Shoulder Pain at Night: Causes and What to Do

Causes of Shoulder Pain at Night

Rotator Cuff Impingement

The rotator cuff^[1] refers to the group of muscles and tendons surrounding the shoulder joint, and it also connects the shoulder blade and upper arm bone. The bursae are small sacs near the joint that provide lubrication and minimize friction.

When someone experiences an impingement, either the tendons or bursae become inflamed or irritated. Impingements^[2] can be caused by deterioration from daily use such as a physical job skill or an injury from a particular event.

Tendonitis is the term for when the tendons are irritated, whereas bursitis refers to the swelling of the bursae. Tendinosis is a form of chronic tendonitis at the cellular level. When someone has tendinosis, the degeneration of cells^[3] in a tendon is what leads to shoulder issues.

Rotator Cuff Tear

Another potential cause of soreness in this area is a tear in one or several tendons. When a tear occurs, the tendon pulls away from the arm bone.

There are two types of these tears: partial and complete. In a partial tear, the tendon is still partially attached, and in a complete tear, the tendon is fully separated from the bone.

According to the Cleveland Clinic, rotator cuff tears can develop in several ways. Repetitive motions over time may lead to tearing, or a one-time accident such as a fall could cause damage. As we age, blood flow to this area also decreases, and experts say this could raise the risk of a tear.

While both tears and impingements can result in pain, a tear is also typically accompanied by weakness, specifically if you attempt to lift an object above your shoulder.

Arthritis

According to the Centers for Disease Control and Prevention (CDC^[4]), just over 54 million adults in the United States are diagnosed with arthritis, with roughly 43 percent of that demographic also experiencing physical limitations due to this condition. Also, with age, the likelihood of developing arthritis increases.

Two types of arthritis can lead to shoulder issues: osteoarthritis and rheumatoid arthritis. While both are forms of arthritis, they have specific differences.

Cartilage is a cushioning that covers the ends of the bones. Osteoarthritis causes this cartilage to deteriorate, and the Cleveland Clinic reports this can cause pain and stiffness. Experts add this condition could eventually prevent someone from being able to reach behind their back.

Typically, osteoarthritis results from general wear and tear, and treatment may involve physical therapy, anti-inflammatory drugs, and ice. However, more severe cases may require surgery.

Rheumatoid arthritis^[5] is an autoimmune disorder that causes your immune system to attack your body tissues. This condition impairs the lining of the joints, resulting in painful swelling. Eventually, that swelling can generate bone erosion and joint deformity.

Rheumatoid arthritis can affect more than just the joints, too. The skin, eyes, lungs, heart, and blood vessels may also become damaged. Usually, the discomfort begins in smaller joints such as the fingers and toes, but it can eventually progress to larger areas, including the shoulders.

Are You Sleeping with Arthritis?

Frozen Shoulder

Contrary to its name, frozen shoulder^[6] has nothing to do with the weather. Also known as adhesive capsulitis, this condition is described as stiffness and pain in the shoulder joint. Symptoms tend to worsen over one to three years.

Individuals recovering from a medical condition or a procedure preventing them from moving their arms are at an increased risk. Therefore, if you have an injury or medical issue impacting your arm mobility, experts advise discussing this with your doctor, who may recommend exercises to help maintain your range of motion.

Treatments for frozen shoulder usually involve a combination of exercises and medication. However, certain cases may result in surgery to loosen the joint. The Mayo Clinic adds that some people with this condition report that their symptoms become worse at night, making it harder to sleep.

Dislocation

A dislocation^[7] occurs when the upper arm bone pops out of the socket attached to your shoulder blade. Unfortunately, health experts say this part of the body is highly vulnerable to dislocation.

Sports injuries, motor vehicle accidents, and falls are examples of incidents that could result in a dislocated upper arm. While most people recover within several weeks, the area can become unstable, increasing the risk of future episodes. Symptoms^[8] of a dislocated shoulder include extreme pain, weakness, swelling, bruising or redness, muscle spasms, numbness or tingling, inability to move the arm, and the shoulder is visibly out of place.

According to the Mayo Clinic, teen and young adult males are the highest risk group for this injury since they are very physically active. To reduce the risk of dislocation, the Cleveland Clinic recommends athletes wear protective gear when playing sports, and while at play, neither children nor adults should pull or tug on the arms.

If your shoulder becomes displaced, it is essential to seek immediate medical attention and avoid moving the joint. Trying to force it back in place could lead to further damage. To help alleviate pain, place ice on the affected area.

Can Side Sleeping Cause Shoulder Pain?

When you rest on your side, your body weight accumulates in a small area, including the hips and shoulders. Experts with the Gobezie Shoulder Institute^[9] say the pressure of this weight could lead to soreness, particularly if there is an underlying condition in that part of the body.

Many top-quality mattresses are designed with comfort layers to help provide relief for those body areas sensitive to pressure. However, if your bed is older or is not a good match for your sleep style and body type, this could also lead to painful pressure build-up.

If you are a regular side sleeper and have noticed you wake up with discomfort in your arm, it may be time to invest in a new bed that prioritizes pressure relief with quality-made comfort layers. Furthermore, you can add more plush comfort to your sleep space with other helpful products such as a mattress pad or topper.

Want to know more? See our full guide to the best mattress for hip and shoulder pain.

While searching for a new bed, you will also want to pay attention to the firmness of the mattress. A bed’s firmness is rated on a scale of 1-10, with one being the softest and ten the hardest.

If you weigh significantly less, beds will tend to feel harder to you than people at an average weight or heavier. Purchasing a mattress that is too firm could impact pressure relief.

Memory foam is a popular material for pressure relief as it is made to contour to the shape of the sleeper’s body, allowing them to feel cradled. Many well-made mattresses feature either an all-foam construction that includes memory foam or a combination memory foam and coil hybrid model.

Most top mattress brands also come with a trial period, allowing you to test out the mattress and make sure it is an ideal fit for you. If you find the bed does not provide adequate pressure relief for your shoulders, then you can return it to the company and receive a refund.

Read More: Best Mattresses for 2024.

How to Relieve Shoulder Pain at Night

Aches and soreness that prevent you from getting much-needed rest can be detrimental to your physical and mental well-being. Sleep deprivation^[10] is linked to poor cognitive performance, accidents, injuries, compromised immune systems, and an increased risk of severe health complications such as cancer, high blood pressure, heart disease, and diabetes. The good news is you can take measures to help mitigate your discomfort and rest better.

1. Adjust Your Sleep Position

If you are a side sleeper who regularly rests on the left shoulder and are now experiencing pain on that side, you will need to adjust how you sleep. One option is to rest on the side that does not have shoulder pain. Often, taking weight and pressure off of the affected area should provide relief.

Experts^[11] advise not sleeping on your stomach, and while back sleeping is still okay, you should utilize a pillow in this position to minimize pressure on the affected shoulder. An adjustable bed may also be helpful as the elevation could help reduce pressure. If you do not have an adjustable bed, though, a reclining chair might do the trick.

You may have been sleeping a certain way for years, and therefore, it can feel unnatural to try something else. However, practicing good sleep habits should help foster tiredness so you can fall asleep easier. Examples of good habits to follow include: a consistent bedtime and wake-up time, avoiding electronics right before bed, cutting out caffeine and alcohol, creating a calming nighttime routine for yourself, no big meals before bed, and making sure your room is cool and comfortable.

2. Try Support Pillows

We mentioned above that good pillows can be a valuable aid for back sleeping. According to St. Kila Osteopathy, you should place the pillow under the elbow of the sore arm. The shoulder joint’s ball and socket are more supported by lifting the elbow, reducing stress in the affected area.

If you plan to sleep on the opposite shoulder, grab a pillow to hug in front of you. Hugging a pillow should prevent the shoulder in pain from moving too far forward and compressing other parts of the upper arm area. Additionally, this should keep the joint in a stable position.

Another tip for resting on the opposite side is to place a second pillow behind you. A second pillow should help prevent you from falling into an uncomfortable position while you are asleep, which could cause you to wake up with even more soreness in the morning.

Find Out More: How to Properly Sleep on Your Side

3. Take It Easy

When aches and pains arise in the upper arms, it is vital to rest and give the affected area a chance to heal. Therefore, Mayo Clinic experts recommend avoiding using your shoulder in any way that may cause pain to develop or worsen.

For those who regularly go to the gym, there are specific exercises to avoid^[12] that could exacerbate pain in the shoulders. They include throwing a ball overhead, swimming, and certain weight-lifting moves. According to Rolling Hills Medical, you should avoid the following weight-lifting maneuvers while the shoulder heals.

• Lifting weights above the head
• Pulldowns behind the neck
• Upright row
• Shoulder press behind the neck
• Bench (tricep) dips

Even though there may be days when your shoulder does not hurt as much, you should still check in with your doctor before attempting any of these activities. You may feel fine, but it is best to consult with a healthcare professional to avoid worsening your condition.

4. Stretch Exercises

While you should take it easy and avoid moves that can aggravate the area, never moving your upper arm is not ideal since the muscles could stiffen up. Harvard Health suggests practicing the following stretches two or three times a week to help maintain flexibility and minimize pain.

However, be sure to check with your doctor before doing them, and do not attempt to over-stretch because you risk pulling a muscle. Instead, ease into each of these stretches and only extend as far as you can comfortably.

Seated Stretch

To begin, sit in a chair facing forward with your feet planted on the ground. Pace the left hand on the right shoulder, and then cup the elbow with the right hand. From there, roll the shoulders down and back.

Lightly pull the left elbow across the chest while extending the left arm. You should feel the stretch in your left shoulder.

Hold for 20-30 seconds, and then do the same thing on the other side. Repeat this stretch two to four times on both sides.

Seated Triceps Stretch

While seated in a chair, place the right hand on the right shoulder. Then, hold the right elbow with the left hand. Make sure to keep the shoulders down and back as you lift the right elbow toward the ceiling as high as it can go.

You should feel a stretch throughout the right upper arm and shoulder. Hold this position for 10-30 seconds and repeat on the left side. Do two to four reps of this on the right and left sides.

Seated Chest Stretch

You will also begin this exercise seated in a chair. However, for this one, you will need to turn your body to sit facing the side. Also, make sure the chair you use does not have armrests.

To begin, roll the shoulders down and back, and then clasp your hands behind you. Intertwine the fingers and have the palms of the hands facing you. Slowly lift the hands toward the ceiling.

This move should stretch the chest and front of the shoulders. Do two to four reps while holding for 10-30 seconds.

Need more info? Check out our guide for bedtime stretches.

5. Ice or Heat

Knowing when to use heat versus ice is vital for navigating body pain, especially since using the wrong treatment could worsen your condition. Whether you use ice or heat^[13] will depend on why your shoulder hurts in the first place.

Short-term injuries last less than six weeks, and they should be treated with ice to help reduce swelling, inflammation, and pain. Using heat could exacerbate an injury by increasing inflammation and slowing down the healing process. Conversely, ice can help decrease inflammation while also numbing pain and restricting the development of bruises.

However, if the injury lasts longer than six weeks, heat is acceptable to use. Since heat increases blood flow, this should loosen up stiff muscles and joints to help with range of motion.

For those with shoulder discomfort due to a form of arthritis, Cleveland Clinic authorities suggest using moist heat such as a warm bath or shower. However, they add that the water should be warm but not too hot. A good temperature range is between 92 and 100 degrees Fahrenheit.

To treat a strained muscle, begin with ice to decrease inflammation. Once that is resolved, switch to heat.

For issues related to Tendonitis, which causes inflammation or irritation in the tendons, experts recommend using ice. Tendonosis, the chronic version of tendonitis, can benefit from both ice and heat. First, use ice to tackle the inflamed area, and then switch to heat to mitigate stiffness.

A good rule of thumb is to leave ice or heat on for 20 minutes and then 20 minutes off. There are also different types of products available to treat discomfort with heat or ice. However, experts advise you to be extra cautious using these products on areas with less sensitivity due to neuropathy or Raynaud’s syndrome.

To ice pain, use packs with frozen peas or carrots, ice cubes in a plastic bag, or purchase a frozen gel pack. An ice massage may also help if you’re having difficulty using a pack.

To do this, freeze water in a Dixie cup. After that, pull back the top of the cup and massage the area that hurts.

When treating with heat, you can choose from heat wraps, warm water, and heating pads. Be extra cautious heating pads as these could cause a burn, and remove the item if it becomes too hot.

5. Pain Relief Medications

Common over-the-counter medications^[14] can be used to treat shoulder soreness. When taking medications, always follow the dosage directions and consult with your doctor if you are pregnant or have another serious health condition such as kidney problems. If you take additional medications, you should check with your doctor to ensure any pain relief drugs won’t affect them.

Acetaminophen and ibuprofen are two forms of over-the-counter pain medications. Tylenol is a well-known acetaminophen, and Advil and Motrin are popular ibuprofen brands. While acetaminophen can help treat achiness, it does not reduce inflammation.

6. Yoga

Yoga is a popular spiritual and physical discipline that originated in India and is now practiced worldwide. This practice focuses on developing a harmonious balance between the mind and body.

During a class, participants will hold a series of body poses – or asanas^[15]. Among the physical benefits of these poses are improved flexibility and strength. If you are experiencing pain, some of the standard poses could be a challenge, but do not feel pressured to be a yoga professional.

Ease into the poses and take it at your own pace. To avoid making your shoulder pain worse, we suggest asking your doctor if it is safe for you to try yoga.

Building strength in the upper arm area may help prevent further issues as well. The following five yoga poses^[16] engage the shoulder muscles to help improve strength. For each pose, you will hold the position for three to five breaths.

Locus with the Arms Back

Begin by lying face down on a mat. Your legs should be straight with the thighs touching and your arms at your side.

With the palms facing down, gently raise your hands. Then, roll your shoulders back and lift your chest, keeping your gaze forward and down.

Locus with the Arms Forward

You will start in the same position as the first Locus but place your arms overhead to create a ‘V’ shape. Then, with the thumbs pointed upward, raise your hands off the ground. After that, place the shoulder blades back as you lift the chest, and just as the first one, remain facing forward and down.

Upward Dog

To get into Upward Dog, start lying face down with the hands beside the chest. Next, put your weight into your hands and straighten the arms.

Raise the thighs by pressing the feet into the floor. Keep your shoulders back and stare forward.

Side Angle

Begin by standing with the left heel in line with the right foot. You will then bend the left leg and rest the left forearm on the left thigh. The right leg remains straight.

Then, stretch the right arm overhead beside your ear. With each breath, try to extend the right arm higher up. Repeat on the opposite side.

Side Plank

To start, place yourself in a standard push-up position, and then put all your body weight onto the right hand. Next, turn your entire body so that the left shoulder is on top of the right.

Reach the left arm toward the sky and stack your feet on top of each other. Remain in a straight line and look forward. Once you are done, do the same thing on the other side.

Want to read more? Here are our favorite yoga poses for better sleep.

7. Physical Therapy

Even after trying out these different treatment options on your own, you may find that your body needs extra help to heal itself. In this case, physical therapy^[17] could be a beneficial choice and a less-invasive alternative to surgery.

Physical therapists offer a structured and personalized treatment program to help you on the road to recovery. There are various methods they can use along the way, depending on what is causing your discomfort and how well you are healing.

• Ice or heat therapy – A physical therapist may use ice, heat, or a combination of the two.
• Hands-on therapy – In this case, the physical therapist uses their hands to relax the shoulder and apply pressure to the tissue to improve mobility.
• Stretching – A therapist may also help stretch the shoulder and surrounding areas, such as the neck and spine.
• Strengthing exercises – A therapist can guide you through specific strengthening exercises designed to help improve your recovery and reduce your risk of a repetitive injury.
• Joint mobilization – For this treatment, the therapist focuses on stretching the joint capsule.
• Therapeutic ultrasound – A therapeutic ultrasound uses deep heating to improve circulation and flexibility in the muscles, tendons, and other soft tissue.
• Electrical stimulation – Electrical stimulation is designed to strengthen the muscles. This treatment may also be used to decrease inflammation or provide medication.

• Athletic taping – The physical therapist may use athletic tape to help limit movement.
• Kinesiology taping – Conversely, kinesiology taping fosters movement safely to improve circulation.

Your physical therapist may have you continue to do some of the exercises at home once your program is complete. In addition, they may show you how to modify certain activities to prevent future problems and discuss ways to support your body while at work.

8. Surgery

If all of the above treatments are unsuccessful, you may need surgery. However, health experts say the amount of people who need to undergo surgery is minimal^[18].

Different surgery options are available depending on the cause of the pain and what is needed. For arthritis, a doctor may perform arthroscopic debridements and capsular releases, and both of these are minimally invasive procedures. With a small incision, the doctor clears out the damaged tissue.

To fix a rotator cuff, the patient may undergo either a superior capsular reconstruction or tendon transfers. During a superior capsular reconstruction, skin tissue is used to rebuild the issue. With a tendon transfer, a tendon from a different area is used to repair the rotator cuff.

In some cases, the shoulder will need to be replaced. There are three types of replacement procedures: anatomic total shoulder, reverse total shoulder, and hemiarthroplasty. While surgery can be very effective, there are also risks^[19] involved, including the ball slipping out of the socket, infection, nerve damage, glenoid loosening, and stiffness.

Recovery time can vary but usually takes about eight weeks. However, the patient will likely not do any heavy lifting or strenuous activities until several months following the surgery.

When to Talk With Your Doctor about Shoulder Pain

If you experience any of the following symptoms with your shoulder pain, the Mayo Clinic^[20] advises contacting your doctor to schedule an office visit.

• Swelling
• Redness
• Tenderness and warmth around the joint

When to Seek Immediate Medical Attention

If you had a shoulder injury and exhibit any symptoms below, immediately ask for a ride to urgent care or the emergency room.

• Joint appears deformed
• Unable to move joint or arm
• Intense pain
• Sudden swelling

A person experiencing a heart attack may also develop pain in their shoulder and difficulty breathing or tightness in the chest. If this happens, call 911 right away.

Frequently Asked Questions

Why do I have shoulder pain at night only?

You may wonder why shoulder pain is worse or only happens at night. According to the Gobezie Shoulder Institute, three conditions can cause this: bursitis, biceps tendinopathy, or a rotator cuff injury.

The biceps tendon connects muscles and bones in the shoulder joint. Biceps tendinopathy usually stems from general deterioration over many years of use, and this condition can trigger sharp pains with specific movements such as reaching behind you.

Shoulder soreness may also feel more pronounced at night because fewer distractions keep your mind off the pain. During the day, you may be focused on work, your children, a partner, friends, and specific social commitments. However, when bedtime rolls around, you do not have other things going on, and therefore, you may notice the pain more at this time.

Lying down may also put more pressure on the shoulder, especially if your mattress does not provide enough relief, which could make your discomfort feel intense. If you notice your pain worsens while lying on your bed, a mattress with advanced pressure-relieving capabilities could help.

Can I sleep on my side with shoulder soreness?

If you are a longtime side sleeper, you may be better off switching to the side that is not sore. Switching sides could help give the affected side a chance to heal without interference.

Sleeping on your back is also a viable option. As mentioned earlier, this position could also be more comfortable with a pillow under the elbow to better support the shoulder. However, we recommend talking with your doctor to help you find the ideal sleep position, so you and your shoulder can rest easily.