When shoulder pain at night keeps you from turning over

What follows combines several people's visits into one reconstructed account. It is not any one person's story, and anything that could identify someone has been removed.

How do people describe it when they come in?

They can more or less put up with it during the day, but at night it throbs so much that even turning over is hard. Of the people who come to us for the first time with shoulder problems, this night pain is the most common reason.

They also say it's been a long time since they could lie on the painful side. Poor sleep makes the days heavy, so some mention fatigue before they even mention the shoulder.

Why is it worse at night?

During the day, blood circulates as you move your arm, but at night the shoulder stays fixed in one position. Pressure sits right on the inflamed area, so the pain stands out.

Lying on your side and pressing on the painful shoulder makes it worse. So we're often asked, "What position should I sleep in?" We tell you upfront that there's a stage when position alone won't solve it.

How do we tell it apart from simple stiffness?

The clearest sign is "Does it still not go up when someone else lifts it?" If you relax and another person lifts your arm, and it still catches at a certain angle, we see it as the joint itself having stiffened.

There are three things you can try at home: put your hands behind your back and slide the back of your hand up your spine, comparing it with the other side; raise your arm out to the side until it touches your ear; and count whether it's been more than two weeks since you could turn onto the painful side.

If two or more of the three apply, it's a good idea to get it checked.

I heard it gets better if you wait?

Sometimes it does get better over time. But you have to put up with the pain and poor sleep in the meantime, and a shoulder that has been stiff for a long time sometimes doesn't get all its movement back even after the inflammation settles.

So we don't answer "it will heal" or "it won't." We first figure out which stage you're in, because what to do differs between the painful stage, the stiffening stage and the loosening stage.

How do we treat it?

In the painful stage, we focus on the pain and inflammation. Once it moves into the stiffening stage, we shift toward getting your range of motion back.

If you start with big shoulder-rotating exercises while the pain is severe, it actually irritates the shoulder. During that stage, we only recommend letting the arm hang and swinging it gently.

We measure and record the angle your arm can be raised. But we don't tell you the numbers. Seeing it together — "Last time it got to here, and today it gets to here" — makes much more sense to people.

What are the limits of this approach?

Not every shoulder that hurts at night is the same. A torn tendon or calcium buildup also gets worse at night.

If it started hurting after a fall or a hard pull on the arm, your arm feels weak, or you have a fever with it, see an orthopedic doctor for tests first.

If you have the same symptoms

1. It gets worse at night because the shoulder is pressed in one position.
2. If it doesn't go up even when someone else lifts it, we see it as the joint itself having stiffened.
3. Hand behind the back, arm to the ear, can't lie on the painful side — if two or more apply, get it checked.
4. We don't start with big rotating exercises while the pain is severe.
5. If it started after an injury or your arm feels weak, orthopedic tests come first.

We start by measuring how far your arm can be raised. Our first goal is for you to be able to turn over in bed at night.

If shoulder pain keeps you from turning over at night, come and see us. That night pain is the first thing we work on. Recovery begins once you can sleep.

Because there are many possible causes, progress differs from person to person, even with the same care.