Shoulder pain at night is a very common problem. If you have shoulder pain at night pain you know how disruptive it can be! Night pain in your shoulder is almost always because of an issue with your rotator cuff. The most common cause of night pain in your shoulder is due to a process we call rotator cuff tendinosis.
Inflammation in the rotator cuff or secondary bursitis (see below) is the most common reason why you can not lay down and sleep through the night. A bursa is a small sack that covers the rotator cuff. It can become inflamed because of various rotator cuff problems. Injuries to the shoulder or rotator cuff will also cause significant pain at night. No matter which side you try to sleep on, your shoulder pain wakes you up. Eventually, this will start to significantly affect your quality of life and your psychological well-being.
Why Does My Shoulder Hurt At Night?
The most common cause of shoulder pain when sleeping is the rotator cuff. Many of you will have mild or moderate pain during the day, but terrible shoulder pain at night. When the rotator cuff is torn or frayed it will irritate a bursa. The 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:
As you can see there are different types of rotator cuff injuries. The most common cause of rotator cuff pain is a process we call rotator cuff tendinosis. This implies that your rotator cuff is starting to wear out and degenerate. If the rotator cuff begins to degenerate enough it may start to tear. A small tear can be referred to as a partial rotator cuff tear. The tearing 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.
What is the Treatment For Rotator Cuff Tendinosis
Most people with night pain from rotator cuff tendinosis will respond to:
- initially sleeping in a reclining chair.
- An ice compression wrap: These ice sleeves are very useful at minimizing your pain and improving your recovery from a rotator cuff injury.
- Sleeping with a Shoulder Support Pillow/System
- Physical therapy to address the rotator cuff
- anti-inflammatories – Tart Cherry Juice, Advil, Alleve- (Talk to your doctor about risks).
- Injections: this will diminish the inflammation.
- Surgery: A novel biological patch now enables us to potentially cure the most common cause of night pain in the shoulder.
I Tried Therapy and My Shoulder Still Hurts At Night
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 of the regenerative patch, we now have a surgical option proven to diminish or eliminate night pain in your shoulder.
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.
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 weakness as well as night pain then a repair of your rotator cuff is possibly likely to be your best option.
For patients with severe night pain due to tendinosis or a partial rotator cuff tear, one of the most promising procedures is where we can 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 healing the tendinosis and partial tear could give you a good chance of not having to deal with this again in the future.
Only a few shoulder surgeons are currently utilizing this technology… but that is changing rapidly.
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