Shoulder Pain at Night
Shoulder Pain at Night
What is Shoulder Pain at Night?
It’s the pain experienced in one or both shoulders at night. It can happen while sleeping or gets worse in that moment. This kind of pain is typical in tendonitis and muscle injuries, but can also be a result of neck pain that radiates into the shoulder. When you have an assessment with one of our Physiotherapists it is common for us to screen the neck for possible referral pain into the shoulder.
Symptoms of Shoulder Pain at Night
The primary symptom will be the pain. It can be felt in the anterior, posterior and/or lateral side of the shoulder joint. Also, it can come with other related symptoms, depending on the cause, such as pain on the clavicular area, upper back, neck, headaches, numbness in the affected arm, lack of strength, loss of movement, among others.
Causes of Shoulder Pain at Night
There’s a variety of causes. Usually, it’s due to the position of sleep. When resting, the muscles relax and if there’s an injury to the ligaments, cartilage, tendon or muscle, it can generate pain, because of the inflammation of those structures.
Frequently, the injured area is the rotator cuff. This is a group of muscles responsible for raising and rotating the arm, specifically the shoulder. It’s composed of four muscles: supraspinatus; infraspinatus; teres minor and subscapularis. The supraspinatus is located above the head of the humerus and under the acromion -the bone at the tip of the shoulder-. This position makes its tendon particularly vulnerable to compression (which means easier damage to the structure).
The most common causes of shoulder pain at night are:
Subacromial impingement syndrome: It’s the most common cause of shoulder pain at night. This is the inflammation of two structures: one or more tendons of the rotator cuff (tendinitis), and the bursa (bursitis). This syndrome is the consequence of a pinching of the supraspinatus tendon, that in the long-term causes thickening of the tendons (in an already tight space). Continued use of the arm can lead to a vicious cycle of progressive pain, poor cuff function and more thickening. Pain is also located on the upper-outer side of the joint. It’s a chronic syndrome.
Rotator cuff tear: The tendons at the end of these muscles can be torn, after a direct trauma or continuous pinching of the supraspinatus’ tendon. Pain is located mostly on the upper-outer side of the joint. It aggravates by overhead activities (reaching things above your head) and weight-carrying. This is characterized by weakness, particularly when lifting objects.
Frozen shoulder: It’s the common name for “adhesive capsulitis”. This causes the poorest sleep quality in patients with shoulder disease. The pain is severe and comes with a significant restriction of motion in the shoulder. It’s common in women, between the ages of 40-60 with endocrine disorders (like diabetes or thyroid problems) and after a shoulder trauma or surgery. It passes through three phases: First, progressive pain where the joint tightens up. Second, the movements are significantly reduced. The last phase comes with slow improvement of motion and gradually decrease of pain.
Referred shoulder pain: It’s the pain caused by a structure outside the shoulder, but refers the symptom there. A pinched nerve in the neck could cause this, as well as a cervical herniated disc, muscle spasms, etc. The symptoms vary, depending on the original area that’s referring pain: numbness, tingling in fingers or hands, weakness or poor coordination. The pain could go from the neck to the upper arm, to the elbow, to the lateral or inner side of the arm… It depends on the location of the actual injury.
-Other causes are; supraspinatus rupture (total discontinuity of the supraspinatus’ tendon), osteoarthritis (a kind of arthritis where the cartilage of the joint degenerates and makes the bones to rub against each other), among others.
Physiotherapy Treatments of Shoulder Pain at Night
Depending on the cause, the Physiotherapy treatments could be:
- Ultrasound therapy, shockwave therapy, laser therapy, electrotherapy, heat therapy and application of kinesiology taping, to help the relaxation of structures, decrease of pain and increase of motion range.
- Specific shoulder exercises to strengthen and improve stabilization of the joint, or to decompress the injured structure.
- If the cause is neurological referred pain that originates at the neck, treatment options may include non-surgical spinal decompression of the neck, and in some cases acupuncture.
*Mulligan, Edward & Christiansen, Meredith & Shirley, Zachary & Khazzam, Michael. (2015). Sleep quality and nocturnal pain in patients with shoulder disorders. Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons … [et al.]. 24. . 10.1016/j.jse.2015.02.013.
*Yildiz, A & Buyuktepe, Y. (2017). THU0722-HPR The effects of kinesio taping on pain, joint range of motion, muscle strength and disability in impingement syndrome. Annals of the Rheumatic Diseases. 76. 1476.3-1477. 10.1136/annrheumdis-2017-eular.4613.
*Vidal. (2011) My aching shoulder! [PDF] Denver: Living Well Magazine. Available at: http://www.denverortho.com/vidal-article-march-2012.pdf
*“Shoulder Pain at Night.” Sports Injury Clinic, http://www.sportsinjuryclinic.net/symptom-checker/shoulder-pain-symptoms/shoulder-pain-at-night