Pain when Sleeping on your Shoulder: 5 Possible Causes

Shoulder pain can cause many problems and a considerable burden.[1] It can happen for several reasons and disrupt a night of peaceful sleep. In this article, we will provide you information about pain in the shoulder and the steps to solve it.

What are the symptoms of shoulder pain when sleeping?

Pain in any shoulder area is the main symptom, but it is crucial to note the root cause of the injury by knowing how it feels. It can be localised, dull, or aching from a muscle injury, and other times, it can be sharp pain from nerve impingement. A nagging and deep pain with a clicking sound could be from a bone problem or joint displacement.

What are the causes of shoulder pain?

Issues with sleeping are an associated effect of shoulder pain. By sleeping on your side and bearing a lot of weight on the torso, it can stress the joint and surrounding areas of the shoulder.

In one study from 2015, those who have pain in the shoulder, especially from adhesive capsulitis, have poor sleep quality because their symptoms appear at night, compared to those with osteoarthritis and rotator cuff disorders.[2]

In retrospect, particular conditions could cause pain in the shoulder when you are trying to sleep, and sleeping on the affected shoulder could aggravate them.

1. Rotator Cuff Injury

The rotator cuff is the group of tendons and muscles responsible for the movement of your shoulder, attached to the end of your arm bone to the shoulder blade to maintain the socket intact and the area when moving. A rotator cuff injury can be either an inflamed, irritated, partially, or entirely torn rotator cuff, which can cause extreme pain.

This can happen secondary to an injury from an outstretched arm, doing sports, and regular arm movements like lifting or overhead activities. Symptoms include dull, aching, localised pain deep in your shoulder that worsens with specific movements, stiffness and decreased range of motion. They can interrupt sleep if you turn to the affected shoulder.

Conservative treatment is recommended, such as resting the area or applying ice on the affected shoulder. You can also use over-the-counter anti-inflammatory drugs like ibuprofen or aspirin.

Some doctors prescribe physical therapy to improve your strength and increase the shoulder's range of motion. In addition, a corticosteroid injection is an optional treatment to help with your pain and inflammation, and if these fail to provide relief, the problem may require surgery.

2. Shoulder bursitis

The bursae are fluid-filled sacs that cushion your joints. If it is inflamed, bursitis can occur. Frequent overuse of the shoulder joint in repetitive activities can lead to shoulder bursitis. It can also appear without apparent cause.

Pain is usually localised, aching, and tender, especially when lying down to the affected side. Other aggravating symptoms are pain with movement, stiffness, and swelling with redness.

The first phase of treatment is conservative, from resting the shoulder moving to prescription painkillers and physical therapy exercises. Corticosteroid injections can also be recommended, and if all are deemed ineffective, surgery to drain or remove the bursa is done.

3. Shoulder impingement syndrome

Shoulder impingement syndrome happens when the soft tissues around your rotator cuff and the shoulder bone rub on each other, especially if you move your arm in a certain way.

It is associated with these three factors: inflammation by a specific tendon, the bursa, any presence of bone spurs that could interrupt the movement of the rotator cuff, or defects of the bone in the shoulder called the acromion, where it is curved or hooked instead of being flat.

The pain is at the top of the shoulder, especially when lifting the arm above the head, and at night when you roll onto the affected shoulder, and muscle weakness. Like any other shoulder problem, the first line of defence is with conservative treatments, including rest, medications, gentle shoulder exercises, and corticosteroid injections. Surgery is warranted if the area is narrowed and needs to be widened.

4. Osteoarthritis of the shoulder

The degeneration of the shoulder cartilage is inevitable, especially as we age, and osteoarthritis also affects the shoulder joint.[3] In some cases, it can also be caused by a culmination of previous injuries, causing the shoulder joint to break down, from a rotator cuff tear to repetitive shoulder dislocation.

Symptoms could include that pain that is worse when movement, stiffness with reduced range of motion on the area, and grinding or clicking sounds called "crepitus" occur when moving the shoulder.

Treatment includes:

• Topical or oral pain relievers

• Physical therapy

• Corticosteroid injections in the doctor's office.

Surgery is only recommended if more conservative options fail in relieving pain.

5. Frozen shoulder

Frozen shoulder or adhesive capsulitis is a condition when connective tissues thicken and impair the movement of the area.[4] It can persist for more than three months due to the inflammation of the primary shoulder joint or the glenohumeral joint.

Its origin may be unknown, but people who cannot move the area for a long time after an injury or surgery, or those with diabetes, have a high risk of its development. Movement on the shoulder with frozen shoulder comes with a natural course of the pathology, occurring from two months to a year or longer.

1. Freezing - the shoulder is painful in movement that is worse at night, and a painful phase that increases the joint restriction that lasts from two to nine months.

2. Frozen - As the pain lessens, the shoulder becomes stiff and immobile and could last from four months to a year.

3. Thawing - A gradual return to the range of motion with the shoulder after a year or more of adhesive capsulitis.

Any stage of frozen shoulder is worse in the evenings. Treatment of this condition is conservative compared to other shoulder problems, but more persistent cases call for corticosteroid injections, shoulder manipulation, or surgery.

What is the best way to sleep if your shoulder hurts?

Here are several tips for being comfortable and eventually sleeping at night whilst having shoulder pain.

• Avoid sleeping on the affected shoulder and adjust your sleeping position to the opposite side. If you can, sleep lying on your back or stomach to prevent giving pressure to the pain.

• If it is difficult to move yourself away from the affected shoulder as it provides comfort for your sleep, use a pillow to anticipate the sudden changes of your movement when sleeping, or avoid yourself from moving to the area affected.

• Regular exercise can increase circulation to the area and promote healing on your injured shoulder. It can also be helpful to move your shoulders through gentle shoulder stretches and exercises to reduce the pain you are experiencing.

• It is also good to know your limits in moving the shoulder or any activity that could further irritate your shoulder joint.

• Taking over the counter painkillers can be helpful, especially if they are taken before sleeping.

• Practise good sleep habits and reduce screen time before sleeping, from watching the telly, surfing the internet through the computer, talking on the phone, or scrolling through social media. It is also great to avoid caffeine, nicotine, or alcohol in the evening.

Prevention Tips

If you are looking for ways to reduce or prevent any injury from your shoulder and keep them strong and healthy, here are some suggestions to take note of:

• If possible, avoid any repetitive motions, especially lifting and throwing objects, because they can strain the shoulder joint.

• If the repetitive motions are not avoidable, especially if it is a part of your job, or participating in sports, taking breaks can reduce the likelihood of injury.

• Again, it is also good to exercise not only your shoulders but your whole body to keep your muscles and joints healthy. Do a proper warm-up and stretch first to prepare the surrounding areas for movement.

• Using a dolly or a wheelbarrow to prevent straining the shoulder is highly required when carrying heavy loads.

When To See Your Doctor

Booking an appointment with your GP is imperative if the pain is sudden or severe, does not go away for more than a few weeks, is accompanied by weakness or loss of motion or injury, or disrupts your day-to-day life, especially with sleep.

The Bottom Line

There are many causes as to why our shoulders hurt and can be a problem, especially when sleeping. Sleeping on the side of the affected area is also another issue because it adds pressure on the shoulder, leading to irritation and increased pain, making it worse.

If you have difficulty sleeping due to shoulder pain at night, adjusting your sleeping position is recommended. Try repositioning the pillow or take over the counter pain relievers to have a good sleep at night.

If it is starting to be an issue in your everyday life, severe, and persistent, it is time to see the GP to help you identify the problem and have a proper treatment plan that is adequate for your pain.