Almost nobody books a shoulder appointment because of the shoulder. They book because they have not slept properly in three weeks.
Night pain is the symptom that finally moves people, and it is also one of the more useful diagnostic clues we have. Here is what it usually turns out to be, and why lying down makes it worse.
Why it hurts more at night
Two things happen when you lie on a shoulder. Body weight compresses tendon that is already irritated, and blood flow through the area drops. Add the absence of anything else to think about, and pain that was a five during the day reads as an eight at 2am.
That is not you exaggerating. It is a genuinely worse mechanical situation.
Most likely: rotator cuff related pain
The rotator cuff is four muscles holding the ball of the shoulder into a very shallow socket. When the tendon has been asked to do more than it has capacity for — a weekend of painting, a new gym program, a job with more overhead work — it becomes irritable.
Rotator cuff pain hurts reaching overhead and behind your back, produces a painful patch partway through raising the arm, and is worst lying on it. It responds to progressive loading, which is slower than people want and more effective than anything else.
Sometimes: impingement, which is the same conversation
Shoulder impingement was for decades explained as tendon being pinched under bone, and treated surgically on that basis. When subacromial decompression was finally tested against placebo surgery, the results did not favour it. Current thinking treats it as a loading problem, which is good news: it means you can change it.
Occasionally: frozen shoulder, which is different
Here is the distinction that matters most. With rotator cuff pain, someone else can usually move your arm through range even when you cannot. With frozen shoulder, they cannot — the joint capsule itself has tightened, and movement is lost in every direction including passively.
That difference changes the treatment completely. Stretching aggressively into a painful frozen shoulder makes it considerably worse, which is why guessing here is expensive.
What helps tonight
Sleep on your back, or on the other side with a pillow supporting the sore arm so it is not hanging across your body. It is a small change and it is frequently the first thing that improves.
What helps in three months
A loading program, adjusted as capacity returns. Where the tendon has been symptomatic for months and has not responded, shockwave therapy is a reasonable addition, and we have it on site. TECAR helps settle the reactive phase and is included in the consultation at no extra charge.
What does not help is waiting to see whether it settles on its own. Shoulders that have been sore for six months are considerably harder work than shoulders that have been sore for six weeks.
Forge West End is at Unit 4, 249 Montague Road, West End. Book online or call 07 3844 0686 — we are open from 6am Monday to Friday.