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Rotator cuff pain at night

Rotator cuff repair surgery can alleviate your shoulder pain at night.

Your rotator cuff consists of four muscles that manage the movement of your shoulder and stabilise your shoulder joint. The tendons of these four muscles join to form a single large tendon known as your rotator cuff tendon. This rotator cuff tendon is attached to your humeral head (the top of your upper arm). When you lift your arm, this tendon passes through a space under your acromion (a bone in your scapula or shoulder blade). This space is referred to as your subacromial space.  

But rotator cuff pain occurs when your rotator cuff tendon or bursa (a fluid-filled sac between your rotator cuff tendon and acromion) becomes irritated when moving your shoulder.  Rotator cuff pain is often felt in your upper arm and the appearance of your pain can be sudden or gradual. Your pain could be caused by an overuse of your shoulder from repetitive movements, muscle weakness or a shoulder injury.

Unfortunately, your rotator cuff pain could become worse at night-time, as falling asleep on the affected side of your body can trigger an onset of pain. You might have trouble finding a comfortable sleeping position which can cause you to wake up from your sleep. These disruptions to your sleep can lead to sleep deprivation. Sadly, one in four people that have chronic pain suffer from a sleeping disorder. 

Sleep deprivation from rotator cuff pain at night can also impact how you feel the following day. It can cause you to feel irritable, anxious and experience a delayed reaction time putting you at risk of suffering an accident. You could suffer from daytime sleepiness that can increase your risk of experiencing an injury and impact your productivity during the day. While excessive daytime sleepiness (EDS) could lead to memory problems and affect your concentration and mood.  

If your pain causes chronic sleep deprivation, you could develop a sleep deficiency placing you at higher risk of developing heart problems, diabetes, obesity and depression. Moreover, sleep deprivation is linked to an increased sensitivity to pain causing your rotator cuff pain to feel worse the following day which, in turn, can lead to more disturbed sleep during the night. This vicious cycle of chronic pain from your rotator cuff and poor sleep is known as paininsomnia.

The most common conditions that can affect your rotator cuff include:  

Rotator cuff tendonitis: This conditions happens when your rotator cuff tendons become inflamed and irritated after an injury or an overuse of your shoulder. Inflammation in your rotator cuff tendons can cause calcium deposits to form in your tendons which is known as calcific tendonitis.  

Rotator cuff impingement:
If your rotator cuff tendon becomes torn or swollen due to an injury, overuse of your shoulder or the natural wear and tear of your tendons, this can cause your tendon to rub against your acromion (a bone in your shoulder blade). A rotator cuff impingement can also occur due to an abnormally shaped acromion, bone spurs (lumps) or bursitis (where your bursa, a fluid-filled sac that cushions your shoulder joint becomes inflamed) 

Rotator cuff tears:
A rotator cuff tear typically occurs in the tendons of your rotator cuff. It can happen after an injury or overuse of your shoulder.

Rotator cuff conditions such as a shoulder impingement, tears and tendonitis can cause many different symptoms, including pain. If you are suffering from rotator cuff pain, an Orthopaedic Surgeon will carry out a physical examination and diagnosis to confirm the cause of your pain. Once a diagnosis has been confirmed, your Orthopaedic Surgeon might advise initial rotator cuff pain treatment such as pain relief medication and physiotherapy to alleviate your symptoms.  

But if this initial treatment does not improve your symptoms, you could be advised to have surgery. These symptoms include: 

  • Pain when lifting, lowering or moving your arm behind your back
  • A clicking sound when you lift your arm
  • Pain at the side of your arm and shoulder
  • Shoulder stiffness
  • Pain which causes you to wake up during the night
  • Shoulder muscle weakness that can make it difficult to raise your arm

At our hospitals, we offer fast access to treatment which means you can book your appointment online today and be seen by a specialist at a time that is convenient for you.  

At your initial consultation, an Orthopaedic Surgeon will discuss your symptoms, including when they first appeared and their impact on your everyday life. Your Surgeon might perform a physical examination of your shoulder and carry out specific movement tests to help diagnose the cause of your symptoms. For example, a drop arm test can be performed for a suspected rotator cuff tear. Your Consultant will raise your arm towards your head and ask you to slowly bring your arm back to your side. If your arm rapidly drops to your side, it could point to a rotator cuff tear.  

In addition to these tests, Your Consultant might recommend an MRI scan or an X-ray to further investigate your symptoms. These are painless scans that allow your Consultant to take a closer look inside your shoulder.  

Preparing for rotator cuff surgery


If you are advised to have surgery, your Orthopaedic Surgeon could recommend making the following lifestyle changes: 

Quitting smoking: Unfortunately, smoking can increase your risk of experiencing infections and deep vein thrombosis (blood clots). Your Orthopaedic Surgeon can help you quit smoking to minimise this risk. 

Avoiding hormonal medication (for women):  You could be asked to stop taking the oral contraceptive pill at least four weeks before your operation due the increased risk of deep vein thrombosis (DVT). Hormone replacement therapy (HRT) might also need to be stopped.  

As well as making these lifestyle changes, you may need to attend a preoperative assessment before your surgery. This will include a general health check, where a Nurse will measure your blood pressure and weight and answer any questions you might have about your surgery. A blood test or an echocardiogram (heart scan) could be performed to confirm that you are fit for surgery. You bring your current medication to your pre-operative assessment and when you come for surgery. 

Prior to your rotator cuff operation, you will be given general anaesthetic which means you will be asleep during the procedure or a nerve block (an injection of local anaesthetic) to numb the area and prevent pain.  

A rotator cuff operation can be performed through an arthroscopy or open surgery depending on your diagnosis. If an arthroscopy is advised, your Orthopaedic Surgeon will create about two to three small incisions (about 3cm) in your shoulder. A small tube with a camera known as an arthroscope is passed into one of these incisions allowing your Consultant to view the inside of your shoulder on a monitor. Specialised surgical instruments are passed into your other incisions to reattach your torn tendon to the top of your humerus (arm bone).  

Alternatively, an open surgery will involve making a single incision (up to 10 cm) over the front of your shoulder to perform your rotator cuff repair.  

If you have had an arthroscopy, dissolvable stitches could be used to close the incisions in your shoulder. These do not need to be removed and your incisions should close within eight days. But for an open surgery, your Orthopaedic Surgeon might use stitches that will need to be taken out about 10 to 12 days following your operation.  

While an arthroscopy usually takes less than an hour to perform, an open surgery for your shoulder could take longer. The length of your procedure will depend on the condition of your shoulder and the surgical technique that is advised.  

Your Orthopaedic Surgeon will discuss when you can return to your everyday activities and begin physiotherapy. You will need to wear your shoulder sling for the first six weeks. This should only be taken off when getting dressed, bathing or doing your physiotherapy exercises. You might find it easier to use your other arm to perform your daily activities around your home.  

You can return to driving after six weeks and by this time, you should no longer require a sling. However, returning to work depends on your role and the procedure used – if your role is mainly sedentary (sitting down) and your surgery was carried out through an arthroscopy, you could return to work within three weeks. But if an open surgery was performed or your role is more strenuous, you might need additional time off work.  

Physiotherapy following rotator cuff surgery

Four to six weeks after your surgery, your Physiotherapist will perform passive exercises where they will move your arm into different positions. At six weeks, active physiotherapy involving a range of shoulder movement exercises can be performed. Your Physiotherapist might delay exercises to strengthen your shoulder until after 12 weeks. After an arthroscopic rotator cuff surgery, you might have regained complete movement in your shoulder at 12 weeks. For an open rotator cuff surgery, this can take around 16 weeks.

As with any surgery, there are possible risks associated with having rotator cuff surgery. These include:  

Post-operative pain: Pain relief will be offered to relieve pain during your recovery.   

Infection: If your wounds oozes fluid or becomes red, this can be a sign of an infection. But antibiotics can be given to treat an infection. 

Blood clots:
You Surgeon can provide you with anticoagulants (medication to prevent blood clots) or compression stockings to minimise your risk of blood clots; 

Swelling: You could experience swelling for six weeks after your surgery. But applying ice (wrapped in cloth) on the affected area for 15 minutes up to four times a day can decrease swelling.  

Scarring: You could have scarring from your incision(s). However, this should become less noticeable over time.

The cost of having rotator cuff surgery at our hospitals will vary depending on your chosen hospital, diagnosis, and the procedure that you need.  

The cost of your treatment can be covered through our flexible payment options. For further information, please visit our payment options page. 

Is rotator cuff pain constant?

Whether your pain appears suddenly or is chronic (long-term) could depend on your diagnosis. While rotator cuff tendonitis can trigger acute (sudden) shoulder pain, a shoulder impingement can lead to chronic pain (long-term). Appropriate treatment such as physiotherapy (rotator cuff pain exercises) and surgery can relieve persistent pain.  

How did I hurt my rotator cuff in my sleep?

If you sleep on your affected side before and during your recovery, this can cause rotator cuff pain.

After your surgery, you could be advised to sleep on your back stop you from rolling onto your operated area during the night which can cause more pain. A pillow can also be placed under your arm to make sleeping more comfortable.  

How to relieve rotator cuff pain at night


If you are having trouble with rotator cuff pain at night, you might find it easier to sleep on your back or on your unaffected side. You can place a pillow under your affected arm and shoulder to support these areas. 

Is rotator cuff surgery painful?

Before your surgery, you could be given a general anesthetic which means you will be asleep throughout your surgery and will therefore not experience any pain. Or a nerve block can be given to numb the area that is to be operated on. A nerve block can prevent pain during surgery and provide pain relief for several hours after your surgery.   

When is open surgery recommended?


An open surgery could be recommended if there is a large tear in your rotator cuff, for example a tear in one of your rotator cuff muscles. 

How long does it take to recover from rotator cuff surgery?


A complete recovery following a rotator cuff surgery can take about six to nine months. 

Rotator cuff pain in your shoulder can impact your quality of life by making it difficult to fall asleep at night-time which, in turn, can have harmful effects on your memory, concentration and ability to function the following day.

If your rotator cuff pain is affecting your sleep at night or ability to perform your normal activities, our specialists are here to help. Book your appointment today or call a member of our team on X to learn more.

Specialists offering Rotator cuff treatment

Dr Gulam Patel

Consultant Rheumatologist

MA, FRCP (UK)

BMI The Princess Margaret Hospital 2 more BMI The Runnymede Hospital BMI Syon Clinic

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