Why Does My Shoulder Hurt at Night? 7 Common Causes and When to See an Orthopedic Surgeon

A sore shoulder is frustrating during the day. At night, it can be even harder to ignore.

Maybe you can’t get comfortable. Maybe rolling onto one side wakes you up. Or perhaps your shoulder aches at night even though it doesn’t bother you nearly as much during the day.

Shoulder pain at night can come from several conditions, including rotator cuff problems, bursitis, shoulder arthritis, frozen shoulder, and biceps tendon irritation. In some cases, simply lying on an irritated shoulder puts more pressure on sensitive tissues. Still, nighttime pain by itself doesn’t tell you exactly what’s wrong.

If the pain keeps coming back, gets worse, or starts causing weakness or loss of motion, it’s worth having your shoulder evaluated.

At Arthritis & Sports Orthopaedics, our shoulder specialists offer both nonsurgical and surgical care for shoulder conditions in Sterling and South Riding, Virginia.

Key Takeaways

• Shoulder pain at night is a symptom, not a diagnosis.

• Rotator cuff problems, bursitis, arthritis, frozen shoulder, and biceps tendon problems can all make it difficult to sleep.

• Pain that travels down the arm along with tingling or numbness may be coming from the neck or a nerve rather than the shoulder itself.

• Nighttime pain doesn’t automatically mean you have a rotator cuff tear or need surgery.

• Consider seeing an orthopedic specialist if shoulder pain keeps waking you, gets worse, causes weakness or stiffness, or interferes with everyday activities.

• Sudden severe pain after an injury, major swelling, deformity, or shoulder discomfort along with chest symptoms may require urgent medical attention.

Dr. Matthew Griffith says “Nighttime shoulder pain is a small clue to a larger problem. We have to look at the whole picture—where the pain is, what movements bring it on, whether there’s weakness, and how well the shoulder moves.”

At a Glance: What May Be Causing Your Shoulder Pain at Night?

What You Notice	Possible Cause	Other Clues You May Notice
Aching along the outside of the shoulder or upper arm	Rotator cuff tendinopathy	Pain with reaching, lifting, overhead activity, or lying on that side
Night pain with noticeable weakness when lifting the arm	Rotator cuff tear	Difficulty reaching overhead or lowering the arm; may follow an injury or develop gradually
Pain when raising the arm or lying on the affected side	Shoulder bursitis or impingement	Tenderness and pain with overhead activities
Deep aching pain with stiffness	Shoulder arthritis	Reduced motion, grinding or clicking, pain with activity or at rest
Increasing pain with major loss of motion in several directions	Frozen shoulder	Difficulty reaching overhead or behind your back; both active and passive motion may be limited
Pain mainly at the front of the shoulder	Biceps tendinitis	Pain with lifting or overhead movement and tenderness at the front of the shoulder
Shoulder pain with neck pain, numbness, tingling, or burning	Neck or nerve problem	Pain may travel down the arm and may include arm or hand weakness

Why Does Shoulder Pain Get Worse at Night?

There isn’t one proven explanation for why every painful shoulder seems to feel worse at night.

For some people, the answer is partly mechanical. Lying directly on a sore shoulder can put pressure on irritated tendons, muscles, or other tissues. Certain sleeping positions may also place the shoulder in an uncomfortable position for hours at a time.

Pain can simply feel more noticeable at night, too. During the day, many things are competing for your attention - from work to conversations and errands. When you’re lying quietly in bed, that nagging ache may suddenly be hard to ignore.

Changing your sleeping position may help. But if the pain comes back night after night, there may be an underlying shoulder problem that deserves a closer look.

Why Does My Shoulder Hurt When I Sleep on My Side?

When you sleep directly on a painful shoulder, your body weight places pressure on structures that may already be irritated.

That can be especially uncomfortable with a rotator cuff problem, bursitis, arthritis, or another shoulder condition.

Some people feel better sleeping on their back or on the opposite side. Supporting the sore arm with a pillow may also make it easier to settle into a comfortable position.

These changes can help with symptoms. They don’t, however, treat the reason your shoulder keeps hurting.

7 Common Causes of Shoulder Pain at Night

A number of shoulder conditions can interfere with sleep. Unfortunately, they can also feel very similar. Where you hurt and when you hurt can offer clues, but symptoms alone can’t confirm a diagnosis.

1. Rotator Cuff Tendinopathy

The rotator cuff is a group of muscles and tendons that help you lift and rotate your arm while keeping the shoulder stable. With time, repeated use, or injury, these tendons can become irritated or begin to wear. You may hear this called rotator cuff tendinitis or rotator cuff tendinopathy.

Common symptoms include:

• Pain along the outside of the shoulder or upper arm

• Pain when reaching overhead

• Discomfort while lifting

• Pain when reaching behind your back

• Trouble lying on the affected shoulder

The discomfort may start gradually and become more noticeable over time.

What Does Rotator Cuff Pain Feel Like at Night?

People often describe rotator cuff pain as an ache along the outside of the shoulder or upper arm. It may become more noticeable when you lie on that side or put your arm in certain positions. You may also notice pain or weakness when lifting the arm.

2. Rotator Cuff Tear

A rotator cuff tendon can tear partially or completely. Sometimes that happens suddenly after a fall, lifting injury, or other trauma. In other cases, a tear develops slowly as the tendon changes with age and repeated use.

Possible symptoms include:

• Pain when raising or lowering the arm

• Shoulder weakness

• Pain during certain movements

• Difficulty reaching overhead

• Nighttime pain

• Trouble sleeping on the affected side

One important point: not every rotator cuff tear causes intense pain. Some people have tears without realizing it.

Does Shoulder Pain at Night Mean I Have a Rotator Cuff Tear?

No. Nighttime shoulder pain doesn’t automatically mean you have a rotator cuff tear. Rotator cuff problems often hurt at night, but bursitis, arthritis, frozen shoulder, and several other conditions can do the same thing. An orthopedic examination can help narrow down the cause and determine whether imaging would be useful.

Learn more about rotator cuff repair.

3. Shoulder Bursitis or Impingement

A small fluid-filled sac called a bursa helps tissues in the shoulder glide with less friction. If that bursa becomes irritated, you may develop bursitis. Bursitis can also occur along with rotator cuff irritation or shoulder impingement.

Symptoms may include:

• Pain when raising the arm

• Tenderness around the shoulder

• Pain during overhead activity

• Discomfort when lying on the painful side

Bursitis, impingement, and rotator cuff problems often overlap, so it isn’t always possible to tell them apart based on symptoms alone.

Can Shoulder Bursitis Hurt More at Night?

Yes. Bursitis can make lying on the affected shoulder uncomfortable and may contribute to nighttime pain. Still, pain at night doesn’t prove that bursitis is the cause. Several shoulder conditions can produce the same symptom.

4. Shoulder Arthritis

Arthritis is often associated with the knees and hips, but the shoulder can develop arthritis, too. Osteoarthritis occurs when the cartilage that helps the joint move smoothly becomes damaged over time.

Symptoms of shoulder arthritis may include:

• A deep ache in the shoulder

• Stiffness

• Less range of motion

• Pain with activity

• Grinding or clicking

• Pain while resting or sleeping

As the condition progresses, everyday movements can become harder. Reaching into a cabinet, washing your hair, or putting on a jacket may start to hurt.

Learn more about arthritis treatment options.

What Does Shoulder Arthritis Feel Like at Night?

Shoulder arthritis may cause a deep, aching pain inside the joint. Stiffness is also common, and finding a comfortable sleeping position can become difficult.

Earlier on, the shoulder may hurt mainly with activity. As arthritis becomes more advanced, pain can also occur at rest. When severe arthritis no longer responds well to nonsurgical treatment, shoulder replacement surgery may be an option.

5. Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, causes shoulder pain along with increasing stiffness. This loss of motion is one of its defining features. Over time, you may struggle to raise your arm, reach behind your back, or perform activities that once felt simple.

Frozen shoulder usually develops in stages. During the earlier, more painful stage, sleep can be especially difficult.

Symptoms may include:

• Shoulder pain that gradually gets worse

• Significant stiffness

• Difficulty reaching overhead

• Trouble reaching behind your body

• Limited movement even when someone else tries to move your arm

How Is Frozen Shoulder Different From a Rotator Cuff Problem?

Both can hurt. Both can make moving your arm difficult. With frozen shoulder, though, movement is usually restricted whether you move the arm yourself or someone else moves it for you. These are called active and passive range of motion.

Rotator cuff problems often produce a different combination of pain, weakness, and motion loss.

There can be overlap, so a physical examination is often the best way to sort out the difference.

6. Biceps Tendinitis

The biceps muscle attaches near the shoulder through two tendons called the long head and the short head of the biceps tendon. These tendons can become irritated because of repeated activity, an injury, or another problem inside the shoulder. Biceps tendon issues may also occur at the same time as rotator cuff injuries.

Common symptoms include:

• Pain at the front of the shoulder

• Pain while lifting

• Discomfort with overhead movements

• Tenderness near the front of the shoulder

• Aching after activity

Depending on the position of your shoulder and how irritated the tendon is, the pain may also bother you at night.

Where Is Biceps Tendon Shoulder Pain Usually Felt?

Biceps tendon pain is most often felt toward the front of the shoulder. That alone doesn’t make the diagnosis certain. Several structures sit close together in this part of the shoulder, so pain location alone isn’t enough to identify the exact problem.

7. Pain Coming From Your Neck or Nerves

Sometimes pain that feels as though it’s coming from your shoulder actually begins somewhere else. Problems in the neck can irritate nerves that travel into the shoulder and down the arm.

Possible signs of nerve involvement include:

• Neck pain

• Burning pain

• Tingling

• Numbness

• Pain that travels below the shoulder

• Weakness in the arm or hand

It’s also possible to have a shoulder problem and a neck problem at the same time. That’s one reason the physical examination matters.

How Can I Tell If Shoulder Pain Is Coming From My Neck?

Pain that starts in the neck and travels into the shoulder or arm, particularly when it comes with tingling, numbness, or burning, may involve a nerve in the neck. That said, shoulder conditions can also send pain down the upper arm. A medical evaluation can help determine where the problem is actually coming from.

When Should You See an Orthopedic Surgeon for Shoulder Pain at Night?

An occasional sore shoulder after a busy day doesn’t always require a specialist.

Pain that repeatedly disrupts your sleep is different, especially if it’s getting worse or changing the way you use your arm.

Consider scheduling an orthopedic evaluation if you notice:

• Pain that isn’t improving

• Increasing stiffness

• Difficulty raising your arm

• Loss of shoulder motion

• New or worsening weakness

• Pain that interferes with work, exercise, or daily activities

• Symptoms that return whenever you resume activity

It's important to remember: You don’t have to wait until the pain becomes severe. An earlier evaluation can help identify the cause and may give you more treatment options. It can also help prevent you from changing the way you move just to avoid pain.

When Is Shoulder Pain an Emergency?

Most shoulder pain isn’t an emergency, but there are exceptions.

Call 911 or seek emergency medical care if shoulder discomfort occurs along with chest pain or tightness, shortness of breath, sweating, faintness, or other symptoms that could point to a heart problem.

After an injury, seek urgent medical attention if:

• Your shoulder looks deformed

• You can’t move your arm

• The pain is intense

• Sudden, severe swelling develops

• Bone or another structure appears exposed

Severe or sudden symptoms shouldn’t be diagnosed at home.

How Is Nighttime Shoulder Pain Diagnosed?

Usually, the first step is a conversation.

Your orthopedic provider will want to know when the pain started, where you feel it, what makes it better or worse, and whether an injury happened.

You may be asked:

• Where does it hurt?

• When did the pain begin?

• Was there an injury?

• Which movements make it worse?

• Does it wake you from sleep?

• Have you noticed weakness?

• Do you have numbness or tingling?

The physical exam may include checking shoulder movement, strength, stability, and areas of tenderness.

Do You Need an X-Ray or MRI for Shoulder Pain?

Not always. In many cases, your symptoms and physical examination help determine whether imaging is needed at all—and which test makes the most sense.

The best imaging test depends on what your provider is looking for.

X-rays are useful for evaluating bones and the shoulder joint. They may reveal arthritis, fractures, or other changes involving the joint.

MRI or ultrasound can provide more detail about soft tissues, including the rotator cuff.

How Is Shoulder Pain at Night Treated?

That depends on why the shoulder hurts in the first place.

Many shoulder conditions can be treated without surgery, especially when care begins early. Depending on the diagnosis, treatment may include:

• Changing activities that aggravate the shoulder

• Physical therapy

• A home exercise program

• Medication when appropriate

• Injections for selected conditions

• A gradual return to normal activity

Our physical therapy team works with patients recovering from a wide range of shoulder injuries and conditions.

Athletes and active adults may also benefit from evaluation by our sports medicine specialists, who treat shoulder problems related to sports, exercise, and repetitive activity.

When Is Shoulder Surgery Considered?

Nighttime pain alone isn’t a reason to have surgery.

Surgery may be considered for certain rotator cuff tears, shoulder instability, advanced arthritis, or other conditions when the diagnosis and the patient’s symptoms make an operation an appropriate choice.

That decision is highly individualized and depends on several factors, including the diagnosis, severity of the condition, activity level, overall health, treatments already attempted, and the patient’s personal goals.

Dr. David Goodwin, orthopedic sports medicine surgeon: “Our goal isn’t simply to treat an MRI or X-ray. We want to understand what’s actually causing the patient’s symptoms and choose the treatment that fits that person’s lifestyle. When a nonsurgical option can get them there, we want them to understand that choice, too.”

How Can I Sleep More Comfortably With Shoulder Pain?

If a certain position clearly makes your shoulder hurt, changing how you sleep may take some pressure off it.

You may feel more comfortable:

• Sleeping on your back

• Sleeping on the opposite side

• Supporting the painful arm with a pillow

• Avoiding positions that clearly increase your pain

The goal isn’t to force your shoulder into one “correct” position. It’s to keep the arm supported and avoid positions that clearly aggravate your symptoms.

These adjustments may make the night easier. They won’t fix the underlying cause if the pain keeps returning. If your shoulder continues to wake you or the problem is becoming more frequent, consider having it evaluated.

Shoulder Pain Treatment in Sterling and South Riding, VA

Arthritis & Sports Orthopaedics provides comprehensive shoulder care for patients in Sterling, South Riding, Ashburn, Chantilly, Leesburg, Reston, and communities throughout Northern Virginia.

Our orthopedic specialists treat a wide range of shoulder problems, from overuse injuries and rotator cuff conditions to arthritis and more complex injuries.

Shoulder Specialist in Sterling, VA

Matthew H. Griffith, MD is a board-certified orthopedic surgeon who specializes in shoulder, elbow, knee, and sports injuries.

Dr. Griffith completed fellowship training in sports medicine and shoulder surgery at Massachusetts General Hospital/Harvard University. His shoulder expertise includes arthroscopic procedures as well as total and reverse shoulder replacement.

He sees patients at our Sterling, Virginia office.

Shoulder Specialist in South Riding, VA

David S. Goodwin, MD is a board-certified orthopedic surgeon specializing in both nonsurgical and surgical care for shoulder, knee, hip, and sports injuries.

Dr. Goodwin completed fellowship training in sports medicine at NYU Hospital for Joint Diseases.

He sees patients at our South Riding, Virginia office.

Frequently Asked Questions About Shoulder Pain at Night

Why does my shoulder hurt at night but not during the day?

Your sleeping position may put pressure on irritated tissues in the shoulder, making pain more noticeable. Pain can also stand out more when you’re resting and there are fewer distractions. Rotator cuff problems, bursitis, arthritis, frozen shoulder, and other conditions can all cause nighttime pain. If it keeps happening or starts affecting how you use your arm, consider having it evaluated.

Does nighttime shoulder pain mean I have a rotator cuff tear?

No. Rotator cuff tears can cause nighttime pain, but they’re not the only possible cause. Rotator cuff tendinopathy, bursitis, arthritis, frozen shoulder, and other conditions may produce similar symptoms. An orthopedic examination—and imaging when appropriate—can help determine what’s going on.

Why does my shoulder hurt when I sleep on my side?

Lying directly on a painful shoulder places pressure on tendons, bursae, and other tissues that may already be irritated. Sleeping on your back or opposite side may feel more comfortable, and supporting the arm with a pillow can help. If the pain keeps returning, an underlying shoulder condition may be responsible.

Can shoulder arthritis cause pain at night?

Yes. Shoulder arthritis can cause aching, stiffness, reduced motion, and pain at rest or while sleeping. As arthritis progresses, it may become harder to find a comfortable position and symptoms may begin interfering with everyday activities.

Do I need an MRI for shoulder pain at night?

Not necessarily. An orthopedic provider will usually begin with your symptoms and a physical examination. X-rays may be helpful when arthritis, a fracture, or another bone or joint problem is suspected. An MRI or ultrasound may be used when more detail about soft tissues, including the rotator cuff, is needed.

When should I see an orthopedic surgeon for shoulder pain?

Consider seeing an orthopedic specialist if shoulder pain repeatedly wakes you, gets worse, limits your normal activities, causes stiffness or weakness, or doesn’t improve with appropriate home care. Severe symptoms after an injury or shoulder discomfort accompanied by concerning chest or breathing symptoms should be evaluated urgently.

Don’t Let Shoulder Pain Keep You Up at Night

One uncomfortable night doesn’t necessarily mean something serious is wrong. But when shoulder pain keeps waking you up, interferes with your usual activities, causes weakness or stiffness, or continues despite changes in activity, it’s worth finding out why.

Getting the right diagnosis can help you understand your choices and decide what treatment, if any, you actually need.

Request an appointment with an Arthritis & Sports Orthopaedics shoulder specialist in Sterling or South Riding, VA.