Shoulder pain while sleeping: When it could be more than soreness
Shoulder pain at night can make it hard to fall asleep, stay asleep, or lie on one side. Learn why shoulder pain may feel worse when you lie down and when it may be time to see a specialist.
Shoulder pain may feel worse at night because of your sleeping position, pressure on irritated tissues, or changes in how the shoulder joint rests when you lie down. Consider seeing a provider if the pain regularly disrupts sleep, limits everyday activities, or does not improve after one or two weeks of home care.
Common signs that it is time to seek an evaluation include:
- Pain that wakes you during the night
- Difficulty finding any comfortable sleeping position
- Pain that interferes with work, exercise, or daily activities
- Symptoms that do not improve with rest, ice, or activity changes
- Increasing weakness or loss of motion
- Pain that continues to worsen
Shoulder pain may be easy to work around during the day, but it becomes much harder to ignore when it keeps you from falling asleep or wakes you during the night.
Nighttime shoulder pain is one of the most common reasons patients seek orthopedic care, says Brendan Patterson, MD, MPH, an orthopedic surgeon with University of Iowa Health Care.
Some people feel pain when they lie directly on the affected shoulder. Others wake with discomfort even when sleeping on their back or opposite side.
The exact reason shoulder pain often feels worse at night is not fully understood, Patterson says. He notes that your sleeping position may place added pressure on irritated tissues, and lying flat may change how your shoulder rests. Pain can also be harder to avoid at night. During the day, you may be able to stop or modify an activity that aggravates the shoulder. At night, there is no easy way to work around the need for rest.
“We all have to sleep, and if your shoulder pain is preventing you from sleeping, it can be challenging to function throughout the day,” Patterson says.
Occasional soreness may improve with simple changes at home. But pain that repeatedly wakes you, makes it difficult to find a comfortable position, or affects how you function the next day may be a sign that your shoulder should be evaluated.
Common causes of nighttime shoulder pain
Shoulder pain does not always begin with a fall, sports injury, or other obvious events. Many conditions develop gradually because of inflammation, repetitive use, or age-related wear and tear.
Patterson says common causes of shoulder pain at night include:
- Rotator cuff inflammation or tendinitis
- A rotator cuff tear
- Shoulder arthritis
- Biceps tendon irritation
- Inflammation in other tissues around the joint
“The vast majority of rotator cuff tears, for example, are caused by wear and tear over time,” Patterson says.
Where you feel the pain may offer some clues. Pain near the front of your shoulder can sometimes be associated with the bicep tendon, while pain along the side may be related to the rotator cuff. However, symptoms can overlap, and pain location alone cannot confirm the cause.
What you can try at home
Mild or recently developed shoulder pain may improve with changes to your sleeping position and daily routine.
Try:
- Avoiding direct pressure on the painful shoulder
- Sleeping on your back or opposite side
- Using pillows to support your arm and upper body
- Sleeping in a recliner or semi-upright position
- Applying ice or heat, depending on which feels more comfortable
- Temporarily limiting activities that aggravate the shoulder
- Practicing gentle stretches that do not increase your pain
Sleeping semi-upright may be helpful because lying flat can change how the shoulder rests. Elevating your upper body allows gravity to support the shoulder in a slightly different position, which may reduce irritation.
Patterson says patients recovering from shoulder surgery often find it easier to sleep in a recliner or with pillows propped behind their backs. People who have not had surgery may find the same adjustment helpful when nighttime pain makes lying flat uncomfortable.
Ice, heat, anti-inflammatory medications such as ibuprofen or naproxen, or acetaminophen may also provide temporary relief. Check with your primary care provider or another member of your care team before taking any medication, particularly if you take other prescriptions or have health conditions that could make those medicines unsafe.
Learn more about your shoulder pain
Answer a few questions about your symptoms and receive personalized guidance about your shoulder health.
When to see a provider
A brief period of soreness after exercise, yardwork, or another strenuous or repetitive activity may improve with rest. Pain that continues for one or two weeks, repeatedly interrupts sleep, or makes it difficult to use your arm may need to be evaluated.
Consider contacting your primary care provider or an orthopedic specialist if the pain:
- Does not improve with rest, ice, or activity modification
- Regularly wakes you or keeps you from falling asleep
- Interferes with work, exercise, or everyday activities
- Causes increasing weakness or limited motion
- Continues to become more severe
“Pain that is interfering with your day-to-day activities and isn’t getting better with home treatments means you should reach out,” Patterson says. “And if it's disrupting your sleep, it may be hard to overcome the pain without help.”
Patterson says the best starting point may depend on access, personal preference, and whether you already have an established relationship with a primary care provider.
Some symptoms should be evaluated promptly rather than managed at home.
Seek urgent care for shoulder pain accompanied by:
- Significant swelling
- Redness or warmth
- Fever
- Excruciating or constant pain
- A serious injury
- A sudden inability to move or use the arm
These symptoms may point to an injury, infection, or another condition that should not wait for a routine appointment.
What to expect from a shoulder evaluation
A provider will ask when the pain began, where you feel it, what movements or positions make it worse, and what treatments you have already tried. A physical examination can help assess your strength, range of motion, and areas of tenderness.
X-rays are often the first imaging test. They can show arthritis and may provide other clues about changes in the shoulder. An MRI may be recommended when there is significant weakness, a history of major trauma, or concern about a rotator cuff or other soft-tissue injury.
The evaluation helps the care team understand what is causing the pain and which treatment options are most likely to help.
Treatment depends on what is causing the pain
Most patients begin with nonsurgical treatment. The right approach depends on the diagnosis, the severity of the symptoms, and how much the pain is affecting sleep and daily life.
Treatment may include:
- Rest and activity modification
- Anti-inflammatory medication
- Physical therapy
- Steroid injections
- Other injections for selected patients
- Surgery when symptoms are severe or do not improve with other care
“Structured physical therapy can be very helpful for many shoulder conditions,” Patterson says.
Physical therapy may be especially helpful for rotator cuff conditions, while advanced arthritis requires a different approach. Steroid injections may also reduce inflammation and provide relief if you are struggling to sleep.
Patterson says patients whose pain severely disrupts their rest may benefit from treatment that helps calm the inflammation.
“They need to get some rest and some comfort. A steroid injection can help a lot with inflammation,” he says.
Most shoulder pain does not require surgery. But if severe pain, stiffness, weakness, or limited motion continues despite medication, physical therapy, injections, and other treatments, your provider may recommend discussing shoulder replacement.
During shoulder replacement surgery, damaged bone and cartilage are removed and replaced with artificial components designed to help the joint move more smoothly. It may be an option for people with advanced joint damage whose pain continues at rest, disrupts sleep, or makes everyday activities difficult.
Get help for shoulder pain that disrupts sleep
Nighttime shoulder pain may improve with changes to your sleeping position, activity, or home care. But pain that repeatedly wakes you, limits movement, or continues to worsen may be a sign of an underlying shoulder condition.
An evaluation can help identify the cause and determine which treatments may help you sleep more comfortably and return to your usual activities.
