Why does shoulder pain get worse at night?

For those coping with shoulder pain, nighttime hours often fuel a dull and constant ache. It’s uncomfortable and common — and can interfere with a much-needed good night’s sleep.

According to Dr. Amarpal Arora, an orthopedic surgeon with Sharp Rees-Stealy Medical Group, there are two main reasons why shoulder pain can worsen at night. “The first one is that you are more focused on shoulder pain when you have nothing else to think about. Without distractions, the pain can feel more pronounced,” he says.

The second reason is that we typically sleep in a level position. “As our muscles relax, there's a natural pull on the shoulder, adding stress to the injured or inflamed areas,” Dr. Arora says.

Common culprits for nighttime shoulder pain
While shoulder pain can have many causes, these three are the most common:

1. Bursitis
   What it is: Bursitis is caused by overuse of the shoulder. People with this condition often complain of pain with overhead activities.
   How it’s treated: Rest, physical therapy and over-the-counter medications can help minimize pain. Persistent pain should be addressed by a professional.
    

2. Rotator cuff injury
   What it is: Injury to the rotator cuff can be caused by overuse, a genetic predisposition or aging.
   How it’s treated: Like bursitis, rotator cuff injury-related pain usually eases with rest, physical therapy and over-the-counter medications. For persistent pain, surgery may be an option.
    

3. Adhesive capsulitis (also known as “frozen shoulder”)
   What it is: The root cause of frozen shoulder — which is marked by a stiff and painful shoulder joint — is unknown. Possible contributing factors include thyroid dysfunction, diabetes and certain neurological conditions.
   How it’s treated: In most cases, frozen shoulder heals on its own. Physical therapy and anti-inflammatory injections can help, but usually time and patience pay off.

How to ease nighttime shoulder pain
Learning to sleep comfortably with shoulder pain can be a matter of trial and error. Dr. Arora recommends these two tips to his patients:

• Sleep in an upright position. As muscles relax, the shoulder won’t pull as much on the painful areas.

• Use a prop or pillow. Placing a pillow under the shoulder and below the elbow can help keep the arm still while sleeping.

When to see a doctor about shoulder pain
Many people are unsure about when to seek medical treatment for shoulder pain — especially because it’s often more of a dull ache than an excruciating discomfort. If your shoulder pain is the result of an injury and there’s sudden loss of function, see your doctor immediately. They can refer you to a specialist for further evaluation, if needed.

If the pain comes on slowly or happens after an activity — without the loss of function — Dr. Arora suggests waiting to see if the problem resolves on its own.

“If pain cannot be controlled with over-the-counter medications, such as Tylenol or ibuprofen; continues to worsen despite time and rest from activities; or is affecting normal daily activities, it may be time to contact a physician to seek further treatment,” he says.

Regardless of the time of day, no one should have to live with pain. Dr. Arora’s advice: “If your pain continues, get help so you can get back to living an active life.”

For the news media: To talk with Dr. Arora for an upcoming story, contact Erica Carlson, senior public relations specialist, at erica.carlson@sharp.com.