Why the shoulder hurts at night

Cause	Typical signs	More
Rotator cuff tendinopathy or tear	Pain when lying on the affected side and lifting the arm sideways	Rotator cuff
Frozen shoulder (adhesive capsulitis)	Severe night pain, gradual loss of movement, especially external rotation; more common with diabetes	Frozen shoulder
Calcific tendinitis	Sudden very severe pain, arm almost impossible to move	Calcific tendinitis
Subacromial pain, bursitis	Painful arc when raising the arm, night pain on the side	Impingement
Shoulder osteoarthritis	Stiffness, grinding, pain with load and at night	Shoulder osteoarthritis
Cervical nerve root irritation	Pain running from the neck into the arm, numb fingers	Neurologist, neck MRI

How to sleep with a painful shoulder

Do not lie on the painful shoulder; on your back, put a pillow under the elbow so the arm rests slightly in front of the body.
On the healthy side, hug a pillow so the painful arm does not hang forward.
A painkiller or anti-inflammatory an hour before bed, if your physician agrees.
Ice for acute inflammation, heat for stiffness.

When an MRI or ultrasound is needed

Ultrasound shows the cuff tendons, bursa and calcifications well; MRI shows tears, cartilage and the labrum. An X-ray is needed if osteoarthritis or calcific tendinitis is suspected. Send your existing images for a second opinion or arrange an MRI in Munich.

Treatment without surgery

The basis is exercise for the rotator cuff and shoulder-blade muscles guided by a physiotherapist. In two large placebo-surgery trials (Lancet and BMJ, 2018), arthroscopic subacromial decompression was no better than sham surgery, so subacromial pain is treated conservatively first. For night pain a corticosteroid injection into the subacromial bursa or joint is used; for chronic tendinopathy PRP may be discussed, for calcifications ultrasound-guided lavage or shockwave therapy. Surgery is needed for a complete traumatic cuff tear in active people.

What to prepare for a free review

Images: MRI, ultrasound or X-ray (DICOM files or photos of the screen) and their reports.
When and how the pain started, where exactly it hurts, what makes it worse or better.
Treatment so far: injections, physiotherapy, surgery — and how it helped.
Other conditions and medications, especially blood thinners.

With this information, a partner-clinic physician can say whether further tests are needed and which treatment options suit you.

See a doctor urgently

Possible heart problem

Left shoulder pain with chest pain, breathlessness or sweating — call emergency services.

Infection or injury

A hot swollen joint with fever, deformity after a fall, inability to raise the arm after an injury.

Other warning signs

Constant night pain in a smoker with weight loss or cough, increasing arm weakness — investigation without delay.

Contraindications to injection treatment: active infection, active cancer, clotting disorders, pregnancy. Possible risks of injections are a temporary pain flare and swelling for 1–3 days and, rarely, infection; the treatment may also not work.

Scientific evidence

Placebo-surgery trials on the treatment of subacromial shoulder pain:

Frequently asked questions about shoulder pain at night

Why is shoulder pain worse at night?

Lying down compresses the cuff tendons and bursa, and during the day movement distracts from the pain. That is why night pain is typical of cuff tendinopathy, bursitis and frozen shoulder.

My shoulder hurts when I lie on it — what is it?

Most often rotator cuff tendinopathy or subacromial bursitis.

How do I recognise frozen shoulder?

Besides night pain, movement is gradually lost: it becomes hard to reach behind the back or rotate the arm outwards, even with help from the other hand.

How should I sleep with shoulder pain?

On your back with a pillow under the elbow, or on the healthy side hugging a pillow. Do not lie on the painful shoulder.

Does a shoulder injection help night pain?

A corticosteroid injection often reduces night pain for several weeks and makes exercise possible.

Is surgery needed?

Usually not: for subacromial pain, decompression did not outperform placebo surgery. Surgery is discussed for a complete traumatic cuff tear.

How can RegenPAS help?

RegenPAS is a patient service centre in Munich, not a clinic. We review your images and symptoms and send a request to several partner clinics at once. Clinics that can accept you send their own conditions and price; prices differ between clinics, and you choose the option that suits you. The coordinator replies within 24 hours, and a clinic physician’s preliminary opinion follows in 1–3 business days. We then arrange the appointment, visa invitation, interpreter, transfers and accommodation. Treatment decisions are made by the clinic physician. Contact a coordinator.

Shoulder keeping you awake? Free review of your images

Send your MRI or ultrasound and describe where and when it hurts. The coordinator replies within 24 hours; a clinic physician gives an opinion in 1–3 business days.

Send images

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