As a physician who sees patients with shoulder pain, one of the more common complaints I hear is shoulder pain at night. What causes this issue? What can be done about it? Let’s dig in.
Shoulder Anatomy 101
The shoulder is a shallow ball and socket joint which is surrounded by a capsule with ligaments and then the rotator cuff tendons. The muscles that make up the rotator cuff are in the back, top, and front of the shoulder. There is also a bursa, which is a lubricating sac between the muscles and tendons. The shoulder has cartilage just like any other joint.
To learn more about shoulder pain and anatomy, you may want to read my book about avoiding shoulder surgery:
What Can Cause Shoulder Pain at Night?
Here’s a video that goes over everything:
Shoulder pain at night can be caused by several different issues:
- Arthritis in the main shoulder joint
- Swelling in the bursa
- A rotator cuff tear
- Referred pain from the neck
Arthritis in the Main Shoulder Joint
The main shoulder articulation is called the glenohumeral joint. It’s a shallow ball and socket joint with cartilage. When that cartilage is injured or damaged through wear and tear, bone spurs can form and the bone can become painful and weak. This leads to deep aching pain, “inside” the joint. Changing the position of the shoulder while sleeping usually doesn’t matter.
Swelling in the Bursa
The bursa is the lubricating sac between the rotator cuff tendons and the deltoid. This is also called the subdeltoid bursa and when it’s swollen it’s called bursitis. This sac can become swollen due to “impingement”. This often happens because the muscles of the shoulder don’t work well and cause the bursa to get banged up. This pain can be worse with lifting your arm above your head. The pain can also get worse without movement as the bursa swells, so pain at night is common. This pain is usually worse with the hand above the head while sleeping as this puts pressure on the swollen bursa.
Rotator Cuff Tear
The shoulder joint is surrounded by tendons/muscles that help to stabilize and move the joint. The tendons can get torn through injury or wear and tear. The pain at night with this problem is usually positional depending on the part of the tendon that’s torn. For example, if the infraspinatus tendon is torn, the pain would be worse with moving your shoulder forward. Or the supraspinatus would be worse with the arm above your head.
Referred Pain from the Neck
Several pain sources in the neck can cause pain that goes to the shoulder. For example, the C5 spinal nerve can get irritated due to a bulging or herniated disc in the neck and can refer pain to the top of the shoulder. Or the C6 spinal nerve can refer pain to the shoulder blade area. Finally, the lower neck facet joints can also refer pain to the shoulder blade. These pains tend to get better or worse at night based on head position.
How Can I Stop My Shoulders from Hurting at Night? How Should I Sleep with Severe Shoulder Pain?
The easiest solution to shoulder pain at night that can be implemented right away is your sleeping position. I’ve personally found and have recommended to my patients that they use a pillow in a different way. Let me explain.
Place a larger pillow under your chest and keep your usual pillow for your head. Hence, as you lie on your side, there is a “hole” for your shoulder between the pillows. This is how it looks:
The next step may be an MRI. If you get that study performed and want a peek at what’s wrong yourself, check out my video:
Obviously, in the long run, getting the shoulder fixed is a good next step. Here are some ways we approach these issues:
- Arthritis: If it’s mild, we usually use platelet-rich plasma injection and if it’s more severe bone marrow stem cells. Obviously, if the shoulder arthritis is more severe, a shoulder replacement may be needed.
- Bursitis: A steroid shot can help, but that can also damage tissues. PRP also works well here.
- Rotator Cuff Tear: Most of these tears can be treated with PRP or bone marrow concentrate injection. Only some tears need surgery.
What does that injection look like? See my video below:
- Referred Pain from the Neck: This all depends on what’s happening in the neck. Epidural injections can help irritated nerves or facet injections can help pain from that structure. Surgery is rarely needed.
Why Does My Arm Hurt at Night?
What if you have shoulder pain at night that goes down your arm? If the pain extends down from your shoulder into your arm, your neck may be the cause. This pain can take the form of radiating pain from the neck to the shoulder to the arm, forearm, and hand. It can feel like pressure in the muscles like a blood pressure cuff. There may also be numbness, tingling, or electrical sensations down your arm.
The upshot? Shoulder pain at night is an indicator that something is wrong. Hence, find a way to get comfortable at night, find out what’s wrong, and then get it fixed!
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