By Steve Mora MD
Orange County Shoulder Specialist at Restore
One of the most common complaints from my patients suffering with shoulder problems is “why does my shoulder hurt at night?”
The pain can occur whether or not one lies on the painful shoulder, on the opposite side pr on their back. Patients just cannot find a comfortable sleeping position.
Night time shoulder pain is probably the most common symptoms I see in patients with shoulder tenditinis, bursitis, tendinosis, impingement, rotator cuff tears and capsulitis. All of these conditions cause some level of shoulder stiffness and inflammation.
The reason that shoulders hurts at night is not fully understood. It may be related to the inflammation that occurs when the joint is in a prolonged static position or it might be due to the inward position of the arm while at rest. When the arm is up against the body the blood flow to the rotator cuff tendon and bursa is slightly restricted. This position might partially account for the pain. What we do know is that night time pain is a red flag that something is wrong.
When I evaluate patients with night time shoulder pain my goals are 1) to make the correct diagnosis and 2) to provide efficient and appropriate treatment to permanently relieve the pain.
Regardless of the pathology, one of the most common non-operative recommendations I emphasize is stretching of the shoulder joint, a.k.a. the glenohumeral joint. In my experience, once the flexibility or range of motion (ROM) of shoulder is optimized the pain will improve. In cases where the pain is caused by inflammation, such as tendinitis or bursitis, the night time pain may permanently resolve. If the painful arm does not move as fluidly and completely as the opposite non-painful shoulder it is considered a stiff joint. The mechanism by which stretching improves ROM is not totally understood however it is likely due to adaptions to elongation of the muscle and tendon units around the glenohumeral joint. These tissues are visco-elastic so they respond to prolonged passive stretching.
I emphasize this: A Stiff joint = A Painful Joint
When the shoulder stiffness is recognized the first treatment measure I recommend is a prolonged passive stretching program. The exercise routine needs to be effective, safe and easy to do. The maneuvers do not need to be too forceful but they do need to be prolonged. After doing these stretches, night time shoulder pain can be improved.
The longer you hold the stretch the more effective you will be at improving shoulder motion.
I recently collaborated with one of my local physical therapy groups, Coury & Buehler in Orange County, to create www.MoraStretches.com stretching videos. Out of the four shoulder stretches highlighted in the link the two most effective for relieving night pain is the “statue of liberty” and the “cross arm” stretch. Please follow the instructions closely and repeat the stretches daily. You can do these exercises on your own.
Unless you have had recent shoulder surgery or you suffer from instability (loose shoulder) these stretches are safe. If you have had surgery or suffer from instability it’s very important that you consult with your doctor and ask if these exercises are appropriate.
Start the exercises slow. You should expect some level of “stretch pain”. The longer you hold the stretch position the better it is for you. Sometimes the shoulder will ache for a few minutes after the exercise. That is normal. This should diminish with time. You should see improvements in ROM after a 1-2 week of doing these exercises diligently.
As the ROM improves the night time pain should start to diminish.
If you do not see improvement after 2-3 weeks you should set up an appointment with your doctor. You will probably need X-rays and an MRI.
I hope this information was helpful. Please let me know if I can be of service. If you know someone suffering from shoulder problems please share!
About Steve A. Mora MD:
Dr. Mora is a native of Orange County. He graduated from Anaheim High School in Orange County CA. He received his medical education at UC Irvine College of Medicine where he finished in the top of his class earning the coveted AOA Medical Society honors. He completed his Orthopedic Surgery training LAC+USC Medical Center and then did a additional Sports Medicine Fellowship at the Santa Monica Orthopaedic and Sports Medicine Group where focused on sports medicine, shoulder, knee, hip arthroscopy. He has published numerous book chapters on the topics of ACL injuries in soccer players, cartilage restoration, and athletic hip injuries. He is currently practicing Orthopedic Surgery in the City of Orange Orange County. He is a founding partner at Restore Orthopedics and Spine Center (www.restoreorthopedics.com). Dr. Mora’s practice focus is on sports related trauma, MMA injury treatment, arthroscopy of the shoulder, hip, knee and elbow, and partial and total knee replacement. He sees athletes of all levels including professional soccer and UFC/MMA patients. Dr. Mora’s family heritage is Peruvian. He speaks fluent Spanish.
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Restore Orthopedics and Spine Center
112o W. La Veta Ave, Third Floor
Orange, CA 92868
Office: (714) 598-1745
Fax: (714) 941-9539