It’s the middle of the night and you wake up to an aching shoulder. You shift positions hoping for relief, but the discomfort lingers.
Many people experience shoulder pain at night, which can be frustrating and confusing. Why does shoulder pain often seem worse when you’re lying down? What could be causing this nighttime pain? And what can you do to help it feel better?
We spoke with Garin Bergeson, DO, a family medicine and sports medicine specialist with Banner Health, to learn why shoulder pain often worsens at night and how to help reduce it.
What is shoulder pain?
Your shoulder is a complex joint made up of several bones, muscles and tendons (thick tissues that connect muscles to bones) and ligaments. These parts work together to help you do things like throw a ball, scratch your back or even lift your groceries.
Because your shoulder is so flexible, it is vulnerable to issues that cause pain. “Some factors that can cause shoulder pain include direct pressure on your shoulder when laying on your side, overuse or certain medical conditions,” Dr. Bergeson said.
For some, it’s a dull ache that comes and goes, while for others it can be sharp or constant. It can also limit your ability to do things like lift your arm or sleep comfortably.
“Often pain intensifies when lying down because you take time to notice what your body is saying,” Dr. Bergeson said. “Days are busy, filled with many tasks that require our attention. When we take time to slow down, our bodies will often let us know we have overdone it.”
What can cause shoulder pain at night?
There are many reasons you might experience shoulder pain at night, but here are six conditions that commonly lead to nighttime pain:
1. Tendinopathy
Tendinopathy (shoulder tendonitis) is a common cause of shoulder pain, especially at night.
“Tendinopathy is inflammation of your rotator cuff or bicep tendon,” Dr. Bergeson said. “Your rotator cuff includes muscles and tendons in your shoulder. They connect your upper arm bone to your shoulder blade.”
When these tendons become overused or injured, they can become inflamed and cause pain. The pain can get worse when resting or lying down because your shoulder isn’t moving as much.
2. Shoulder arthritis
Osteoarthritis and rheumatoid arthritis can cause shoulder pain, stiffness and swelling at night.
“Shoulder arthritis is damage to the cartilage inside the shoulder joint (glenohumeral joint) or the AC (acromioclavicular) joint,” Dr. Bergeson said.
3. Bursitis
Bursitis happens when the bursae (small fluid-filled sacs that cushion the shoulder joint) become inflamed. “The most common bursa in the shoulder that can become inflamed is the subacromial bursa,” Dr. Bergeson said. The subacromial bursa is located near the top of your shoulder, between your rotator cuff tendons and the highest point of your shoulder blade.
Bursitis can occur from overuse or injury, and it can lead to a dull ache that worsens at night.
4. Frozen shoulder
Frozen shoulder, or adhesive capsulitis, occurs when the capsule surrounding the shoulder joint thickens and tightens, making it difficult to move your arm. This condition often develops slowly and can lead to shoulder pain at night, especially if you keep your arm in the same position while you sleep.
5. Rotator cuff injury or tear
The rotator cuff is a group of muscles and tendons that stabilize the shoulder. Injuries to the rotator cuff are common and can cause sharp pain when lying on the affected side. You might notice the pain gets worse when you try to move your arm at night or when you roll over in bed.
6. Poor sleeping position
“If you sleep on your side, it can put pressure and irritate the shoulder muscles, tendons and joints,” Dr. Bergeson said.
When your shoulder is unsupported or twisted, it can aggravate pre-existing conditions or cause new pain.
How to find relief from shoulder pain at night
Now that we’ve covered the most common causes of shoulder pain at night, here are some ways to ease discomfort and get a better night’s sleep.
Rest your shoulder
If your pain is caused by overuse or muscle fatigue, the best thing you can do is give your shoulder some TLC. Avoid heavy lifting and activities that strain the shoulder.
“This may require doing less lifting, pushing, pulling and focusing on stretching and range of motion,” Dr. Bergeson said. “There are many good resources for shoulder mobility exercises.”
Use ice or heat
“Ice decreases blood flow and swelling, dulls pain and can be soothing for some conditions,” Dr. Bergeson said. “Heat increases blood flow and can improve mobility in some cases.”
Apply an ice pack to your shoulder for 15 minutes several times a day, especially before bed. If your shoulder feels stiff or sore but not inflamed, heat can help. A warm compress or heating pad before bed can relax the muscles. Learn more about when to use ice or heat for aches and pain.
Adjust your sleeping position
Try sleeping on your back with a pillow under your arm or on your non-painful side. Avoid sleeping directly on the painful shoulder.
A good pillow can help support your shoulder and neck, keeping your posture neutral. Find the perfect pillow for you.
Consider over-the-counter (OTC) medicines
Take acetaminophen (Tylenol) to help with pain and non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation.
“Talk to your health care provider about the use of NSAIDs like Advil or Aleve as these can affect blood thinners, kidney function and stomach problems,” Dr. Bergeson said.
Stretch and strengthen your shoulder
Gentle stretching and strengthening exercises can help reduce shoulder pain over time. A physical therapist can show you the right exercises to improve flexibility, reduce stiffness and strengthen the muscles around your shoulder. Here are 17 exercises you can try.
When should I see my health care provider?
If your shoulder pain doesn't improve with rest, ice and OTC treatments, talk to your health care provider.
“My rule is: If it’s affecting your daily life, come get checked out,” Dr. Bergeson said. “Waking up multiple times a night, unable to perform normal activities, having worsening pain, motion or weakness are all reasons to make an appointment to be seen.”
Your provider will be able to diagnose the cause of your shoulder pain and recommend the best treatment, whether it’s physical therapy, medications or injections to decrease pain or, in some cases, surgery.
Takeaway
Shoulder pain at night is common, but there are many ways to find relief. Simple remedies like rest, ice, heat and OTC medicines can often help your shoulder feel better.
If your pain doesn’t improve or gets worse, see your health care provider or a Banner Health specialist.
