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Shoulder pain at night can make it difficult to fall asleep, wake you when you turn over or leave your shoulder feeling particularly stiff in the morning.
The pain may become more noticeable when you lie on the affected side, when your arm is unsupported or after the shoulder remains in one position for several hours. Possible causes include rotator cuff-related pain, tendon irritation, frozen shoulder, arthritis, a recent injury or pain referred from the neck.
Night-time pain does not, by itself, identify the cause. The location of the pain, how the shoulder moves and whether you have stiffness, weakness, numbness or a recent injury all provide important clues.
At Head 2 Toe Chiropractic in Carrigaline, an assessment can help determine whether conservative care is suitable or whether medical investigation may be required. You can also read about our dedicated shoulder pain treatment in Carrigaline.
Shoulder pain can seem worse at night for several reasons.
Sleeping directly on a sore shoulder places pressure on the joint and the surrounding muscles, tendons and other soft tissues. This may make an already sensitive area more uncomfortable.
The HSE advises people with shoulder pain not to sleep on the affected side and suggests sleeping more upright with additional pillows where necessary.
When you lie on your back or opposite side, the painful arm may fall forwards or backwards into an uncomfortable position. Supporting the forearm and elbow with a pillow can reduce the amount of strain placed on the shoulder.
The shoulder may stiffen when held in one position for a prolonged period. This is one reason pain can become more noticeable when you first wake or move during the night.
Pain that was present during the day may feel more prominent once you are lying quietly in bed. This does not necessarily mean that the condition has suddenly worsened at night.
Repeated lifting, overhead work, gym training, gardening or sport may aggravate a shoulder problem. The resulting discomfort can become more noticeable later that evening or when you lie down.
Several shoulder and neck conditions can produce pain in bed. Because many of them have overlapping symptoms, an examination may be needed before the likely cause can be identified.
The rotator cuff is a group of muscles and tendons that helps move and stabilise the shoulder.
Rotator cuff-related symptoms may include:
Night-time shoulder pain is sometimes associated with a rotator cuff tear, but it does not automatically mean that a tendon is torn. Tendon irritation and several other shoulder problems can produce similar symptoms.
Shoulder tendons may become painful following repetitive activity, a sudden increase in training, overhead work or an injury.
Symptoms may be aggravated by:
The terms tendonitis, tendinopathy, rotator cuff pain and shoulder impingement are sometimes used when discussing these symptoms. They are not necessarily interchangeable, however, and the correct management depends on the individual presentation.
Learn more about assessment and physical therapy for tendon-related pain.
Frozen shoulder, also known as adhesive capsulitis, causes pain and a progressive loss of shoulder movement.
The pain can be particularly troublesome at night during the earlier stages. As the condition develops, substantial stiffness may become the more obvious problem.
You may find it difficult to:
Frozen shoulder may develop without a clear injury, although it can also occur after an operation or injury that has limited normal shoulder movement. The HSE notes that it is more common among people with diabetes.
Persistent shoulder pain combined with substantial stiffness should be medically assessed rather than assumed to be a simple muscle strain. Read more about frozen shoulder treatment in Carrigaline.
Arthritis can cause shoulder pain, stiffness and a reduced range of movement. Some people also notice grinding, clicking or catching sensations.
Pain may become more noticeable at night, after activity or when the shoulder has remained in one position. Arthritis is only one possible explanation for night-time shoulder pain and should not be assumed without an appropriate assessment.
A fall, collision, sudden pull or heavy lift can injure the bones, muscles, tendons or ligaments around the shoulder.
Arrange prompt medical assessment when the pain began after an injury, particularly if you have:
People who develop symptoms through training or sport can also read about our approach to sports injury assessment in Cork.
Not all pain felt around the shoulder originates in the shoulder joint.
A problem involving the neck can sometimes refer pain into the shoulder blade, upper arm, forearm or hand. Neck involvement may be more likely when shoulder pain is accompanied by:
Persistent numbness, weakness or other neurological symptoms require appropriate assessment. Find out more about neck pain treatment at Head 2 Toe.
There is no single sleeping position that suits every shoulder condition. The aim is to avoid direct pressure on the painful side and keep the arm comfortably supported.
Lie on the non-painful side and hug a pillow with the affected arm.
The pillow supports the forearm and may prevent the upper arm from falling across your body. Placing another pillow behind your back can reduce the likelihood of rolling onto the painful shoulder during the night.
When sleeping on your back, place a pillow beneath the forearm and elbow of the painful side.
This keeps the arm supported rather than allowing it to drop backwards towards the mattress. Some people also find a slightly more upright position comfortable during an acute flare-up.
Additional pillows or a supportive wedge may help when lying flat is uncomfortable. The HSE includes sleeping more upright among its self-care suggestions for shoulder pain.
Sleeping on the painful side can compress sensitive tissues and repeatedly disturb sleep. Try to use the opposite side or sleep on your back until the shoulder becomes more comfortable.
Some people sleep with an arm beneath the pillow or above their head. Holding the shoulder in this position for a prolonged period may aggravate certain shoulder problems.
A neutral, supported position is generally preferable.
Simple changes may make night-time shoulder pain easier to manage while you arrange an assessment or allow a mild problem time to settle.
Complete immobilisation can contribute to stiffness. Continue gentle, comfortable movement unless a healthcare professional has specifically advised you to restrict the shoulder.
Do not force the arm through sharp pain or begin strenuous exercises without understanding what may be causing the symptoms.
Temporarily reduce movements that clearly worsen the pain, such as heavy overhead lifting or repeated reaching at arm’s length.
This does not necessarily mean stopping all activity. The aim is to reduce excessive irritation while maintaining comfortable movement.
Some people find a wrapped heat or cold pack temporarily soothing. Do not apply either directly to the skin, and stop if it causes additional discomfort, numbness or skin irritation.
A pharmacist or GP can advise whether a pain-relieving medicine is suitable for you, particularly if you have other medical conditions or take regular medication.
A mattress can influence comfort, but persistent shoulder pain should not automatically be blamed on the bed.
First try supporting the arm with pillows and avoiding direct pressure on the painful side. If symptoms continue, the shoulder itself may need to be assessed.
Contact your GP or an appropriate musculoskeletal healthcare professional when:
The HSE advises contacting a GP if shoulder pain has not improved after two weeks, movement is very difficult or the pain began following an injury.
Go to an injury unit or emergency department if:
These symptoms can occur with a fracture, dislocation or significant tendon or ligament injury.
Call 112 or 999 if shoulder or arm discomfort occurs with chest pressure or tightness, shortness of breath, sweating, nausea, dizziness or pain spreading from the chest into the arms, neck, jaw or back.
A shoulder assessment should consider more than where the pain is located.
Your clinician may ask about:
The physical examination may include:
Imaging is not automatically needed for every painful shoulder. Where the history or examination suggests that an X-ray, ultrasound, MRI or medical opinion is required, referral may be recommended.
Read more about what to expect during your first visit to Head 2 Toe.
The appropriate approach depends on the likely cause of the symptoms and whether conservative care is considered suitable.
Following an assessment, an individual care plan may include:
Not every shoulder problem is suitable for chiropractic care. Suspected fractures, dislocations, significant tendon ruptures, infections and certain neurological symptoms require medical investigation or referral.
No treatment can guarantee a particular result. Recommendations should be based on the person’s symptoms, examination findings, medical history and response to care.
Lying down may place direct pressure on a sensitive shoulder or allow the arm to fall into an uncomfortable position. Pain can also become more noticeable when the shoulder remains still and there are fewer distractions. Pain that occurs only when lying down can still have several causes and may require assessment if it persists.
Not necessarily. Rotator cuff tears can cause pain at rest or at night, but tendon irritation, frozen shoulder, arthritis, sleeping position and referred neck pain can produce similar symptoms.
Side sleeping places body weight directly through the lower shoulder. If the joint or surrounding tissues are already sensitive, this pressure can aggravate the pain. Try sleeping on the opposite side while supporting the painful arm with a pillow.
Yes, a pillow can support the forearm and prevent the shoulder from falling into an uncomfortable position. When lying on your back, place a pillow under the affected arm. When lying on the opposite side, hug a pillow with the painful arm.
Complete rest is not usually recommended for uncomplicated shoulder pain because prolonged inactivity may contribute to stiffness. Continue gentle, comfortable movement while temporarily reducing activities that clearly aggravate the problem.
Not everyone with shoulder pain needs imaging. The need for an X-ray, ultrasound or MRI depends on the injury history, examination findings and symptoms. Imaging may be considered following substantial trauma, persistent weakness or other concerning findings.
Yes. Pain from the neck can sometimes be felt around the shoulder blade or upper arm. Neck pain, numbness, pins and needles, hand weakness or pain extending below the elbow may suggest neck or nerve involvement.
The HSE recommends contacting your GP if shoulder pain has not improved after approximately two weeks, is very difficult to move or began after an injury. Seek help sooner for severe symptoms, significant weakness or the urgent warning signs listed above.
Shoulder pain that repeatedly interrupts sleep deserves attention, particularly when it is accompanied by weakness, restricted movement or symptoms following an injury.
Head 2 Toe Chiropractic is located at Old Waterpark in Carrigaline and serves patients from Carrigaline, Crosshaven, Passage West, Douglas and the wider Cork area.
An initial assessment can help clarify what may be contributing to your symptoms, whether conservative care is suitable and whether referral or further investigation should be considered.
Book an appointment online or contact Head 2 Toe Chiropractic for further information.
