Shoulder pain at night, or when sleeping, can be distressing — anyone who’s had it knows how disruptive it is. So what causes shoulder pain at night, and what simple remedies can ease it?
Causes of shoulder pain at night
Here are the more common causes of shoulder pain at night. Follow the links to learn more, or read on for the simple treatments.
Rotator cuff tendonitis
As we age, the rotator cuff tendons start to wear, leading to tendonitis. The pain occurs with activity but also at night, and in more severe cases — such as a tendon tear — it can be brutal.
Frozen shoulder
Frozen shoulder (adhesive capsulitis) is driven by inflammation of the shoulder capsule, causing pain and stiffness. The pain is commonly worse at night.
Shoulder arthritis
Shoulder arthritis is common in older people, causing pain and restricted movement. The inflammation is especially troublesome at night, when the shoulder isn’t being used.
Calcific tendonitis
Calcium deposits can form in the rotator cuff tendons, causing intense inflammation that keeps you up at night and limits movement. The typical story: you’re between 40 and 60, you develop a dull shoulder ache, and it suddenly ramps up over 1–2 days until you have to see a doctor.
AC joint arthritis
The AC joint connects the collarbone to the top of the shoulder. Arthritis here typically develops after age 35, and sleeping on the shoulder compresses the joint, increasing inflammation and pain.
Why is shoulder pain worse at night?
Night pain is usually related to a build-up of inflammation. During the day, we move the shoulder and arm, which disperses inflammation. At night, the shoulder is still, so inflammation accumulates — and sleeping on the shoulder compresses the inflamed structures, worsening the pain.
How to ease pain
If you’re up in the night with shoulder pain, these simple measures can help:
- A hot water bottle or heating pad, placed on the painful shoulder, can ease the pain. Use it for 15 minutes on, 15 minutes off, and repeat as needed.
- Improving the shoulder position — sleep with the top of the bed propped up, and place a rolled towel behind the shoulder to bring it slightly forward. This relieves pressure on the inflamed structures. Try to sleep on the other side.
- Ibuprofen gel or tablets — ibuprofen is an anti-inflammatory. The gel can be soothing for a painful shoulder, and in more severe pain the tablets are more effective (mind the side effects).
- Capsaicin cream — available over the counter —is a skin irritant thought to deplete a pain-signalling chemical (substance P) in the nerves around the shoulder, calming them and easing pain.
- Physiotherapy — addressing movement restriction and shoulder strength helps night pain, typically over 2–3 sessions across up to 6 weeks.
When is an injection needed for shoulder pain?
When simple measures haven’t worked, injecting cortisone into the painful structure — the bursa or the joint — can reduce the pain. We inject under ultrasound guidance to improve accuracy and effectiveness, placing the cortisone exactly where it needs to be. Make sure whoever performs it is experienced in ultrasound-guided injections. Cortisone usually starts working within 3–4 days, sometimes sooner.
Frequently asked questions
Why does my shoulder hurt more at night than during the day?
Because inflammation builds up when the shoulder is still, daytime movement disperses it; at night it accumulates, and lying on the shoulder compresses the inflamed tendons and joint — so the pain feels worse even though nothing has changed structurally.
How should I sleep to reduce shoulder pain?
Sleep on the unaffected side, or on your back, with the top of the bed slightly propped up. A rolled towel placed behind the affected shoulder gently brings it forward and relieves pressure on the inflamed structures. A pillow to support the arm across the body also helps.
What does night shoulder pain usually mean?
Most often a rotator cuff problem, frozen shoulder, calcific tendonitis, or shoulder or AC joint arthritis — all of which are known for night pain. Persistent shoulder pain at night is worth getting assessed, especially if it’s regularly disturbing your sleep.
When should I see a doctor about shoulder pain at night?
See a doctor if the pain regularly disturbs your sleep, hasn’t settled with simple measures over a few weeks, or is accompanied by weakness, significant stiffness, or reduced movement. These point to a specific cause that benefits from diagnosis and targeted treatment.
Final word from Sport Doctor London about shoulder pain at night
Night pain is a common feature of many shoulder conditions, from rotator cuff problems to frozen shoulder and arthritis. Simple measures — heat, better sleeping position, anti-inflammatories, and physiotherapy — help many people, and where they don’t, an ultrasound-guided injection can settle things. An early diagnosis points you to the right treatment.
If shoulder pain is disturbing your sleep, Dr Masci can assess you in London, including ultrasound in clinic. Contact the team here or call +44 (0) 203 488 0350.
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