routine leading up to it. Avoid caffeine after lunch. Switch your phone off at least an hour before going to bed. Try doing some meditation, deep breathing, listening to relaxing music or have a warm bath - whatever helps you to relax.
If you get shoulder pain at night it is usually best to try and avoid lying on the affected side to reduce the pressure through your shoulder.
Ideally, you want to sleep on your back with your arms down by your sides but if you prefer to sleep on your side (the unaffected one!), pop a pillow or large cushion underneath the painful arm for support to reduce the strain on your shoulder.
You may also want to put a pillow behind your back to stop you from rolling over in your sleep. And if your arm is really painful, you could always wear a sling to keep the arm supported.
Make sure your bed is comfy. If your mattress is too hard or too soft, you can end up sleeping in awkward positions that put strain on your shoulder.
Before going to bed, try doing some gentle shoulder and arm stretches. These can help to reduce tension and inflammation in the shoulder and reduce pain. You might like to try out some of these arm stretches.
If shoulder pain at night is affecting your sleep, talk to your doctor about what medication could help. Over-the-counter medication may well be sufficient but it might be that you need something stronger.
Try and take any pain relief or anti-inflammatories around half an hour before you go to bed so they have time to work. And if arm pain at night is waking you up, ask your doctor about switching to slow-release medication.
Many people find that applying an ice pack or heat pad to their shoulder before going to sleep helps to reduce shoulder pain at night. Both can help, it generally comes down to personal preference which one people choose. In most cases, ice tends to work better in the early stages after an injury whereas heat gives more benefit with longer term pain.
Exercising during the day can also help reduce shoulder and arm pain at night. Try doing some form of cardiovascular exercise such as a brisk walk, cycling or swimming to increase blood flow and use up some energy.
Physical activity has been shown to be associated with better sleep. Ideally, try and exercise in the morning rather than before bed so your body and shoulder have time to relax and recover so you can get to sleep quickly.
Most cases of shoulder pain benefit from a course of physical therapy which may involve a combination of rehab exercises to strengthen and stretch the shoulder, joint mobilisations, acupuncture and electrotherapy.
Strengthening the rotator cuff muscles with shoulder rehab exercises helps to improve the strength, stability and position of the shoulder which all help to reduce shoulder pain.
During the day try to avoid activities that trigger your shoulder pain. Many cases of shoulder and arm pain and due to overuse and repetitive friction and it’s important to give your shoulder time to heal. It’s not always a case of no pain no gain!
Not all shoulder pain at night is the same. The location, frequency, intensity and even the type of pain (e.g. burning vs stabbing pain) will vary depending on what structures in and around the shoulder are damaged.
But how do you tell what is wrong? Let’s have a quick look at the most common features of shoulder pain that gets worse at night and what they might point to: