Have you ever gone to bed feeling fine, only to wake up in the middle of the night with a burning pain in your shoulder? Maybe you can’t sleep on that side anymore, and every attempt just jolts you awake. If this sounds familiar, you’re not alone—turns out, a startling 67% of people with nighttime shoulder pain ignore the warning signs for months, often leading to permanent, sometimes irreversible damage. The good news is, most shoulder pain at night is treatable, especially if you catch it early. Let’s dive into the five real reasons your shoulder hurts when you’re trying to get some rest—and why one of these needs urgent medical attention. (Based on the insights of Oswaldo Restrepo RSC)
Key takeaways:
- Nighttime shoulder pain isn’t normal—it’s your body warning you.
- Ignoring the pain can lead to permanent damage and even surgery.
- There are 5 main causes, from common conditions to the most dangerous.
- With the right steps, many of these problems can be managed at home—once you know what to look for.
1. Rotator Cuff Impingement Syndrome: The Most Common Culprit
Your shoulder’s rotator cuff is a team of four small muscles that stabilize and move your arm. Unfortunately, there’s only a tiny space between those muscles and a bone called the acromion at the top of your shoulder. Over time, with aging, repetitive overhead movements, or poor posture, that space gets even tighter. The tendons of the rotator cuff start to get pinched and inflamed—this is known as impingement.
During the day, you might barely notice. Your muscles are in action and there’s plenty of blood flow. But when you lie down at night, especially on the sore shoulder, gravity and your body weight push those inflamed tendons into an even tighter space, ramping up the pain. If this goes ignored, the tendons can weaken and may eventually tear, requiring surgery to fix.
How to spot it:
- Can’t sleep on the affected shoulder
- Wake up frequently due to pain
- Difficulty lifting your arm overhead, especially in the morning
Pro tip: Try the Hawkins-Kennedy test at home: Raise your affected arm straight in front to 90 degrees, then use your other hand to rotate it inward. Sharp pain? You might have impingement.
2. Calcific Tendinitis: When Calcium Causes Chaos
Imagine tiny glass shards lodged in your shoulder tendon—that’s how calcific tendinitis can feel. In this condition, calcium deposits build up in the rotator cuff tendons, causing intense pain, especially at night. It’s more common in women aged 40-60, and often appears without any warning or injury.
Your symptoms might mirror those of impingement, but calcific tendinitis pain can come on suddenly and feel more severe. X-rays often reveal the tell-tale white calcium spots. Sometimes, your body can naturally reabsorb the calcium, resolving the problem. Other times, treatments like shockwave therapy or surgery may be needed.
Signs to watch for:
- Sudden, intense pain in the shoulder at night
- Trouble raising your arm or sleeping on the side
- “Stone-like” areas visible on shoulder X-rays
3. Subacromial Bursitis from Poor Posture: The Digital Age Injury
The bursa is a tiny fluid-filled pouch that cushions your shoulder joint. Hunching over computers, driving, or scrolling on your phone for hours all push your shoulders forward, compressing the bursa. The result? It can become inflamed—bursitis.
During the day, moving around lets the bursa decompress, but at night, if you sleep on your side, your body weight presses into that inflamed pouch, resulting in sharp, stabbing pain. Studies show people with over 6 hours of screen time daily are 4 times more likely to develop bursitis.
Symptoms include:
- Piercing pain when lying on the affected shoulder
- Soreness when lifting your arm sideways
- Feeling like your shoulder is swollen inside
Good news: Many cases improve with simple measures—ice, posture tweaks, anti-inflammatory foods, and avoiding sleeping on the sore side.
4. Suprascapular Nerve Compression: The Hidden Nerve Issue
Tucked behind your shoulder blade is the suprascapular nerve. It controls key muscles that stabilize your upper back and shoulder. Constantly carrying heavy bags on that shoulder, keeping your arms raised at work, or even sleeping awkwardly can pinch this nerve.
The pain from suprascapular nerve compression typically feels like a deep, burning ache at the back of your shoulder, especially between your shoulder blade and spine. Lying down can lock the nerve in a compressed position, making things worse.
Do you notice:
- Dull or burning pain in the back of the shoulder
- Symptoms worsen when lying down, relieved by moving your shoulder forward
- Growing weakness or shrinking muscles around your shoulder blade
Untreated nerve compression can lead to muscle wasting and instability—so it’s important to address it early.
5. Early Frozen Shoulder (Adhesive Capsulitis): The Dangerous One
This is the big one you shouldn’t ignore. Frozen shoulder is when the capsule surrounding your joint stiffens and thickens, gradually locking your shoulder in place. The first stage, called the “freezing phase,” features intense nighttime pain and a shrinking range of motion. If nothing is done, the joint literally freezes, sometimes for years.
Frozen shoulder is most common in people with diabetes, thyroid issues, and women 40-60 years old. If you’re noticing a rapid loss of movement and nighttime pain that gets worse every week, don’t wait! Early aggressive physiotherapy is critical to avoid long-term disability.
Stages of frozen shoulder:
- Freezing phase: 6-9 months—painful, progressive loss of movement, mostly at night
- Frozen phase: 4-6 months—pain lessens, but shoulder gets extremely stiff
- Thawing phase: 6 months to 2 years—mobility gradually returns
Sadly, in 40% of people, full range of motion never comes back. Early treatment can make a huge difference.
Warning Signs That Mean You Need Urgent Help
If your shoulder pain comes with shortness of breath, cold sweats, or pain radiating down your left arm—STOP reading and call emergency services. These may signal a heart problem, not a shoulder issue.
Simple At-Home Tests to Check Your Shoulder
Want to figure out exactly what’s going on? Here are some quick checks:
- Hawkins-Kennedy test (as above): Pain means likely impingement.
- Neer test: With your arm straight, raise it in front and then overhead. Pain between 60-120 degrees confirms impingement.
- Bursitis check: Press just below the tip of your shoulder. Sharp, localized pain? Likely bursitis.
- Frozen shoulder check: Try to touch your upper back from above, then tuck your hand in your back pocket. If you can’t, or it’s getting worse every week—see a doctor now.
Your Shoulder Rescue Plan: What You Should Do Next
Here’s what to do if your home checks point to impingement or bursitis:
- Stop sleeping on the sore shoulder. Use a pillow to prevent rolling over.
- Ice the area for 15 minutes, 3 times a day.
- Try gentle stretching. The “pendulum stretch” works wonders: Lean on a table, let your sore arm hang, and gently swing it in circles for 2 minutes.
- Avoid overhead reaching or heavy lifting.
- Natural anti-inflammatories: Foods like turmeric, ginger, garlic, and onions may help.
- Improve your posture: Keep shoulders back, chest open, and screens at eye level.
If your pain isn’t better in two weeks, or it worsens, get checked by a shoulder specialist to avoid surgery down the road.
In Conclusion
Shoulder pain at night isn’t something you just have to live with—your body’s telling you something important! Whether it’s a simple impingement or a warning sign of frozen shoulder, acting early can save you months or years of pain (and maybe even surgery). Share exactly where your shoulder hurts—front, side, or back? Tried any self-tests yet? Let’s help each other stay pain-free and get back to restful sleep!
Source: Oswaldo Restrepo RSC