Night Time Shoulder Pain and What To Do About It

One very common complaint I hear from patients with shoulder problems is “doc my shoulder pain wakes me up at night”.

The pain can occur whether or not one lies on the painful shoulder, opposite side or on their back.  Patients cannot find a comfortable sleeping position.  The pain just does not let them sleep well.

Night time shoulder pain is probably the most common symptom I see in patients with shoulder conditions such as tenditinis, bursitis, tendinosis, impingement, rotator cuff tears and capsulitis.  All of these conditions cause some level of shoulder stiffness and inflammation.

The reason that shoulders hurt at night is not fully understood. It may be related to the inflammation that occurs when the joint is in a prolonged static position or it might be due to the inward position of the arm while at rest.  When the arm is up against the body the blood flow to the rotator cuff tendon and bursa is slightly restricted.  This position might partially account for the pain.  What we do know is that night time pain is a red flag that something is wrong.

When I evaluate patients with night time shoulder pain my goals are 1) to make the correct diagnosis and 2) to provide efficient and appropriate treatment to permanently relieve the pain.

Regardless of the pathology, one of the most common non-operative recommendations I emphasize is stretching of the shoulder joint, a.k.a. the glenohumeral joint.  In my experience, once the flexibility or range of motion (ROM) of shoulder is optimized the pain improves.   In cases where the pain is caused by inflammation, such as tendinitis or bursitis, the night time pain may permanently resolve.  If the painful arm does not move as fluidly and completely as the opposite non-painful shoulder it is a stiff joint.  The mechanism by which stretching improves ROM is not totally understood however it is likely due to adaptions to elongation of the muscle and tendon units around the glenohumeral joint.  These tissues are visco-elastic so they respond to prolonged passive stretching.

I emphasize this:  A Stiff joint = A Painful Joint

The majority of the the shoulder conditions that cause night time pain also cause shoulder stiffness. When the shoulder stiffness is recognized the first treatment measure I recommend is a prolonged passive stretching program.  The exercise routine needs to be effective, safe and easy to do. The maneuvers do not need to be too forceful but they do need to be prolonged.

The longer you hold the stretch the more effective you will be at improving shoulder motion. 

I recently collaborated with one of my local physical therapy groups Coury & Buehler in Orange County to create www.MoraStretches.com stretching videos.   Out of the four shoulder stretches highlighted in the link the two most effective for relieving night pain is the “statue of liberty” and the “cross arm” stretch.  Please follow the instructions closely and repeat the stretches daily.  You can do these exercises on your own.

Unless you have had recent shoulder surgery or you suffer from instability these stretches are safe.  If you have had surgery or suffer from instability (loose shoulder) it’s very important that you consult with your doctor and ask if these exercises are appropriate.  They are usually are okay even if you have had rotator cuff tear surgery.

Start the exercises slow.  You should expect some level of  “stretch pain”.  The longer you hold the stretch position the better it is for you. Sometimes the shoulder will ache for a few minutes after the exercise.  That is normal.  This should diminish with time.  You should see improvements in ROM after a 1-2 week of doing these exercises diligently.

As the ROM improves the night time pain should start to diminish.

If you do not see improvement after 2-3 weeks you should set up an appointment with your doctor.   You will probably need X-rays and an MRI.

I hope this information was helpful.  Please let me know if I can be of service.  If you know someone suffering from shoulder problems please share!