Night pain is a common symptom for many people suffering from shoulder pain.  It causes sleepless nights and can be very distressing.

A recent audit at Complete revealed night pain to be the most significant symptom for patients suffering with shoulder pain.  It is particularly common in the following shoulder injuries;

What causes shoulder related night pain?

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Inflammation

Shoulder related night pain is often caused by inflammation (Omoigui., 2007).  During the day our bodies are constantly moving.  This constant movement stops inflammation from accumulating at the shoulder however, at night we find ourselves staying in one position for many hours with only the occasional movement or adjustment.  This causes inflammation to “pool” around the shoulder.  We may also sleep directly on the painful shoulder which compresses the shoulder and can also cause pain in already inflamed structures.  When inflammation is present, nearby nerve fibres are stimulated and transmit signals to the brain causing us to feel pain.

Inflammation is present in irritated or injured tissue and is often a sign of the following underlaying problems;

  • Osteoarthritis (inflammation associated with an injured joint is known as synovitis)
  • Tendinitis
  • Tendon tears
  • Ligament strains and tears
  • Muscle injury
  • Broken bones (fractures) will also cause night pain.  If your pain started because of a traumatic incident then attend your local A&E department at the first possible opportunity for an X-ray.

Direct compression of the shoulder

The shoulder is a very mobile joint which is capable of providing a multitude of fine movements, allowing us to interact with our environment.  Direct pressure through this hypermobile joint can compress both the joint and surrounding soft tissue structures, such as the rotator cuff tendons.  This can exacerbate any underlying issues that may be present.  Poor sleeping positions are often responsible for compressive shoulder pain.  When sleeping on your painful side your shoulder is subjected to the extra weight of your torso.  This increased weightbearing, over a prolonged period of time, can cause pain.  It is important to try to sleep on your back or opposite side to avoid compressing your painful shoulder.  To stop yourself rolling back onto your painful side you may need stabilise yourself with some pillows.

Shoulder related night pain is often experienced as;

  • Sharp
  • Dull
  • Burning
  • Achey
  • Stabbing
  • Shooting

What can I do to help reduce my night pain?

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Gaining an accurate and timely diagnosis is crucial to accessing the most appropriate treatment options.   Accurately diagnosing the cause of your night pain is a complex procedure which is routinely conducted by a physiotherapist, orthopaedic consultant or G.P.  Assessment starts with a clinical interview, used to understand your symptoms.  Your clinician will also complete a series of clinical tests designed to pin point your pain causing structures. This may provoke your symptoms for a short period however, it helps the clinician understand your situation better.  Unfortunately, research has revealed that clinical tests for the shoulder are not specific enough to accurately diagnose the cause of pain.  A formal diagnosis for shoulder pain can only be made using diagnostic imaging.  Diagnostic ultrasound has been proven to be as effective as MRI for assessing shoulder injuries, including tendons, muscles and bursa (small friction reducing washers located at high pressure points throughout the body).  Diagnostic ultrasound can quickly and accurately assess for swelling and inflammation in the shoulder.

At Complete our highly experienced team of clinicians are dual trained physiotherapists and musculoskeletal sonographers.  An assessment by one of our team involves a clinical interview, physical examination and a formative musculoskeletal diagnostic ultrasound scan.

Once a formal diagnosis has been made your clinician will be able to advise you on the most effective, evidence-based treatment options available.

Tips and tricks to help reduce night pain

  • Avoid activities which provoke your pain in the daytime.  This will help your body to recover during the night.
  • Try completing a series of gentle stretches before going to bed.  This may help disperse inflammation from the local area.
  • Consider regular icing of the affected area. Frozen peas in a tea towel placed over the shoulder for 10 minutes can help reduce pain and local inflammation.
  • How old is your mattress? If your mattress is old it may have lost its support.  Maybe it is time for a new mattress?
  • Try to strengthen your shoulder with some simple exercises using a resistance band.

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  • Try not to sleep on the affected area.  For instance, if your shoulder is painful sleep on your back or on the opposite side. You may need to support your sleeping position using pillows to stop you rolling on to your painful side.
  • Try to maintain a neutral body position, both at night and during the day.  This will keep you aligned and limit the build-up of inflammation at night.
  • Try a short course of over the counter pain medication however, please consult your pharmacist or G.P prior to starting any medication.

What if conservative management doesn’t work?

The majority of patients suffering from night pain respond positively to a combination of analgesic medication (please consult your GP or pharmacist before starting any medication) and a course of physiotherapy. Physiotherapy uses a combination of manual therapy techniques and individualised rehabilitation exercises to help reduce your symptoms, manage pain flares, and allow you to return to the activities that you love.

If Physiotherapy, the advice highlighted above, and over the counter pain medication is unsuccessful then a steroid injection may be appropriate.

Injection therapy

Corticosteroid injections, a potent anti-inflammatory medication, is a highly effective technique used to reduce pain associated with inflammation.  Research states that steroid injections are highly accurate and effective when administered under ultrasound guidance.  To ensure you get the best outcomes possible all our injection procedures are ultrasound guided.  All our clinicians are fully qualified to advise you on the most effective medication and prescribe it for you all in the same appointment.  This unique service means you do not need to consult your G.P to gain a referral.  You are able to self-refer directly into your service, often with 24 hours.

For further information or to book an appointment please contact Complete on 0207 4823875 or email injections@complete-physio.co.uk.

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