Shoulder pain after sleeping is one of the most common symptoms for patients with shoulder conditions such as shoulder impingement, bursitis, tendinitis, rotator cuff tears, frozen shoulder, and arthritis.
Other shoulder pain conditions at night may also include poor posture, overexertion, ageing, or repetitive work injuries. Read on to learn more about what may be causing your shoulder pain at night as well as the best ways to find relief.
What are the causes of shoulder pain at night?
There could be many different causes of shoulder pain that could arise out of either specific shoulder injury or your shoulder conditions. The most common causes include shoulder impingement, bursitis, tendon damage (tendinopathy or tendinitis) or rotator cuff tears and arthritis (which can affect a few areas of the shoulder).
Unfortunately, most of these common sources of shoulder problems cause elevated pain at night or during periods of rest. It definitely becomes difficult to have a peaceful night’s sleep when your shoulder is in pain, which affects your work and leads to other problems. Lets talk about each of these injuries and how you can best manage your shoulder pain that arises at night.
Shoulder impingement is when there is a reduced space in the shoulder between the rotator cuff tendons and a bone above these tendons. This bone is called the acromion and it is a part of the scapula or shoulder blade.
There are a few causes for this condition.
Most commonly, it is due to an altered shape of the acromion or an extra bone forming under the acromion. This extra bone reduces the space for the tendons to move and can cause direct injury to the tendons
Some people are born with this condition and some develop an abnormal shaped acromion as they age. Hence when you sleep at night, the space between shoulder bone compresses once you lie down which leads to a restless night grappling with pain.
Tendon damage (tendinopathy or tendinitis) or tear (rotator cuff tears)
Rotator cuff tendons that surround the shoulder joint help keep the joint steady and gives it the capability to have move. Their synchronization is important to maintain movement, strength and power.
Tendon injury happens from a few known causes ranging from trauma or an injury, to slower processes involved in increasing age and wear and tear. The most common cause is repeated microtrauma to the rotator cuff tendons rather than a specific one of trauma. Rotator cuff surgery and recovery may be required to alleviate pain and get back a full range of motion.
Shoulder tendonitis (or tendinitis) is an inflammation injury to the tendons. Because inflammation is not always present in injuries to the shoulder tendons, this group of injuries are medically known as a rotator cuff tendinopathy or tendinopathies. Once this progresses, the tendon will fail and cause a tear.
Shoulder tendonitis commonly has the following symptoms:
- Shoulder popping or clicking and/or an arc of shoulder pain when your arm is about shoulder height
- Pain when lying on the sore shoulder or lifting with a straight arm
- Shoulder pain or clicking when moving your hand behind your back or head
- Anterior shoulder painand upper arm pain (potentially as far as your elbow)
- As your shoulder tendonitis deteriorates, your shoulder pain may even be present when resting and often worsens at night after using the shoulder all day.
The bursa is a normal structure within the shoulder that helps lubricate the joint and buffers the tendon from damage from the overlying bone.
Once irritated the bursa becomes swollen. Swelling causes the bursa to over react and develop cells that induces pain. That’s the first symptom when you suffer from Bursitis
Shoulder bursitis commonly presents with the following symptoms:
- Gradual onset of your shoulder symptoms over weeks or months
- Pain on the outside of your shoulder
- Pain may spread down your arm towards the elbow or wrist
- Pain made worse when lying on your affected shoulder
- Pain made worse when using your arm above your head
- Painful arc of movement – shoulder pain felt between 60–90 degrees of the arm moving up and outwards
- When your arm is by your side there is minimal pain and above 90 degrees relief of pain
- Shoulder pain with activities such as washing hair, reaching up to a high shelf in the cupboard
Often the problem causes a vicious cycle of further pain and shoulder problems; the more the bursa gets inflamed and tightens up the space, the more irritated it gets and hence enlarges even more, leading to even more pain and discomfort.
While sleeping or lying directly on the side of shoulder, the bursa can be compressed without the help of gravity.
Wear and tear of the part of the shoulder that touches the cartilage lining of the shoulder joint is called arthritis. This progressive condition causes shoulder pain and is often worse at night after a day of use. The chances of you suffering shoulder arthritis are increased if your shoulder has been overworked or injured. It can be a result of years of sports that involve heavy use of the shoulder including AFL football, cricket, and tennis.
Arthritis can affect the main joint of the shoulder (gleno-humeral joint) or the AC joint (acromio-clavicular joint).
The acromio-clavicular joint (AC joint) is the intersection between the end of the collar bone and the end of the shoulder blade. The joint often gets earlier wear and tear from ageing and can suffer an AC joint injury and arthritis due to an injury from a fall or as result of playing sports that involve arm elevation. Arthritis from this area presents with pain on top of the shoulder and is often worsened by sleep when your arm is crossed over your chest or when lying directly onto your shoulder.
Other shoulder pain conditions that lead to discomfort at night include poor posture, sports & work injuries, ageing, overuse, and overexertion.
Why does my shoulder pain get worse at night?
Shoulder pain at night is a very common problem and can be both disruptive and frustrating. The most common cause of night pain in your shoulder is due to a process we call rotator cuff tendinosis and shoulder bursitis.
While there is no exact science as to why your shoulder pain is worse at night, some factors may be sleeping on your side, direct pressure on your shoulder, and/or your mattress. Certainly, using your shoulder during the day means that the bursa is more inflamed and the rotator cuff tendon is over worked by the end of the day, hence the symptoms worsening by night time. Other factors may be unrelieved tension of pressure and stress.
During the day, the weight of the arm and gravity help to increase the space in your shoulder to reduce pressure and compression on the bursa and rotator cuff tendons. However, at night and during sleep, this is no longer the case as gravity is eliminated while lying flat. The muscles are also relaxed while sleeping and aren’t activated to centre the ball within the socket so this also reduces the space.
Direct pressure when sleeping directly on the painful side exacerbates the problem, especially when this occurs for an extended period of time while in deep sleep. Pressure for prolonged periods throughout the night puts direct compression on the subacromial joint space and compresses this inflamed tissue and bursa.
Uncontrolled movements of the arm or sleeping with your arm across your chest or above your head for extended periods (abnormal positions) are other factors that may contribute to more pain at night and after sleeping.
How should you sleep if your shoulder hurts?
Going to sleep with shoulder pain is difficult and certainly if you wake due to shoulder pain, falling back asleep can be very troublesome.
Resting your shoulder during day may reduce the inflammation, reducing the pain enough that you can sleep.
Taking tablets that help reduce pain and inflammation (analgesics and anti-inflammatories) can also assist in reducing pain during the night. Taking the tablets well before night time is advisable to allow enough time for them to work.
If you wake up with a shoulder that hurts after directly lying on the shoulder, try sleeping on the opposite side. It might sound obvious but it isn’t as easy as it sounds given you often don’t control your movements when in deep sleep. Try placing a pillow behind you to stop you rolling over while sleeping on your affected shoulder and changing sides with your bed partner depending on which shoulder is involved. Sleeping propped up on a few pillows or on a special bed that has you a bit upright might also stop you rolling over onto the painful shoulder.