Why does my shoulder hurt at night? 7 questions with orthopedic surgeon Lee Stowell, M.D.

By Kristy Bleizeffer Oct 6, 2016

Orthopedic surgeon R. Lee Stowell, M.D., completed a fellowship in shoulder surgery.

Unresolved pain can distract at any time of day, but is often most noticeable at night when all you have to think about is your discomfort. When it’s your shoulder that is hurting, it can be particularly hard to drift off to sleep.

Shoulder-related night pain usually a signifies rotator cuff issue. Here, Dr. Lee Stowell of Advantage Orthopedics and Neurosurgery answers seven questions about your aching shoulder. 

1. What is my rotator cuff?

The rotator cuff is a system of four muscles and corresponding tendons that function as a single unit to move and stabilize the shoulder.  Because the range of motion of the shoulder is so great, the rotator cuff is inherently prone to injury and irritation. Rotator cuff injuries occur in many varieties, however, one of the most common forms we see is acute irritation of the muscles and tendons.  This is known as “rotator cuff syndrome” or “rotator cuff tendinosis” and often results from over-use or repetitive micro-trauma.

Other types of rotator cuff injuries include major trauma, neglected prior injury or tearing of the rotator cuff.

2. What is rotator cuff tendinosis?

Rotator cuff tendinosis is inflammation and irritation of the cuff muscles and tendons.  This can have may causes.  Many that we often see include over-use type injury, repetitive micro trauma such as in overhead laborers, and damage caused by bone spurs.

3. Why does it hurt more at night?

There are many theories for why rotator cuff irritation can cause pain at night.  In reality, they are all probably correct to some degree. These include:

  • Lack of cognitive protection that is readily evident during waking hours
  • Increase in mediators and stimulators of the inflammatory response when lying on your back
  • Increased fluid accumulation in the bursa (fluid-filled cushions between muscles) when lying down
  • Postural changes causing traction irritation of the nerves that supply the rotator cuff, and many others parts of the body

One thing we do know through multiple studies is that relief of the typical “night pain” is one of the complaints most consistently alleviated and resolved with proper treatment.

4. Can it be treated without surgery?

The degree of irritation or damage to the rotator cuff can help us predict who will do well without surgery and those who will not.  There are clear situations in which surgery is the standard of care.  However, in the absence of those indications, approximately 80 percent of patients will get better with conservative treatment including subacromial injections, rest and eventual structured formal physical therapy to prevent recurrence.

5. When should I consider surgery?

Excluding surgical urgencies or emergencies, attempts at conservative, non-operative measures should be attempted first.  If these measures fail to completely relieve symptoms, or if symptoms return, further consultation to discuss possible surgical intervention should be considered.

6. What surgical treatments are available?

There have been many advances in shoulder surgery within the last 10 to 15 years.  Many procedures can be performed either arthroscopically or through minimally invasive procedures.  This allows for smaller surgical incisions, less trauma to the surgical site and, often, quicker recovery.

The specific type of surgery is dictated by the diagnosis but can include removal of torn and damaged tissue, shaving of bone spurs and arthritis, repair of damaged and torn tendons, fracture treatment and also types of shoulder replacement options.

7. What can I expect after surgery?

Surgeries can be performed in the outpatient setting allowing patients to return home the same day, or done in the hospital with a short overnight stay.  After surgery, patients can expect to wear a sling for a variable amount of time.  There will also be incision sites that need to be cared for.  Pain control is provided along with detailed instructions for what can and cannot be done based on the procedure performed.  Ultimately, most procedures will require some physical therapy to help restore range of motion and increase strength.  Timing for maximal improvement can be as short as a few weeks to a several months, but will vary from patient to patient.

R. Lee Stowell

R. Lee Stowell M.D.

Dr. Lee Stowell is an orthopedic surgeon and completed a fellowship in shoulder surgery at the CORE Institute in Phoenix. He was selected chief resident of the Orthopaedic Surgery Residency Program at the University of Pennsylvania Medical Center-Hamot; Shriners Hospital for Children in Erie, Pa.