Why Is My Shoulder Pain Worse at Night?

There are basically three conditions that can cause shoulder pain to worsen at night: bursitis, tendonitis, and rotator cuff injuries. This is because the inflammation involved in each can pull on the shoulder joint, especially when the area is compressed (as when laying on your side in bed).

This can make your shoulder feel stiff and painful. You may also experience muscle spasms, numbness, or tingling that radiates down to your fingers.

Shoulder pain that worsens at night may be caused by the following:

• Bursitis. This condition is caused by an inflammation of the bursa, a fluid-filled pad that cushions joints. Once bursitis develops in the shoulder, you are subjected to a vicious cycle of swelling, pain, and more swelling, leading to more pain … until you appropriately treat the condition. Bursitis in the shoulder is a common culprit of nighttime shoulder pain because laying on your side can compress the bursa, increasing the level of pain you’d normally feel with the bursitis.
• Tendonitis. This also is an inflammation-due-to-repetitive-use type of injury. When it occurs in the shoulder, the tendons that attach muscle to bone become inflamed and irritated, causing pain and stiffness in the area. Pain usually worsens at night, making it difficult to go to sleep or stay asleep at night. This may be because the effects of gravity when laying down cause the muscles and tendons in the shoulder to settle in a slightly different position, decreasing blood flow to the area and aggravating the pain of tendon issues like tendonitis.
• Rotator Cuff Injuries. The rotator cuff consists of muscles and tendons that connect the upper arm to the shoulder blade. The rotator cuff stabilizes the shoulder and enables smooth movement of the joint. Damage to the rotator cuff of the shoulder is a common overuse injury that can also result from a fall, lifting too heavy an object, or a car accident. It causes swelling and pain in the shoulder that can worsen at night because your position in bed – especially if you lay on your side – can further irritate and inflame the damaged muscles and tendons of the rotator cuff.

What to Do About Nighttime Shoulder Pain

If one shoulder hurts when sleeping, try laying on the other side. While people often do not control their bodies while asleep, you could try building a wall with pillows to prevent rolling over onto the injured shoulder while asleep. If that doesn’t help, try sleeping semi-upright either in a chair or by propping a few pillows under the upper body to alleviate pressure on the affected shoulder. Ask your doctor for a list of stretches that can be done to loosen the shoulder; these may be especially beneficial to do before going to bed.

However, if shoulder pain is a fact of life for you, it may be time to seek treatment.

Your orthopedic doctor will physically examine your shoulder, assess your medical history, and may order tests that can help with a diagnosis and identifying the cause of your shoulder pain. In general, an X-ray can identify structural issues such as bone fractures or spurs or the presence of arthritis; for soft tissue assessment, an MRI may be required.

Depending on your diagnosis, your doctor might prescribe corticosteroid injections to counter the effects of swelling. Specific exercises or stretches may be recommended and, if all else fails, surgery may be necessary to fix the problem. Most shoulder repairs can be done arthroscopically, requiring small incisions in a relatively quick procedure that involves less trauma to surrounding healthy tissue than is typical in traditional “open” surgeries. In some cases, a joint replacement surgery may be the best way to treat your pain for long-term symptom relief.

The Orthopaedic Associates of Central Maryland offer all manner of orthopedic treatments under one roof. If your shoulder has been aching and shows no sign of improvement, schedule your appointment by calling (410) 644-1880 or use the request an appointment form. We look forward to seeing you.