Rotator Cuff Tears and Shoulder Pain at Night

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. Other issues that can affect the rotator cuff and cause night pain include calcific tendonitis, rotator cuff tears, 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 or bursitis (see picture below) above the rotator cuff 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. The bursa can become inflamed because of various rotator cuff issues.

In addition, recent sports injuries or overuse injuries to the 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 only mild shoulder 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:

• 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 there are many different types of rotator cuff issues.  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, fray 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 rougher surface 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.

What is the Treatment For Rotator Cuff Tendinosis and Severe Night Pain

Most people with night pain due to rotator cuff issues will respond to:

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.

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 sleeve have been useful.  Heating pads might be useful as well.  Some people prefer ice, 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.

Shoulder Injections for Night Pain:

Injections into the subacromial bursa, that area above your rotator cuff that tends to become inflamed can be very useful 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 very useful 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 are able to start 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 very useful 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 afterwards with a course of physical therapy.  That therapy is generally taken 2-3 times per week for 4-6 weeks.  Many of you are able to learn the exercises yourself so you can continue the exercises on your own.  Continuing the exercises, even after the physical therapy is done is important 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 starts with NSAIDs like Ibuprofen, Naproxen and Naprosyn which are available over the counter.  Those of you with heart disease, ulcers, kidney disease, asthma and 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 the last choice.  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. During the surgery we remove the inflammation in that bursa on top of your rotator cuff.  If the rotator cuff has damage such as a partial tears, then we often place a  novel biological patch which can help to regenerate a worn our rotator cuff.  tThat patch is placed after the inflammation is removed, and the rotator cuff is smoothed out to remove the degenerative / frayed tendon which might be irritating your shoulder. This post describes this biological patch in more detail.  

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 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.

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 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.