If you've ever experienced shoulder pain that seems to be worse at night, you might be wondering why it happens. In this blog, we will explain in simple terms why night time shoulder pain can be so intense and why it's different from neck-related issues.

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The Shoulder's Anatomy: The shoulder has a rotator cuff tendon that sits between two bones and is protected by a cushioning tissue called the bursa. In cases of inflammation or tendinosis (tendon degeneration), both the tendon and bursa can become thicker, reducing the available space in the shoulder joint. This restricted space can limit certain movements, especially lifting the arm in front and to the side.

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Daytime Relief: During the day, when your arm is naturally positioned by your side, there is a tiny bit of space created that allows some relief for the inflamed rotator cuff. This slight distraction helps provide some breathing space for the shoulder joint.​​

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Night time Aggravation: When you lie down to sleep, the advantage of gravity is lost. The ball of your shoulder (known as the head of the humerus) is pushed up into the already narrow space between the bones. This compression of the inflamed rotator cuff in the confined space can lead to severe pain. It's not uncommon for individuals with frozen shoulder, rotator cuff tendinosis, or tears to find it more comfortable to sleep in an armchair or in an upright position to avoid worsening the night-time pain.

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Differentiating Shoulder Issues from Neck Problems: night time shoulder pain can be a valuable clue in determining whether the problem lies in the shoulder or the neck. If the pain is primarily experienced at night and not related to neck movements, it is more likely to be associated with genuine shoulder pathology such as frozen shoulder or rotator cuff issues, rather than perceived neck degeneration.