Shoulder pain at night is a prevalent and debilitating problem. If you have shoulder pain at night, you know how disruptive it can be! Night pain in your shoulder is often present because of an issue with your rotator cuff. Inflammation of the subacromial bursa overlying the rotator cuff is the reason why you are awakened at night. This post will cover the most common issues that can affect the rotator cuff and cause night pain. These issues include calcific tendonitis, rotator cuff tears, subacromial bursitis, and rotator cuff tendonitis.
Not being able to sleep can significantly affect your quality of life. We are going to explore the common causes of shoulder pain that can affect your ability to sleep, and some of the ways to treat it.
Inflammation of the rotator cuff and secondary bursitis (see picture below) are the most common reasons why you can not lay down and sleep through the night. The subacromial bursa is a small sack that sits on top of the rotator cuff tendons. A healthy bursa will lubricate the rotator cuff tendons in the shoulder to minimize friction between the rotator cuff and the bones of the shoulder. The bursa can become inflamed because of various rotator cuff issues. Once angered, the bursa is likely responsible for a significant amount of your night pain.
Recent sports injuries or overuse injuries to the rotator cuff will also cause significant pain at night. Injuries to the rotator cuff will also cause inflammation of the bursa. No matter which side you try to sleep on, your shoulder pain wakes you up. Eventually, this will start to affect your quality of life and your psychological well-being significantly.
Why Does My Shoulder Hurt At Night?
The most common causes of shoulder pain when sleeping are the rotator cuff and subacromial bursa. Many of you might have mild shoulder pain during the day, but terrible shoulder pain at night. When the rotator cuff is torn or frayed, it will irritate the subacromial bursa. That bursa is a small pocket that sits on top of the rotator cuff. The bursa can become inflamed, causing bursitis. That inflammation is the reason you have such severe pain at night. Not everyone with rotator cuff pain at night has a torn rotator cuff. There are many different reasons why your rotator cuff is causing you to wake up at night.
Most common causes of rotator cuff pain:
- Rotator cuff tear
- Rotator cuff tendinosis
- Calcific Tendonitis
- Tendonitis/Bursitis and inflammation.
- AC Joint Arthritis
- Tendonitis of the biceps
- Labral tears do not cause night pain.
As you can see above, there are many different types of rotator cuff issues. One of the more common causes of rotator cuff pain is a process we call rotator cuff tendinosis. This implies that your rotator cuff is starting to wear out, fray and degenerate. If the rotator cuff begins to degenerate enough, it may begin to tear. A small tear is referred to as a partial rotator cuff tear. The rough surface of the rotator cuff tendons due to a partial tear can irritate or inflame the bursa sitting on top of the rotator cuff. Your shoulder might hurt with certain activities too… but it is the night pain that usually makes you call our office.
Some of you have injured yourself or fallen onto your arm, and now your shoulder pain is keeping you up at night. For those of you with night pain following an injury, a more severe full-thickness rotator cuff tear is possible. You should have your shoulder evaluated sooner rather than later.
What is the Treatment For Rotator Cuff Tendinosis and Severe Night Pain
The goal of treating people with severe night pain is to limit the inflammation within the shoulder, and more specifically, within the subacromial bursa. Many people with night pain due to rotator cuff issues will respond to:
A heating pad… yes, a heating pad. Used carefully (do not fall asleep with it on) and often a heating pad can provide a surprising amount of relief. If your shoulder is not allowing you to sleep and you can’t get in to see your shoulder specialist, this is an excellent place to start. Many people think that ice is most appropriate for this type of inflammation… but a surprising number of you will feel better with a heating pad. They should be applied for 15 minutes, then taken off for 15 minutes… you can continue 15 minutes on/15 minutes off for as long as needed.
Sleeping in a reclining chair.
Sleeping in the semi-sitting position can help many people with severe shoulder pain get to sleep. You can also prop yourself up on a couch or in bed with many pillows to get yourself elevated at least 45 degrees. Putting a small rolled-up towel behind your shoulder to push it forward can also help minimize the pain you are experiencing.
An Ice Compression sleeve:
An ice compression wrap: These ice sleeves seem to be very useful at minimizing your pain at night and allowing you to fall asleep. Many patients have commented over the years that these sleeves have been helpful. Again, heating pads are helpful as well. Some people prefer ice, and some prefer heat. There is little chance of harm, so try both until you find what works best for you. These ice compression sleeves are also useful and improve your pain following a rotator cuff overuse injury, or surgery.
Shoulder Injections for Night Pain:
When you are in our office, we will discuss options to improve your night pain. Not being able to sleep is very disturbing, so you may want to consider an injection. Injecting cortisone, or a steroid into the bursa can be one of the fastest means of achieving meaningful pain relief. Injections into the subacromial bursa, that area above your rotator cuff that tends to become inflamed can be beneficial in some circumstances. We know that routine cortisone injections are not the best idea. Frequent injections near tendons can cause the tendons to degenerate further. Injections of cortisone into the bursa, however, can be beneficial in people who are very unhappy because they can not sleep. These injections often start working in one day and continue to work for a few weeks to months, so you can begin recovering from your loss of sleep.
Shoulder support pillow:
Again, I have had a few patients who brought these in to show me when they found their own way to get to sleep. These patients found that sleeping with a Shoulder Support Pillow/System enabled them to get to sleep. There is no research to support its use, but if you can’t sleep at night, many people will try everything.
Physical therapy:
Physical therapy to address the rotator cuff is beneficial over the long term to help improve your shoulder pain. For patients without severe night pain, then we start with physical therapy and try to avoid injections. If the pain at night is severe, then we usually try an injection first to calm things down and follow that soon afterward with a course of physical therapy. That therapy is generally taken 2-3 times per week for 4-6 weeks. Many of you can learn the exercises yourself so you can continue the exercises on your own. Maintaining the activities, even after the physical therapy is done is essential to decrease the risk of the pain coming back.
Medications :
Many patients with severe shoulder pain at night require medications to help get them to sleep. At least until the pain starts to improve. Most people will start with NSAIDs like Ibuprofen, Naproxen, and Naprosyn which are available over the counter. Those of you with heart disease, ulcers, kidney disease, asthma, or hypertension will want to speak with your doctor or cardiologist first. Combining an NSAID with Tylenol can be even more useful. The two medications together can be very effective at minimizing your pain.
Rotator cuff surgery for night pain:
Surgery has been proven to be effective at helping alleviate the night pain associated with many rotator cuff disorders. Surgery should be your last choice. But if you do not respond to medications, injections, physical therapy and changing your sleeping positions, then surgery might be appropriate to consider. Surgery for night pain in the shoulder is arthroscopic. That means that the surgery is performed through small holes with a fiberoptic camera. The procedure we recommend to alleviate night pain is called an arthroscopic decompression. That name implies that we will be decompressing the space above your rotator cuff by removing the inflammatory tissue. During the surgery, we remove the inflammation due to the bursa that sits on top of your rotator cuff.
During the arthroscopy, we also inspect and evaluate the rotator cuff. If the rotator cuff has damage such as a partial tear, then we may consider placing a biological patch which might help to repair a worn-out rotator cuff. That patch is placed after the inflammation is removed, and the rotator cuff is smoothed out to eliminate the degenerative/frayed tendon which might be irritating your shoulder. Not everyone who has partial tears or fraying of the rotator cuff will require a patch. Many of us have seen issues in some people after the patch is placed. There is a chance that you will react to the patch– so we tend to use it in people with certain types of deep partial tears, or if we are repairing a degenerative rotator cuff tear.
I Tried Therapy, and My Shoulder Still Hurts At Night
Non-surgical treatment of rotator cuff related pain is very often effective. Most patients will be able to sleep comfortably after an injection and a course of physical therapy.
A small percentage of people will not respond to non-surgical treatment. I find that people with severe night pain are usually ready to have surgery sooner. They are miserable …as are those who live with them. Because we have a surgical option proven to diminish or eliminate night pain in your shoulder, it may be a reasonable option for you to consider if you do not respond to non-surgical or conservative treatment.
Research has shown that surgery on your rotator cuff to repair a rotator cuff tear or to reverse tendinosis can dramatically improve or eliminate your night pain.
Sleep disturbance is common in patients undergoing rotator cuff repair. After surgery, sleep disturbance improves to levels comparable with those of the general public. Preoperative and prolonged postoperative use of narcotic pain medication negatively affects sleep.
Source: Sleep Disturbance Associated With Rotator Cuff Tear
Surgical options for patients with night pain and injuries to the rotator cuff depend on the type of damage you have. The possible types of injuries we are dealing with include rotator cuff tendinosis, bursitis, a partial rotator cuff tear or a full-thickness rotator cuff tear. For those of you who injured your rotator cuff from a fall and have developed weakness, as well as night pain, then a repair of your rotator cuff might be your best option.
For patients with severe night pain due to tendinosis or a partial rotator cuff tear, a promising procedure is where we place a small patch into the shoulder during a shoulder arthroscopy (minimally invasive). Using a camera and other instruments, we place the patch over the area of degeneration or tearing. Then biology should take over and slowly regenerate your rotator cuff over time. The patch usually becomes absorbed into your tendon and “induces” the tendon to heal. Before we place the patch, we will also clear away any inflamed bursa. Removing the inflamed bursa will ease your discomfort. Reversing or improving the tendinosis and partial tear could give you a good chance of not having to deal with this again in the future.
A fair number of shoulder surgeons are currently utilizing this technology.
Disclaimer: this information is for your education and should not be considered medical advice regarding diagnosis or treatment recommendations. Some links on this page may be affiliate links. Read the full disclaimer.
Hi, Thankyou for the informative site! It’s great!r Not getting to sleep is right! The pain/dull constant ache always seems worse at night! My left arm has a stabbing feeling on top of shoulder, with ache down the front, and side. It feels weak. It was diagnosed by ultrasound and X-ray with tendonitis, bursitis and spur, yet ROM is pretty good! (Cortisone did nothing to help, and I sit up most nights as it hurts to lie in bed, though doesn’t usually wake me once I get to sleep!
I have been told it needs an op. However, not until my first right arm improves..I’m actually 10 months post op for rotator cuff surgery (due to a car accident) for full thickness tear, bicep tenodesis, subacromial decompression and AC joint excision, CA ligament removed, bursar removed, etc. and have had severe inflammation ever since. A cortisone injection a month ago has made no difference. I can only raise my right arm forward to around shoulder height without pain/soreness..and sideways is not too great.. is this normal at this stage? I have a numb hand and elbow pain on inner and outer elbow, which has only been since the op..but was told it is probably not related to the surgery.For now I am told to give it time..around 18 months to heal..is this as good as it gets or how long until you know if the surgery actually failed? Many thanks!
Excellent Post very informative Dr. Luks. Having a torn rotator cuff brings some serious pain to the shoulder and surrounding areas. Physical therapy and anti-inflammatory pills can really help even temporarily. However, what we have found with our patients who try our newly designed rapid release pro 2; also have seen significant reduction of pain in their shoulders. All while treating their pain naturally, without any pills or medications.
Excellent Post .I experienced the same pain and so the post helpful me very much. It is very informative and explain the causes neatly and also mention the treatments its also good. Thanks for sharing this with us.
Thanks for you help
That whole article was written as if you were in my head, explaining my exact case. I prop pillows under both of my shoulders at night, after wrapping a blanket around them. The only comfort I have found besides doing this is sleeping with both arms above my head. The lack of sleep has been detrimental to my way of life and I have found myself feeling overwhelmed with every normal day activities simply because I do not have the energy to do them. I am sleepy throughout most of my days and I need a resolution, ASAP! I had my rotator cuff checked years ago and was told that I had hyperlaxity. Well, many years later I still have pain and it only seems to be getting worse. I LOVE that I found your page and that someone else knows how I feel. I am a Tricare Prime customer and am hoping that changing to a different Primary Care Physician will help resolve my issues!
Thank you for this information. I had surgery in October of 2015 Arthroscopic Subacromial Decompression / Distal Clavicle Resection. And a bicep moved. I have popping when push my self up away from a table or when get up out of the recliner. I have a great amount of pain and discomfort during the day and especially at night. I have had Cortizone shots and I sleep in different positions. Nothing is help me. I’m just wondering if my Doctor is not see that I may a Rotator Cuff Tendinosis? I’m a Electrician and I always have tools above my head. What would you recommend that I do or say to my currant doctor?
Thank you
The pain I wake up with at 5 AM is like a knife being twisted in both of my deltoids between the mussels. Very Very sore this morning.
Shoulder pain at night really can be awful….
Have a shoulder doc check out your shoulder. Various non-surgical treatments can work well at alleviating night pain.
Dear Dr. Luk,
If possible and if you have time to respond to me than that would be greatly appreciated.
A few months ago I was trying to prevent a neighbor from falling down because of dizziness and in doing so I didn’t have proper leverage and I hurt my right shoulder as he was falling and my attempt of trying to keep him upright.
I had an MRI done and I would like to share it with you to see if you have any recommendations as far as physical therapy that may allow me to heal the tears if that is possible, rather then go through surgery which will take me out of work and be in a sling for at least 4 months.. I also have a very low tolerance for pain..Thank you for your interest in helping people, that is very commendable. The following is the MRI results..
Thanks,
Stan Levy
MRI date 11/16/17
Clinical Infomation..
Right shoulder pain with history of a lifting injury. Evaluate for rotator cuff tearing.
Comparison
None.
Contrast
None.
Technique
MR imaging of the right shoulder was performed, including the following pulse sequences, Corona T 1, coronal STIR, coronal T2, axial T2, sagittal STIR
Findings
Rotator Cuff: A small full-thickness tear of the supraspinatus tendon is seen at its greater tuberosity insertion posteriorly, measuring approximately 9 x 6 mm (series 105 image 10, series 109 image 1 5, series 104 image 5). Mild diffuse thinning of the supraspinatus tendon is seen in its distal 2 cm. The infraspinatus tendon shows mild tendinosis. There is also intermediate signal along the undersurface of the distal infraspinatus tendon, which could reflect mild undersurface tendon fraying. The teres minor and subsapularis tendons appear intact.
Muscles
The regional muscles show normal signal intensity and volume.
Biceps:
The Long-head of the biceps tendon shows a mild degree of tenosynovitis.
Subcromial/SubdeloidBursa:
A small amount of fluid is present in the subacromial/subdeltoid bursa.
Acromion/AC Joint: The anterior acromion shows a type of 1 flat undersurface. There is no lateral or anterior downsloping of the acromion, lateral subacromial enthesophyte formation, or osacromial. The acromiohumeral distance is narrowed to approximately 5 mm. There is a mild degree of osteoarthritic change at the acromioclavicular joint, without evidence of mass effect on the rotator cuff.
Glenohumeral Joint/Labrum: No discrete labral tear is seen. Capsular structures and articular surfaces appear intact. There is no significant glenohumeral joint effusion;
Bone Marrow:
Mild marrow edema and cystic change are seen in the distal clavicle adjacent to the acromioclavicular joint.
Impression:
1. A 9 x mm focal full-thickness tear of the distal posterior supraspinatus tendon fibers is seen in the right shoulder. There is diffuse attemuation of the distal 2 cm of the supraspinatus tendon, which may reflect more diffuse partial thickness tendon tearing or attritional/atrophic type change in the tendon.
2. Mild tendinosis of the infraspinatus with questionable mild undersurface tendon fraying distally.
3. Mild biceps tenosynovitis.
4. Small amount of fluid in the subacromial/subdeltoid bursa.
5. Mild osteoarthritic change at the acromioclavicular joint.
Hi ..
Many of these small rotator cuff tears are degenerative in nature. As your report says… the “diffuse attenuation” is likely due to time related degeneration. In all likelihood these findings were there before the incident in question. There is no “edema”, etc to lead one to believe that the tear is acute.
Depending on your age, nearly 25-50% of people are walking around with these tears and do not know it. Why some hurt and others do not we can not answer.
Most of these shoulders are treated with PT to see if the pain subsides and your function improves. Some of these tears might become larger over time (usually many years) while some tears do not become larger over time. We can not predict which tears might become larger. Therefore we monitor people who have been treated non-operatively with small tears like this.
Thank you for this post !
Amy J.Mattox
Hi,
Wow I don’t know why I didn’t search night time shoulder pain sooner. This is exactly how I feel and it is AWFUL. I had a baby a week ago and did something to my shoulder either during labor or in the few days following birth. I had to wake up my significant other at 2am and make him bring me to the ER because I was so desperate for pain relief. I feel like knife is constantly stabbing me in the top of my shoulder. Ibuprofen I was prescribed isn’t helping at all! Well the Dr’s at the ER sent me home with the same regimen NSAID and Tylenol and I’m still waking up in excruciating pain around 2-3am. Currently my ice pack compression sleeve is helping me get sleep. My baby sleeps so well and it’s frustrating that I’m still awake when he isn’t! This new mom needs HELP! I’m going to call my primary physician tomorrow.
HI Kathryn,
You need a good examination by a good shoulder doc. Both the neck and shoulder can cause severe night pain in the shoulder region. If people are truly miserable we will often try an injection to calm things down. Further imaging may be needed depending on the examination and the xrays. Bursitis, calcific tendonitis, and
“pinched” nerves in the neck are the most common causes of shoulder pain at night.
Good luck to you.. and your newest member of your family.
Your article was very helpful as I finally found a description of what I think might be going on with my shoulder. For the past several months I have been waking up several times at night with severe shoulder pain-impossible to get back to sleep. I have been using Naproxen and Tylenol plus heat and usually end up propped on pillows on my couch-then I might get an hour of not very restorative sleep. I am desperate for relief as I know my lack of sleep is affecting my ability to function during the day, and I am now falling asleep in the middle of the day because I am able to sleep then-the pain is still there but not so extreme. I have a history of falls on my shoulder that have been successfully treated with heat, massage, followed by exercises to mobilize and strengthen my shoulder. This episode is not directly related to any specific fall and is not responding well to my usual treatment. I am exhausted and really need some help. Cortisone injections have been very helpful for other injuries (knee and thumb). Maybe this is the way to go? Your thoughts? Thanks-Beth
HI Beth .. Night pain can truly be exhausting. An injection might help. A thorough history and exam by a shoulder doc should be able to pinpoint the issue .. eg. Bursitis, vs Calcific tendonitis, etc. Then they can determine if an injection can help and where the injection should be placed.