Why does my shoulder hurt more at night?

Rotator cuff problems commonly cause pain at rest and at night, especially when you lie on the affected side. Sleeping on your back or the other side with a pillow supporting the sore arm often helps. Night pain that comes with fever, or that doesn't change with any position, should be checked by a physician.

How long does frozen shoulder last?

Frozen shoulder usually improves over time, but full recovery can take up to 3 years, according to the American Academy of Orthopaedic Surgeons. It typically moves from a painful freezing stage to a stiff frozen stage and then a gradual thawing stage. Physical therapy focused on flexibility is the primary treatment.

Which exercises help shoulder pain?

It depends on the cause. Frozen shoulder needs gentle, consistent stretching, while rotator cuff and impingement problems usually need progressive strengthening of the cuff and shoulder blade muscles. AAOS advises against starting shoulder exercises without first consulting your doctor or physical therapist.

Shoulder Pain Physical Therapy in Buffalo, NY

Q: Can a torn rotator cuff heal with exercise?

Exercise won't reattach a torn tendon, but it often relieves pain and restores function. The American Academy of Orthopaedic Surgeons reports that nonsurgical treatment relieves pain and improves function for most people with rotator cuff tears. A tear can enlarge over time, so persistent weakness or a recent traumatic tear deserves a physician's follow-up.

Here’s a question we ask early: does your shoulder hurt when you lift your arm, or does it refuse to go up even when you help it with your other hand? Pain with movement but decent range often points to the rotator cuff or the space beneath the bony point of the shoulder. A shoulder that’s stiff in every direction, even when someone else moves it, suggests frozen shoulder. Sorting that out is the first job of shoulder pain physical therapy at Lake Erie Physical Therapy in Buffalo, because each problem needs a different plan.

Three common problems, three different plans

Rotator cuff tendinopathy and tears

The rotator cuff is a group of four muscles whose tendons wrap the ball of the shoulder and help you lift and rotate your arm. Irritated or worn cuff tendons typically hurt when you raise or lower the arm and at night, especially when you lie on that side. Weakness lifting or rotating the arm is common, and some people feel a crackling sensation.

Most tears develop from gradual wear rather than a single injury, which is why people over 40, and anyone who works or plays overhead (painters, carpenters, tennis players, pitchers), are at higher risk. The American Academy of Orthopaedic Surgeons (AAOS) reports that nonsurgical treatment relieves pain and improves function for most people with rotator cuff tears. Exercise doesn’t reattach a torn tendon, though, and a tear can get larger over time, so we coordinate with your physician if strength isn’t returning as expected.

Subacromial pain (impingement)

When you raise your arm, the cuff tendons and the bursa that cushions them pass beneath the acromion, the bony point of your shoulder. MedlinePlus describes the most common cause of shoulder pain as these tendons getting trapped and irritated there, known as rotator cuff tendinitis (often spelled tendonitis) or bursitis. Reaching overhead, forward or behind your back usually hurts.

For impingement syndrome, physical therapy centers on the muscles that control your shoulder blade and rotator cuff, your posture, and how much overhead work you do while things calm down.

Frozen shoulder (adhesive capsulitis)

Here the joint capsule itself thickens and tightens. Frozen shoulder most often affects people between 40 and 60, women more than men, and it’s more common with diabetes or thyroid conditions. It can also follow a stretch of time when the arm was immobilized after an injury or surgery.

It tends to move through three stages: a painful freezing stage (about 6 weeks to 9 months), a stiff frozen stage (4 to 6 months) and a gradual thawing stage (6 months to 2 years). Full recovery can take up to 3 years. AAOS calls physical therapy focused on shoulder flexibility the primary treatment, and if you have diabetes, improving blood sugar control with your physician can help speed recovery.

Is it really your shoulder?

Pain felt in the shoulder doesn’t always start there. MedlinePlus notes that shoulder pain can be referred from the neck or even the lungs; with referred pain, there’s usually pain at rest that doesn’t get worse when you move the shoulder. A pinched nerve in the neck can send pain over the shoulder, around the shoulder blade and down the arm.

That’s why our exam includes your neck. Using the McKenzie Method (MDT), we check whether repeated neck movements change your shoulder pain. The same system applies to the shoulder itself: some shoulders respond quickly to one specific repeated movement, while others, especially tendon problems and frozen shoulder, need gradual loading or stretching over weeks. We’ll tell you which picture fits once we’ve seen how your shoulder responds.

Inside a shoulder pain physical therapy plan

Expect a one-on-one evaluation that measures how far your arm moves on its own and with help, tests strength in several positions, checks your neck and shoulder blade, and asks about sleep, work and sport. From there, a plan typically includes:

Progressive strengthening for the rotator cuff and shoulder blade muscles, increased as your shoulder tolerates it
Range-of-motion work and stretching, the main tool for frozen shoulder and an important one after tendinitis, since MedlinePlus advises continuing range-of-motion exercises to avoid a frozen shoulder
Hands-on manual therapy for stiff joints and tight tissues
Pain-relieving modalities when indicated, as a supplement to exercise, not a replacement for it
Activity changes for how you sleep, reach, lift and work overhead while it heals
Education with joint models and pictures, plus a home program that’s updated as you improve

If you’re recovering from surgery, our rotator cuff and shoulder surgery rehab is built around your surgeon’s instructions. Throwers, swimmers and lifters can find return-to-sport details on our sports physical therapy page.

When to get a medical opinion first

Physical therapy does not replace a medical diagnosis. Based on MedlinePlus and AAOS guidance:

Call 911 for sudden pressure or crushing pain in the shoulder, especially the left, that runs from the chest to the jaw, arm or neck, or comes with shortness of breath, dizziness or sweating. That can be a heart attack.
Go to an emergency department after a severe injury if the shoulder is very painful, swollen, bruised or bleeding, or looks out of place.
See a physician soon for shoulder pain with fever, swelling or redness, skin that turns red or blue, or sudden weakness after a fall or heavy lift, especially with a snapping sensation. A recent traumatic tear is one situation where an early surgical opinion matters.

Shoulder pain that hasn’t improved after 2 to 4 weeks of home care is a good reason to get evaluated, and that’s a visit we can help with.

Before your first visit

Wear a sleeveless shirt so we can see your shoulder and shoulder blade move. Bring your insurance card, a medication list, any X-ray or MRI reports, and a referral if you have one. Under New York’s direct access law, with most plans you can start without a referral for up to 10 visits or 30 days, whichever comes first, though some plans still require one to pay. If you hurt your shoulder at work, Workers’ Compensation has its own referral and authorization rules.

To have your shoulder evaluated, call (716) 332-4838 or request an appointment online.

Sources

Written by the Lake Erie Physical Therapy clinical team. This page is general information, not a diagnosis; your physical therapist will assess your situation in person.

Physical Therapy for Shoulder Pain