About the author:

Howard J. Luks, MD

Howard J. Luks, MD

A Board Certified Orthopedic Surgeon in Hawthorne, NY. Dr. Howard Luks specializes in the treatment of the shoulder, knee, elbow, and ankle. He has a very "social" patient centric approach and believes that the more you understand about your issue, the more informed your decisions will be. Ultimately your treatments and his recommendations will be based on proper communications, proper understanding, and shared decision-making principles – all geared to improve your quality of life.

23 comments on “Rotator Cuff Tears and Shoulder Pain at Night

  • 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.

    • Thank you Dr Luks. I hurt myself in September and didn’t take it seriously. In October I went to do an XRAY at the nearest ER in Pasadena. No bone problems but recommended an orthopedic surgeon for further investigation. I felt like that was an exaggeration. But pain at night and the nerve pinching during the day on my neck and hands has led me to this article. It is so clear and empowering. Now I will confidently see my nearest orthopedic Dr. I now wish I was in NYC as I’ve recently moved here from NY. All the best with your super duper blog.

  • 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.

    • I must agree, after reading through Dr Luk article, it was like this doctor is pinpointing every area I have pain and I have not seen him one time. OMG, I’m sadden to also know that the doctor only practice in New York and I live in La. At night I toss and turn and now the pain runs down my arm and with weakness to grip things. I was injured from a fall in Sept of 2019. But I need a Ortho that can lay it out like Dr Luk explains in his article.

  • 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..
    Stan Levy

    MRI date 11/16/17
    Clinical Infomation..
    Right shoulder pain with history of a lifting injury. Evaluate for rotator cuff tearing.



    MR imaging of the right shoulder was performed, including the following pulse sequences, Corona T 1, coronal STIR, coronal T2, axial T2, sagittal STIR

    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.

    The regional muscles show normal signal intensity and volume.

    The Long-head of the biceps tendon shows a mild degree of tenosynovitis.

    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.

    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.

  • 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.

  • I looked at a half dozen other websites before I found this one. The information provided was vastly superior to anything else. I appreciate the detail and expertise without the excessive medical terminology.

  • Hi, just read this article because I’m worried about the pain in my right shoulder. I do know I have to see a doctor and stop playing doctor on Google but something that worried me when reading your article is that this tear will not heal and will continue progressing? At least this is what I understood.

    I’ve been with this pain around three weeks now. It seemed to go but it returned back, not as painful as the beginning. The only thing different from the rest is that I had real sleep problems maybe the first day only. Now I do wake up but only if I sleep over my right arm or if I turn to sleep on a side on right shoulder. I’m still working out. Where some days I forget I have a shoulder injury and some it is a little painful. Thank you for your article and greetings from Uruguay, South America!

    • Hi Enrique!
      Actually, only some tears become larger over time. Some tears might not become larger over time. Many people with severe shoulder pain do not even have a rotator cuff tear :-) Most just have some fraying (age-appropriate changes). Many radiologists read that as a “partial tear”- that’s not entirely accurate. Surgery for most partial tears is rarely necessary.
      Good luck to you!

  • 7 months after surgery, acromium impingement (type 3) Chondroplasty to both the humeral head and glenoid. MRI suggested small cuff tears of the supaspinatus, and infraspinatus. The surgeon didn’t remark on the infra.. the supra, <25% linear tear at the footplate. Doc didn't repair the supraspinatus tendon. I seemed to have aggravated it, appointments to come… My question(s) is/are: Not only sleep time hurts, but driving is torture. The pain goes down my upper forearm and finishes at the tip of my forefinger, actually, the finger is kind of numb. What, exactly causes these particular pains? Why is laying down for sleep so painful? Also pain behind the same shoulder around the scapula. Great writing, and explanations, by the way.

    • Thank you Nathan, I’m glad you found this useful.
      We are not sure why the shoulder acts up so much at night.
      A decompression- removal of the acromion – is not always met with success. Cuff disease.. or rotator cuff tendinopathy/tendinosis is a common cause of pain in some people. PT remains the best way to approach rotator cuff related pain if your surgeon feels that is the source of your pain.
      In patients with chest wall pain, scapula pain and radiating pain or numbness in the forearm/fingers we often look to the neck as a potential source. Just something for you and your surgeon to potentially explore further.

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