Why Does Rotator Cuff Pain Get Worse at Night?

You finally make it through the day, but as soon as you lay down, your shoulder begins to scream. If this is well known to you, you aren't alone. Shoulder pain at night is one of the most prevalent complaints of individuals suffering with rotator cuff issues – and for good reason.

What is a Rotator Cuff?

The rotator cuff is the collection of four muscles and tendons which surround the shoulder joint. Their role is to ensure that the upper arm bone (humerus) stays securely in the socket and that it moves along a wide range of movements, such as lifting, rotating and reaching over your head.

Damage or irritation to any of these parts results in pain. The two most frequent offenders are:

• Rotator Cuff Tear - partial or complete tear in the tendon, usually caused by trauma or wear and tear.
• Rotator Cuff Tendonitis & Bursitis - inflammation of the tendons (tendonitis) or the fluid filled sac that cushions the joint (bursitis) typically as a result of repetitive overhead movements or extended poor posture

The pattern of the two conditions is the same: Pain is tolerable during the day, but it is much more difficult to endure at night.

6 Reasons Rotator Cuff Pain Gets Worse at Night

The rotator cuff injury becomes worse during sleep for the following reasons:

1. When you sleep in this position, your shoulder is compressed

People naturally gravitate to sleeping on their side. When sleeping on the affected shoulder, its direct impact on already-inflamed tissue. Sleeping on the other side can also be an issue - the injured shoulder is hanging un-supported and the rotator cuff tendons are strained during sleep.
When horizontal, there is no "neutral" "float" position. The joint is assaulted by gravity and body weight all the time.

2. Fewer Distractions during Rest

Your brain gets stimulated during the day with plenty of work, movement and talk. These inputs automatically block pain signals. That noise goes away at night. There's nothing else for your nervous system to process, and so pain signals from your shoulder get to the front of the line. But the pain has not worsened, you've become more aware of it.
3. Inflammation is highest during the evening

3. Inflammation is highest during the evening

The inflammatory process is cyclic. These natural anti-inflammatory processes, which are primarily under the control of cortisol, are most effective in the morning. Cortisol levels lower considerably in the evening. This drop is for those who have Rotator Cuff Tendonitis & Bursitis, and the inflamed bursa or tendon is less lubricated, or relieved, with its internal chemistry at the time you're trying to sleep.

4. Blood flow will change on lying down

When you're standing, gravity helps to regulate the body's fluid levels. Lying down causes blood flow to change. This can add to the fluid build-up around the already-irritated structures in your shoulder, putting pressure on your shoulder and worsening your pain, particularly in cases of bursitis, where the bursa is already swollen.

5. Muscle Relaxation removes Protective Support

A muscle surrounding your shoulder is active and engaged during the day. They work as a moving stabilizer which keeps them in alignment. During the night, those muscles are completely relaxed. With a Rotator Cuff Tear (where the integrity of the tendon itself is already destroyed) the loss of active muscular support places the damaged tissue at an unequal stress without the restraining tension which normally stabilizes the tendon during waking hours.

6. Cold temperature and decreased activity

Cold and inactive joints and tendons become stiff. In the night-time, temperature is low, there is no active motion and a longer static holding time. This mixture inhibits blood flow, decreases activity of synovial fluid in the joint, and increases the pain of any minor movement of the body part with inflamed or damaged tissue.

How to Reduce Nighttime Rotator Cuff Pain?

These are practical measures that can be taken, not solutions, but ways of coping with symptoms until the right remedy can be found:

• Sleep on your back with a pillow under your affected arm keeping the shoulder slightly lifted and supported. This helps to decrease compression and to alleviate tension of tendons.
• If you need to sleep on your side, hold a body pillow in front of you to stop rolling to the hurt side of your shoulder.
• Ice or heat before bed as ice helps to calm down active swelling, heat makes the tissue more flexible. Try out things which prove effective in your case.
• Don't overlook activities overhead in the evening. Don't aggravate the joint hours before bedtime.
• Use a wedge pillow to elevate the breast bone and even a slight tilt (15-20 degrees) will help minimize fluid build-up around the shoulder joint overnight.
• Use prescribed anti-inflammatory medicine at night. If you have been prescribed any NSAIDs, taking them at night may lessen the peak of inflammation when you sleep. Always adhere to medical advice on this.

When Nighttime Pain Is a Red Flag?

Severe pain that gets worse from week to week, weakness or failure to respond to conservative treatment is not a condition that can be treated with pillows and ice packs. This is a warning sign that there is something wrong that needs a specialist's attention.

If left untreated, a Rotator Cuff Tear will not heal by itself; partial tears may turn to full tears. Chronic Rotator Cuff Tendonitis & Bursitis causes structural changes which make treatment more difficult and recovery more prolonged. The longer you wait, the more complicated the road is to get back to a pain-free function.

Conclusion

The pain in the rotator cuff at night time is no random event; it's an event that can be predicted based on physical and biological factors when your body is at rest. If you can understand its cause, you can deal with it appropriately.

Don't feel like you have to get used to it if shoulder pain is always getting in the way of your sleep. The exact nature of your rotator cuff condition (torn from tears, tendonitis, bursitis or a combination) is assessed by the orthopedic specialists at Elite Ortho and a treatment plan is developed aimed at your daytime function as well as sleeping pain-free. Thinking, but waiting, will restrict your choices further.

Frequently Asked questions (FAQs)