Why Is Shoulder Pain Worse At Night?

Most times, a painful shoulder will go away on its own. But, there are other cases when it doesn’t. Sometimes, the pain even feels worse at nighttime. So, exactly why is shoulder pain worse at night?

There are various reasons for nighttime shoulder pain. These include:

Adhesive capsulitis
Shoulder bursitis
Shoulder tendinopathy
Rotator cuff tear

We’ll shed light on why these conditions can feel worse at night and show you some exercises that might help. Are you ready? Let’s get to it!

Why is my shoulder pain worse at night?

First of all, night-time shoulder pain doesn’t happen by accident. Some of the most common reasons include:

A sudden increase in daytime activities
Chronic sleep deprivation
Reduced melatonin hormone
Poor sleeping posture
Too much stress

But, the major reason for night shoulder pain is pre-existing shoulder issues. In fact, as much as 91% of people who have nighttime shoulder pain have an underlying shoulder problem. (1)

Here are the most common causes related to having a painful shoulder:

Adhesive capsulitis (frozen shoulder)

This condition is due to the excessive formation of scar tissue. It usually happens inside your shoulder joint, causing adhesions and a vicious cycle of pain and inflammation. Hence, why it’s also called adhesive capsulitis.

More about this: Our overall guide to frozen shoulder

Why is frozen shoulder worse at night?

As you rest at night, you don’t usually move your arms as much. In turn, joints become stiff and tight.

Now, if you have adhesive capsulitis, you also have chronic inflammation. This turns your shoulder joint capsule into a less flexible fibrotic tissue that’s also much smaller than normal. Hence, any arm movement increases joint pressure and tenderness (2).

This is why, especially at nighttime, you may feel an increase in joint pain and stiffness.

Shoulder bursitis

Bursae are fluid-filled sacs that decrease friction between soft tissues. Repetitive overuse or trauma to the shoulder can lead to irritation and swelling.

It can lead to pain coming from your shoulder down to your arm and shoulder blade.

For more info on this injury: Our complete guide to shoulder bursitis

Why does my shoulder hurt more at night?

If there is one thing that can exacerbate symptoms of shoulder bursitis, it’s direct compression. Case in point: Assuming a side-sleeping position.

Laying on your side for long periods will trigger a pain response from your already inflamed bursa. This leads to further inflammation and shoulder pain.

Shoulder impingement

Whenever you move your arm, your shoulder tendons hold your upper arm bone and keep it stable.

But, with a combination of repetitive movements, poor shoulder mechanics, and muscle imbalances, these muscles can get pinched by your shoulder blades (scapula).

This leads to irritation, inflammation, pain, and stiffness.

Why does shoulder impingement hurt more at night?

Like bursitis, a poor sleeping posture with direct compression can harm your rotator cuff tendons.

So, when you sleep with your arms overhead or when you sleep on your affected shoulder, pain can feel worse. It can also temporarily reduce blood flow to the area which can aggravate your shoulder pain at night (3).

Rotator cuff tear

Overuse, physical trauma, or longstanding tendinitis can cause a tear to the rotator cuff tendons. The damage can either be partial – where the tendon is frayed or barely hanging from its attachment – or a full (complete) tear on the tendon.

Why is rotator cuff pain worse at night?

Aside from your tendons having been torn apart, being in a position for too long can increase shoulder pain with a rotator cuff tear. (4)

When you sleep, a shoulder with a torn rotator cuff doesn’t have that much muscular support to keep it stable. Gravity and how much you toss and turn during your sleep can do damage and lead to a more painful shoulder.

This will help: How to alleviate rotator cuff pain at night

3 quick and easy exercises to relieve shoulder pain at night

1. Shoulder Rolls

This exercise helps loosen muscle stiffness and increase blood flow to your shoulders.

Here’s how:

You can start either standing or sitting
Let your arms relax and hang by your side
Take a deep breath and shrug your shoulders up, like your trying to touch your ears with them
After a few seconds, roll your shoulders backward
Squeeze your shoulder blades for a couple of seconds
Exhale and relax
Repeat for 10 times

2. Pendulum stretch

This type of stretching exercise addresses pain relief and shoulder mobility by inhibiting pain signals inside your joint.

Here’s how:

Stand with your feet hip-width apart
Bend forward while one arm is holding on to a sturdy chair or table
Let your affected shoulder hang down and relax
Shift your body weight forward and backward through your feet and hips
Use your body’s momentum to swing your arms in the same direction
Do this 10 times

3. Cat and camel stretch

Your thoracic spine is interconnected with your shoulders. A non-flexible spine may be the cause of your shoulder problems. To remedy this, this exercise improves spinal mobility.

Here’s how:

Start with your hands and knees on the floor
Take a deep breath while curving your back to the ceiling
Slowly exhale as you now arc your lower back into the floor
Repeat this 10 times

When should I consider medical help?

Schedule a visit to your doctor if:

Your sore shoulder starts to disrupt your sleep consistently
Pain has affected your daily activities
Your symptoms worsen or have been going on for a couple of weeks

There are times when medications such as corticosteroid injections do the trick. For torn rotator cuff injuries, though, surgery proves to work best.

Best to consult your doctor so that he/she can guide you with your persistent shoulder pain.

FAQs:

Will drinking alcohol affect my pain?

Alcohol is both a sedative and temporary analgesia. It can dull the pain, but only for a short while.

It can also help you fall asleep much quicker but it can affect the quality of your sleep. (5)

Excessive alcohol intake has also been associated with inflammation, leading to more intense pain.

How should I sleep with shoulder pain?

First of all, sleeping on your affected arm is not the way to go as it leads to more pain at night. (6) Here are a few ways you can optimize your sleep posture:

Side sleepers

While laying on your opposite side, place pillows between your legs and your arms to reduce pressure and comfort. Also, make sure to add another pillow under your head to maintain good spinal alignment

Back sleepers

Place a pillow under your knees to avoid rounding out your back

Belly sleepers

Avoid placing your arms overhead as this increases night pain. Also, place a pillow under your hips to promote a neutral spine alignment.

Conclusion

The night is when most people find time to relax after a long day of work. We hope that what you learned here made you better understand your shoulder pain at night, so you spend less time worrying and more time resting.

Resources

Khazzam, Michael S et al. “Sleep Quality in Patients With Rotator Cuff Disease.” The Journal of the American Academy of Orthopaedic Surgeons vol. 26,6 (2018): 215-222. DOI: 10.5435/JAAOS-D-16-00547
Le, Hai V et al. “Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments.” Shoulder & elbow vol. 9,2 (2017): 75-84. doi: 10.1177/1758573216676786
Holdaway, Lincoln A et al. “Is sleep position associated with glenohumeral shoulder pain and rotator cuff tendinopathy: a cross-sectional study.” BMC musculoskeletal disorders vol. 19,1 408. 23 Nov. 2018, DOI: 10.1186/s12891-018-2319-9
Longo, Umile Giuseppe et al. “Sleep Disturbance and Rotator Cuff Tears: A Systematic Review.” Medicina (Kaunas, Lithuania) vol. 55,8 453. 8 Aug. 2019, DOI: 10.3390/medicina55080453
Pacheco, Danielle et al. Alcohol and Sleep. Sleep Foundation. 4 Sept 2020. https://www.sleepfoundation.org/nutrition/alcohol-and-sleep
Casper Editorial Team. The 3 Main Sleeping Positions: Which is Best? Casper. 23 Sept 2021. https://casper.com/blog/sleeping-positions/