Why Does My Shoulder Hurt at Night? Causes and What Helps

By Michael Carroll, M.D., family physician and inventor of the Shoulder Reliever

The short answer

Shoulder pain is often worse at night for two reasons. When you lie down, you lose the gentle pull of gravity that keeps space open in the shoulder joint. And while you sleep, your arm drifts overhead or you roll onto the sore side, which pinches the rotator cuff tendons for hours at a time. The most common cause is rotator cuff tendinopathy, sometimes called impingement. What helps most is keeping the arm at your side while you sleep and strengthening the deep rotator cuff muscles during the day.

Why shoulder pain gets worse when you lie down

When you are standing or sitting, the weight of your arm gently pulls the top of the arm bone down and away from the bony roof of the shoulder. That keeps room for the rotator cuff tendons, which run through a narrow space between the two.

Lying down takes that pull away. Then, during sleep, two things tend to happen. You may roll onto the painful shoulder and press on it, or your arm may move up and away from your body, even overhead. Both close the space and squeeze the tendons. Night after night, that keeps the tendon irritated, and an irritated tendon does not get the blood flow it needs to heal. I call this the nighttime injury cycle, and it is why so many of my patients told me the nights were the worst part.

Common causes of night shoulder pain

Rotator cuff tendinopathy or impingement. The most common cause. The tendons are irritated or worn, and pain is often worse reaching overhead, reaching behind you, and lying on that side.
Bursitis. Inflammation of the small fluid-filled sac that cushions the tendons. It often goes hand in hand with impingement.
Rotator cuff tear. A partial or full tear of one of the tendons, from wear over time or an injury. Night pain and weakness lifting the arm are common.
Frozen shoulder (adhesive capsulitis). The joint lining tightens, and the shoulder becomes stiff and painful in every direction, not just overhead.
Arthritis. Wear of the shoulder joint or the small joint at the top of the shoulder, often with grinding and stiffness.
Pain coming from the neck. A pinched nerve in the neck can be felt in the shoulder, often with tingling or numbness down the arm.

What helps tonight

Sleep on your back or on the other side. Avoid lying on the painful shoulder.
Keep the arm at your side. Do not sleep with the arm overhead or under the pillow. If you sleep on the good side, hugging a pillow keeps the sore arm from falling forward across your body.
Prop the arm if you sleep on your back. A small pillow under the elbow can take pressure off the front of the shoulder.
Ice or heat. Ice for 15 to 20 minutes can calm a flare-up; heat can help when stiffness is the main problem.
Pain relievers. Over-the-counter medicine can help short term. Use it as your doctor recommends.

What helps over the next few weeks

Lasting relief usually takes two things working together.

Protect the shoulder at night. Keeping the arm at your side while you sleep breaks the nighttime injury cycle. In a 2006 randomized trial I presented at the American College of Sports Medicine, all 11 patients with rotator cuff tendinopathy who wore a nighttime brace for 28 days improved, compared with about half of patients who did not. You can read the details on our Research page.

Strengthen the deep rotator cuff muscles during the day. These small muscles hold the arm bone down in its socket and keep space open for the tendons. Gentle, controlled exercise, done consistently, rebuilds them. A physical therapist can guide this, and many people do it at home.

That combination is what the Shoulder Reliever is built around: a support sleeve that keeps the arm at your side at night, and a five-minute daytime exercise with four progressively heavier balls. Most people use it for 40 nights and 40 days. See how it works.

When to see a doctor

Night shoulder pain is usually not an emergency, but get checked promptly if you have any of these:

Pain that started after a fall or injury, especially if you cannot lift your arm
Sudden, severe pain or a shoulder that looks out of place
Fever, or a shoulder that is red, hot or swollen
Numbness, tingling or weakness down the arm
Pain that is not improving after several weeks
Unexplained weight loss, or a history of cancer

Call 911 if shoulder pain comes with chest pain, pressure, shortness of breath or sweating. Left shoulder pain can be a sign of a heart attack.

Common questions

Is it normal for rotator cuff pain to be worse at night?

Yes. It is one of the most common signs of a rotator cuff problem, because lying down and moving the arm in your sleep pinch the tendons.

What is the best sleeping position for shoulder pain?

On your back with the arm at your side, or on the good side hugging a pillow. Avoid sleeping on the painful shoulder or with the arm overhead.

How long does night shoulder pain take to go away?

It depends on the cause. With tendinopathy, many people notice better nights within a few weeks once they protect the shoulder at night and start strengthening it. If it is not improving after several weeks, see your doctor.

This page is general information, not a diagnosis. Individual results vary, and the Shoulder Reliever is not a substitute for medical care. If you are unsure what is causing your pain, talk with your doctor.