A sore or throbbing shoulder can make it tough to fall asleep or wake you up in the middle of the night. Especially if simply turning over doesn't solve the problem.
Sometimes nighttime shoulder pain just comes from sleeping in a wonky position, says Brian Lee, MD, an orthopedic surgeon at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles, California, and an orthopedic consultant for the PGA Tour.
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Other times, the culprit is a shoulder injury that's getting irritated from sleeping on your side.
"Side-sleeping can sometimes increase pressure on the [injured] tendon or joint, leading to increased pain and inflammation," explains Trong Nguyen, MD, an orthopedic surgeon and the medical director of the Total Shoulder Replacement Program at MemorialCare Joint Replacement at Orange Coast Medical Center in Fountain Valley, California.
Here's how to tell what might be causing your shoulder pain when sleeping and what you can do to feel better (and catch some pain-free zzzs).
1. Rotator Cuff Injury
The rotator cuff is a group of muscles and tendons surrounding the shoulder joint. Strains or tears "are a common problem as we age, and many patients with rotator cuff problems feel increased pain at night," Dr. Lee says.
Rotator cuff injuries can happen from repeatedly making the same shoulder movement (like in baseball, tennis or basketball, or from overhead tasks like carpentry or painting). They're more common in adults over 60, per the Mayo Clinic.
The pain feels like a dull ache. You might also notice that your arm feels weak during the day and have trouble doing tasks like reaching overhead or brushing your hair.
Rest, ice and physical therapy exercises are often enough to heal mild rotator cuff injuries. Steroid injections can also manage the pain. More severe injuries might require surgery to fully heal, the Mayo Clinic says.
Shoulder bursitis, or inflammation of the cushioning pad around the shoulder joints, can cause similar symptoms to a rotator cuff injury, says Dr. Lee. In addition to pain when you're lying on the affected shoulder, the area might feel stiff or achy when you try to move it, especially when you make an overhead motion.
Anyone can get shoulder bursitis, but you're more prone if you play sports like football, softball or lacrosse. Painters, builders and carpenters are also at higher risk, notes the Cleveland Clinic.
Rest and ice can do the trick for a mild case of bursitis.
If you're still having pain, your doctor may recommend physical therapy or corticosteroid injections, or in rare instances, surgery.
3. Dislocated Shoulder
The shoulder can become dislocated when the upper arm bone pops out of the shoulder socket. It can cause intense pain, including when lying on it, as well as swelling or bruising.
You may not be able to move the affected area and it could appear deformed or out of place, per the Mayo Clinic. Some people also feel pain or numbness radiating down their arm.
Shoulder dislocations are often caused by a sudden blow. Serious falls or contact sports like football or hockey are common culprits.
Seek medical attention if you think you have a dislocated shoulder. Your provider may be able to manually maneuver the arm bone back into the shoulder socket. You'll need to wear a splint for a few weeks afterwards to keep your shoulder from moving while it heals.
4. Separated Shoulder
Severe direct falls and injuries from contact sports can cause a shoulder separation, where the ligaments between the collarbone and shoulder blade are torn, per the Cleveland Clinic.
Separated shoulders cause intense pain around the top of the shoulder, and the pain might be worse when you're lying on the affected area. You might also notice a bump around the painful area.
Most separated shoulders heal on their own within 12 weeks, according to the Cleveland Clinic. You should wear a sling to keep the area immobilized and may need physical therapy to build back your strength. Severe separations may require surgery.
5. Impingement Syndrome
Also called rotator cuff tendonitis, impingement syndrome is another injury that can cause your shoulder to hurt when you're lying on it, Dr. Nguyen says.
The symptoms can be similar to a rotator cuff tear: Pain in the front of the shoulder that gets worse when you raise your arm, along with weakness or stiffness.
More severe injuries can also make it harder to do everyday activities where you raise your arm, like grabbing or reaching something high up.
Rest and ice will help your rotator cuff heal within several weeks to months, says the American Academy of Orthopaedic Surgeons. Your doctor might also recommend physical therapy to rebuild your shoulder strength and flexibility.
If these measures don't help, surgery may be needed.
6. Frozen Shoulder
Frozen shoulder can happen when the capsule of connective tissue that encloses the shoulder joint thickens and tightens, restricting the shoulder joint's movement. It can cause shoulder stiffness and pain that worsens at night, Dr. Lee says.
Experts don't fully understand why some people get frozen shoulder. But it's more common in adults over 40, people who've had a rotator cuff injury or shoulder surgery and people with health conditions like diabetes, heart disease, Parkinson's disease or an over- or underactive thyroid, says the Mayo Clinic.
Frozen shoulder often gets better on its own within 18 months. In the meantime, over-the-counter pain medications like ibuprofen can reduce your discomfort, while mobility exercises or physical therapy can help improve your range of motion.
If your symptoms don't ease up, your doctor might recommend steroid injections or surgery.
7. Shoulder Osteoarthritis
Osteoarthritis, which happens when the cartilage cushioning around the joints deteriorates, can affect any joint in the body, including the shoulder. It can cause aching and stiffness that tends to worsen over time, and may be more noticeable at night when you're lying on it, Dr. Lee says. Only one shoulder may be affected.
Shoulder osteoarthritis is caused by wear and tear, so it's more common in older adults, according to Johns Hopkins Medicine.
Stretching exercises guided by a physical therapist can help you preserve your range of motion and manage stiffness. Resting the area, applying ice or heat and using over-the-counter pain relievers like acetaminophen can also help, Johns Hopkins Medicine says.
More severe pain can also be managed with corticosteroid injections.
8. Rheumatoid Arthritis
Rheumatoid arthritis (RA) is a chronic autoimmune condition where the immune system mistakenly attacks healthy joint tissue. This can cause joint pain, stiffness and swelling, including in the shoulders.
While osteoarthritis might affect just one shoulder, rheumatoid arthritis tends to affect both shoulders as well as other joints throughout the body.
Older adults, particularly women, are more prone to developing RA. Genetics, smoking and obesity can also increase a person's risk, notes the Centers for Disease Control and Prevention (CDC).
RA is a progressive condition that requires medications (like methotrexate) to slow the condition and prevent further joint damage, the CDC says. Activities like regular exercise, stretching or physical therapy can also be helpful.
How to Relieve Shoulder Pain When You're Trying to Sleep
Nighttime shoulder pain caused by an injury will ease up as the affected area heals. In the meantime, changing the way you sleep might make a difference.
"Most people find that sleeping in an upright or semi-upright position can alleviate some of the pain," Dr. Lee says. "This can be as simple as sleeping in a recliner, or using pillows or a wedge in your bed to support the torso."
Stretching before bed may also be helpful. University Hospitals recommends shrugging your shoulders up and down and rolling your shoulders in a backward motion. You can also try wall stretches, where you walk your fingers as high up the wall as you can to stretch your shoulder and chest area.
Always check with your doctor before starting a new stretching regimen to make sure the exercises won't worsen your shoulder injury or condition.
When to See a Doctor About Shoulder Pain When Sleeping
You should seek medical attention if you've sustained a shoulder injury or have severe or persistent pain that's interfering with your everyday activities (including sleeping), Dr. Nguyen says.
Your provider might order an X-ray or MRI to diagnose the problem and determine the best way to treat it.
- Cleveland Clinic: "Bursitis In Shoulder"
- Cleveland Clinic: "Separated Shoulder"
- American Academy of Orthopaedic Surgeons: "Shoulder Impingement/Rotator Cuff Tendinitis"
- Johns Hopkins Medicine: "Shoulder Impingement/Rotator Cuff Tendinitis"
- Centers for Disease Control and Prevention: "Rheumatoid Arthritis (RA)"
- University Hospitals: "Can the Way You Sleep Cause Pain in Your Shoulders?"
Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.