Slept on your shoulder wrong? 5 ways to solve it and how to prevent shoulder pain when sleeping

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What is the cause of shoulder pain when sleeping?

Shoulders can be irritated when sleeping on the side, people experience shoulder pain for a variety of reasons. According to a 2012 research paper, 67 % of those who experienced shoulder pain during the evening reported side sleep on the affected shoulder as causing shoulder pain. 1

Although sleeping sideways is the most popular sleeping position, it is a good idea to change your sleeping position when you start getting numbness or shoulder pains. A side lying sleep position can sometimes cause excessive strain on shoulders and neck muscles, especially if you have unsupportive mattresses.

Shoulder Bursitis

bursitis 1

Shoulder bursitis can occur when a bursa swells due to inflammation in your shoulder joint, these are fluid filled sacs which allow the slide and glide of tendons. The inflammation might result from a muscular or joint injury (such as rotator cuff tears), repetitive stress of the joint or repetitive motions that push the humerus (upper arm bone) into the bursa leading to a dull ache. It can cause pain in joints, stiffness and limited movement. Symptoms include pain, swelling, redness or sensitivity around the affected shoulder. Treating shoulder bursitis with anti-inflammatory drugs may be a good option. If you find it is constant, it may be worth talking to your doctor or considering physical therapy.

Frozen Shoulder

Frozen Shoulder: (also known as adhesive capsulitis) is characterized by stiffness, pain, irritation or swelling of the shoulder joints.

Frozen shoulder (also known as adhesive capsulitis) is characterized by stiffness, pain, irritation or swelling of the shoulder joints. The capsule thickens around the shoulder joint, making it stiffer and immobile. Your X-rays may appear normal on examination but range of motion (ROM) will still be decreased.

Symptoms of frozen are often initially inflammatory, and can affect muscles and joints in their function. It often occurs when the shoulder is immobilized for a long time. Whether due to rotator cuff tears, broken bones, stroke or recovering from surgery.

The problem occurs to adults aged 40 and older (particularly women), although the problem can also occur to anyone with a shoulder injury. Depending on the time and place of treatment, relapses in pain during the night time can affect sleep quality and irritate the shoulder. Frozen shoulders typically begin gradually and typically have 3 phases, Freezing (2-9 months), Frozen phase (4-12 months) and the Thawing phase (5-24 months).

Depending on the patient’s age, corticosteroids or a hydrodilitation are available. You can also use physical therapy either just by itself (helpful if you have a phobia of needles) or in conjuction with the injection. It is best to consult your physician as to the best approach for recovering from frozen shoulder. The approach is orthopedic surgery, by which the surgeon through the use of arthroscopy attempts to physically remove adhesions.

Shoulder Impingement Syndrome

Shoulder Impingement: occurs when tendons running across shoulder joints are rubbing between the upper arm bone (humerus) and the top, outer edge of the shoulder.

Shoulder impingement occurs when tendons running across shoulder joints are rubbing between the upper arm bone (humerus) and the top outer edge of the shoulder. This causes pain and inflammation. Often a person with shoulder impingement can feel stiffness and restriction in movements, especially overhead or when lying on the shoulder while sleeping. To reduce shoulder pain, it may be advised to change sleeping position, either sleeping on the opposing shoulder or on the back. This will give time for the painful shoulder inflammation to settle down. This condition is typically seen in people who participate in sports (i.e. Baseball, volleyball, tennis, etc.) or in people who work over head (i.e. painters, plasterers, tradesman, etc.)

Rotator cuff tear or injury

Rotator Cuff Tear: Our sleeping positions also play a factor if you slept on shoulder wrong. It may cause some of the rotator cuff muscles to remain in an over lengthen position which can irritate them.

Rotator cuffs are tendons which in four muscles support in the shoulder joints by performing their respective actions, abduction, internal and external rotation. The rotator cuff is susceptible to what’s called rotator cuff tendonitis. Rotator cuff muscles can be used for various activities such as; lifting the head and raising the arm, or it may be used to throw.

The space within your shoulders may swell irritating the subacromial space compressing the nerves and creating irritation, this is usually caused by repetitive movements. Our sleeping positions also play a factor, if you sleep on that shoulder, it may cause some of the rotator cuff muscles to remain in an over lengthened position which can irritated them. You may find that you wake up stiff and sore after sleeping all night on that shoulder.

Common investigations are Ultrasounds or MRI, an X-Ray will not show the soft tissues affected. Although typically more expensive for imaging it is advised to consider an MRI as that is the gold standard for diagnosis of RTC tears.

Osteoarthritis and other rheumatological disease

Osteoarthritis causing shoulder pain while sleeping

Osteoarthritis is the most common form of arthritis, it typically affects the body unilaterally (one side) but still may affect both, bilateral (both sides) is common in other rheumatological diseases like Rheumatoid Arthritis. When it comes to osteoarthritis you may have injured the shoulder and damaged the cartilage between your joints which causes the bones to rub and the gradual degeneration of the shoulder joint. It is often common in older adults.

Osteoarthritis symptoms include:

  • Pain during or after movement: You may find that when you move your arm during the night time, the pain in the shoulder wakes you. And change positions helps relieve it.

  • Stiffness on waking: Due to the inactivity while sleeping it can lead to the shoulder feeling stiffer.

  • Tenderness: The areas around the shoulder may feel tender to the touch or while putting pressure onto it during sleep.

  • Bone spurs: Extra bone may form in the joint as it begins to degenerate. These are known as osteophytes and may feel like hard lumps.

  • Loss of flexibility: Due to either the bony growths created by the degeneration or the stiffness with inflammation or even the pain, the shoulder joint may lose some flexibility.

  • Audible clicking sounds (crepitus): Sometimes, you’ll hear clicking sounds as you move the shoulder.

  • Swelling: The swelling may be caused by the soft tissues around the joint, creating an increase in the inflammation.

The CDC (centre for disease control) has stated that up to 1 in 4 people in the US may be suffering from some sort of OA, which is approximately 54 million people. This is projected to increase to as much as 78 million by the year 2040.

There are multiple arthridities that may have an influence on the shoulder, these include but are not limited to:

  • Rheumatoid arthritis

  • Post traumatic Arthritis

  • Psoriatic Arthritis (uncommon)

  • Osteonecrosis

  • Gout (Rare)

Treatment for the issue may range from physical therapy, topical pain relievers, oral medication (including supplements), Injection of viscosupplementation or PRP and even total joint replacement for those who experiencing shoulder pain. If you believe you may have OA, it would be advised to talk to your doctor. A plain radiography (X-Ray) is a simple way of finding your diagnosis.

AC Joint issues

AC joint issues can seem like they are deep in the shoulder and result in shoulder pain from sleeping. Night time shoulder pain can be an idicator that this joint is an issue, whether its due to any number of these causes.

The AC Joint is the joint at the top of the shoulder, it connects the Acromion process that originates on the shoulder blade to the clavicle (Hence, the AC joint name). It is integral in shoulder joint stability.

Damage to the ligaments supporting the AC joint can loosen, degrade or even tear, the joint may also suffer from osteoarthritis or even fractures! (Fractures are more common in the clavicle portion of the joint, often when the patient has had trauma to the collar bone, this would result in more severe shoulder pain)

AC joint issues can seem like they are deep in the shoulder and result in shoulder pain from sleeping. Night time shoulder pain can be an indicator that this joint is an issue, whether its due to any number of these causes.

Depending on the mechanisms involved, treatment for the AC joint may include anti inflammatory medications, corticosteroid injections, a physical therapist to diagnose and treat or osteotomy performed by a surgeon if needed.

Muscle Strains

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Excluding the rotator cuff as previously mentioned, there are multiple muscles that could be involved, if you’re talking about the back of the shoulder toward the shoulder blade, you may be looking at the Rhomboids, Trapezius, biceps or triceps tendons and even smaller muscles which govern function (i.e. the serratus anterior which supports the rotator cuff). These may even contribute to neck pain. You may benefit from heat and exercise. Finding a good heat pack may be useful in this endeavour.

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Cardiovascular disease or heart attack

experiencing shoulder pain from sleeping

If you are experiencing shoulder pain from sleeping on your left shoulder, it may be a sign of cardiovascular disease. The shoulder pain may spread down the arm or up to the chin for men. In women, the pain may be a little more subtle. It may travel down the arm and up to the chin but possibly also into the shoulder blade or upper back and even the abdomen. You may also feel short of breath, nausea or vomiting.

Survival of a heart attack may rely on your ability to recognise the symptoms and act quickly. “Time is muscle” is a common expression, the longer you leave it, the more at risk you are of damaging the heart.

Our 5 Solutions To Shoulder Pain When Sleeping On Your Side

Sleeping on your side may be the worst sleeping position for shoulder problems. When you sleep on either side the shoulder muscles support your weight of your upper body.

1. Rotator cuff and muscle strengthening

Resistance bands, starting at yellow or the lightest colour are a good way to strengthen the rotator cuff. Basically, loop your band around the knob on a closed door. Press your elbows to your side at 90 degrees and facing either left or right to the door you can internally (pull toward) or externally (pull outward). Refer to image 1. Repeat 3 sets 10 times and change sides.

Other quality exercises may be to slide your arms up and down the wall (this is called a scap wall slide, reference image 2). A low row may also be a good way to strengthen posterior chain muscles. (Reference image 3) Repeat these following the 3 by 10 reps rule following the process of regular exercise for a few weeks and see if the shoulder pain is relieved.

If this does not work, it may be worth seeing a physical therapist for further advice.

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2. Change sleep positions

Side sleepers sleeping on one shoulder may cause more pain and may worsen the issue of a sore shoulder. It is hard for a person to adjust their sleep position, the best sleeping position is the one you don’t feel pain in. You may avoid sleeping on this arm by placing pillows on the affected side and blocking them to avoid accidentally turning on the side while you sleep. Try combining sleeping positions such as sleeping on the opposite side and sleeping on the back. Recent research found sleeping in the wrong positions may increase shoulder and neck discomfort. Although you may think it’s a comfortable position for the affected arm, avoid sleeping with your arms above your head or outstretched arm, this may compress muscles, nerves, bursa and tendons and possibly even blood flow which will result in a painful shoulder.

3. Change your mattress

If the mattress is not very comfortable you can have shoulders ache while sleeping. Some experts recommend using medium-firm pillows to reduce musculoskeletal discomfort. Perhaps try a good matteress with memory foam combining memory foam that curves and provides extra stability while minimising tension in the body and taking pressure off the sore shoulder. In addition, choosing a comfortable cushioned mattress is essential in minimizing shoulder discomfort. Your pillow should be thick and fluffy to fit the width of your shoulders and normal contours and properly fill in gaps between your neck and shoulders. This will aid in neck support and support of the injured shoulder.

4. Practice better sleep hygiene

Sleep deprivation can have an impact on your health – primarily we are talking about the affect your physical wellbeing and sleeping habits are all a contributing factor. If our body is not getting adequate rest it cannot function properly and your recovery time will be impacted.

Sleeping in an environment conducive to sleep helps improve sleep quality and restful sleep. It means your room is dark and quiet. Try developing an enjoyable and regular nighttime routine. This could mean, winding down before bed, avoiding blue light (Phones or tablets), having a nice hot shower or bath, making sure your sleep clothing is comfortable, having a set bed time, etc.

5. NSAIDS or pain killers

Taking medication isn’t your first line of attack. However, it may be useful in the short term to decrease pain and inflammation and provide some level of pain relief. Although it should be avoided for prolonged periods.

In summary, can you do damage if you slept on shoulder wrong?

If you experience shoulder pain when side sleeping all night long you may feel stiffness and pain. Sleeping on your shoulders for a long time can cause stress on your shoulders muscles. Rotator cuff injuries, bursitis, OA, previous shoulder surgery, may all contribue to reasons as to why your shoulder hurts while sleeping on your side. Generally speaking, if left untreated it can lead to additional stress that may cause degeneration and impact the body’s ability to heal faster. Shoulder pain at night is not an uncommon issue. However, it all comes down to good management and sleep habits!