Shoulder pain at night: why it happens and what may help

Why shoulders hurt more at night

Shoulder pain that wakes you, or stops you lying on one side, is one of the most common complaints we see. There are a few reasons the shoulder tends to feel worse in bed:

• Lying on it compresses the joint. The weight of your body presses the upper arm bone into the socket and the tendons beneath the bony arch above them.
• Gravity stops helping. Standing, your arm hangs and the joint has a little space. Lying down, the tendons and bursa can be squeezed in positions you would not hold during the day.
• Fewer distractions. Pain that is easy to ignore while busy becomes much more noticeable in a quiet, dark room.
• Inflammation and stiffness. Some shoulder conditions involve an inflamed lining or a tightened joint capsule, both of which tend to ache more after a period of stillness.

Night pain on its own does not point to one diagnosis, but together with your age, how the pain started and how the shoulder moves, it helps your clinician narrow things down.

Common causes

Rotator cuff tendinopathy. The rotator cuff is the group of tendons that hold and steer the ball of the shoulder in its socket. When a tendon is overloaded — from repetitive overhead work, a new sport, or simply age-related change — it can become painful, especially when lifting the arm out to the side or reaching behind you, and when lying on that side. See rotator cuff tendinopathy.

Shoulder impingement. Sometimes called subacromial pain, this describes pain when the tendons and the bursa (a fluid-filled cushion) are irritated under the bony arch at the top of the shoulder. A painful arc when raising the arm and discomfort lying on the shoulder are typical. See shoulder impingement.

Frozen shoulder. Here the joint capsule becomes inflamed and then tight, so the shoulder gradually loses movement in all directions. In the early "freezing" phase, pain can be severe and night pain is often the main complaint. It is more common between the ages of 40 and 60 and in people with diabetes or thyroid conditions. It usually improves over time, but that can take many months. See frozen shoulder.

Calcific tendinitis. A deposit of calcium within a rotator cuff tendon can cause a sudden, intense flare of pain, often with marked night pain. See calcific tendinitis.

Other possibilities include acromioclavicular joint pain at the top of the shoulder, shoulder osteoarthritis, and pain referred from the neck.

Sleeping positions that may help

• Avoid lying directly on the painful shoulder. If you are a side-sleeper, try the other side with a pillow in front of you to rest the painful arm on, so it is not pulled across your body.
• On your back, place a small pillow or folded towel under the upper arm and elbow so the arm is slightly lifted and supported, rather than falling back towards the mattress.
• If you lie on the unaffected side, hug a pillow to keep the top arm supported at roughly chest height.
• Try not to sleep with the arm above your head, which can irritate the tendons.
• A gentle routine before bed — a warm shower, a few minutes of easy pendulum movements and slow breathing — may help some people settle.

These are general suggestions; what helps varies, and your clinician can tailor advice to your diagnosis.

Daytime self-help

• Keep the shoulder moving within a comfortable range. Complete rest tends to stiffen it.
• Reduce, but do not necessarily stop, overhead and repetitive activities while it is irritable.
• Ask a pharmacist about over-the-counter pain relief if you need help to sleep.
• A cold pack after activity, or warmth before gentle movement, suits some people.

What assessment and treatment involve

At your first appointment, one of our physiotherapists or our chiropractor will take a history, examine how the shoulder and neck move, test the rotator cuff and explain what they find. Most shoulder problems are diagnosed by examination. Where imaging would change the plan — for example to check for a significant tendon tear or calcium deposit — we can arrange X-ray or MRI through our imaging partner, often with same- or next-day appointments subject to availability.

Treatment is usually a graded exercise programme to restore movement and build the cuff's capacity, alongside hands-on techniques, advice on sleep and activity and, where appropriate, focused shockwave for long-standing tendon pain. For some people with a very painful frozen shoulder or persistent bursitis, a prescribed anti-inflammatory injection or hyaluronic acid injection may be discussed as part of the plan. Outcomes vary from person to person, and fees are on our fees page.

When to seek urgent help

• Call us for a same-day assessment if the shoulder pain followed a fall or injury, if you suddenly cannot lift the arm, or if pain is severe and not settling. We can examine you and arrange fast-track imaging where needed.
• Go straight to A&E for more severe symptoms, such as an obvious deformity, a suspected dislocation or broken bone, or a deep wound.
• Call 999 for life-threatening signs: shoulder or arm pain with chest pain, breathlessness, sweating or nausea, or a shoulder that is hot, red and swollen with a high fever.

When to book

If shoulder pain is waking you regularly, has lasted more than two to three weeks, or the shoulder is losing movement, an initial assessment at our Bloomsbury clinic is a sensible next step. We will examine the shoulder, explain what we find and agree a plan with you.