Why does my shoulder hurt at night?
Shoulder night pain is a common problem seen in our practise. It is one of the criteria indicating that the shoulder pain is severe and interfering with your sleep and rest.
The most common shoulder conditions that can result in night pain are:
Other less common causes include:
What are the causes of shoulder pain at night?
Shoulder pain can be felt more at night, possibly due to increased inflammation within the joint. During the day, constant activity usually prevents inflammatory material (mediators that increase inflammation and make the pain feel worse) from accumulating within the joint. The daily activities may also provide some distraction so we do not feel the pain to the same degree. However, at night and after using your shoulder during the day, the inflammatory mediators would pool within the shoulder joint, resulting in increased shoulder pain sensation.
Another possibility is applying direct pressure on the shoulder while sleeping. The shoulder joint is very mobile by its nature. If a certain part of the shoulder joint or tendons is already inflamed and irritated, then sleeping on that side would apply pressure upon the shoulder and can cause further irritation to the area.
What is shoulder inflammation?
Shoulder inflammation is a general term. It can indicate inflammation of the ball and socket joint (shoulder arthritis) due to wear and tear or other types of arthritis (like inflammatory arthritis). It also includes wear and tear changes to the smaller joint between the collar bone and shoulder joint (the acromioclavicular joint) and inflammation of the soft tissues like the rotator cuff and biceps tendons or the shoulder bursa. Frozen shoulder is a term used to describe generalised stiffness and inflammation of the shoulder joint, which can cause significant pain and limitation of movement. Inflammation can also result from the deposition of calcium material within the rotator cuff tendons, a condition called calcific tendonitis. A shoulder ultrasound or MRI examination is very useful to assess for these conditions and establish the diagnosis.
If you had a recent injury, your shoulder pain could be due to injury to the bone (fracture) or significant injury to the tendons. You should seek urgent medical attention in this case. A shoulder x-ray is usually performed initially to assess for shoulder fractures or dislocations.
How is shoulder pain felt or described?
Usually, when there is severe and active inflammation, the shoulder pain can be felt as sharp, stabbing or burning. This is usually seen in the painful stages of adhesive capsulitis and calcific tendonitis. If the condition is more long-standing (chronic), the pain is usually described as dull and achy, for example, in shoulder osteoarthritis. It is very often for the patients to feel their pain going (or shooting) down the arm, the side or the back of the shoulder. In shoulder impingement, the pain is specifically felt when trying to lift up the arm above the head level (painful arc syndrome).
How can I reduce my shoulder pain at night?
You should get a formal assessment by a competent healthcare professional to assess and examine your shoulder. This is essential to establish the correct diagnosis and decide the appropriate treatment options. An experienced GP, an experienced physiotherapist or a shoulder specialist doctor are all adequately qualified to assess your shoulder pain. Shoulder imaging is vital to establish the correct diagnosis. Usually, a combination of tests (like a shoulder X-ray, ultrasound or MRI) can be done depending on the clinical findings. These should be interpreted by a specialist doctor (radiologist) with experience in dealing with joint and tendon problems.
Some useful techniques to reduce shoulder pain and inflammation, particularly at night time, include:
· Activity modifications and avoiding certain movements/activities that can aggravate your shoulder pain during the night.
· Physiotherapy. This would include stretching exercises useful at night to help disperse the inflammatory material. Strengthening exercises during the daytime might also be useful.
· Anti-inflammatory tablets (like ibuprofen) and also creams (like voltarol gel) to reduce local inflammation. Please ask your GP or pharmacist before starting such medications.
· Applying an ice pack to the area is also usually useful in reducing local inflammation.
· Ensure good posture when you sleep at night and avoid sleeping on the painful side. Also, ensuring you have a comfortable and supportive mattress and pillow is very helpful
What if conservative treatment is not helping?
If the above measures are not helping and your shoulder pain is severe, affecting your daily activities, exercises and sleep, then there is a role of an ultrasound-guided cortisone injection into the shoulder joint. Injecting under ultrasound guidance is very useful as it allows for live visualisation of the needle to ensure accurate injection into the exact site of inflammation. Ultrasound guidance results in more accurate, less painful and faster procedures when compared to injections done without imaging guidance.
Shoulder conditions and treatments