If your shoulder hurts more at night and wakes you up, what should be checked?

If shoulder pain worsens at night compared to the day, especially when lying on the affected side and waking you from sleep, it may indicate that the rotator cuff tendons or surrounding shoulder tissues are being irritated. We must also examine whether the patient woke up due to pain or because their posture was compressed while tossing and turning.

It also helps to check whether pain occurs at certain angles when raising the arm during the day, and whether the range of arm movement has itself decreased over time.

• If I lie on the painful side, I often wake up due to pain.
• Pain only at certain angles when raising the arm (a painful arc)
• Discomfort when wearing clothes or placing hands behind the back
• Over time, the range of motion for lifting the arm itself decreases.
• A sensation of weakness when lifting objects
• Pain that began after falling or supporting oneself with the arm

The difference in range of motion when lifting the arm independently versus when it is gently lifted by another person also serves as an important clue.

After a fall, if the shoulder looks different, or if the arm cannot be lifted at all and there is severe swelling and bruising, check for fracture or dislocation. Worsening neck pain together with sudden arm weakness or reduced sensation in the hand also requires neurological assessment.

If chest pain, shortness of breath, and cold sweats occur together with shoulder pain, seek immediate evaluation in the emergency room.

We examine the circumstances under which the pain began, as well as repetitive movements and sleeping positions. Compare the range of motion when the patient actively lifts their arm with the range observed when the examiner gently moves it, and assess shoulder and scapular movement as well as rotator cuff muscle strength.

We also check whether arm pain changes with neck movement to distinguish between pain originating from the neck and problems specific to the shoulder.

When fracture and acute rupture are not suspected and limitation of movement in the shoulder and scapula is confirmed, Chuna manual therapy and acupuncture combined with pharmacopuncture may be considered. Do not forcibly move to the end range while enduring pain; instead, adjust the intensity within the currently possible range.

When sleeping, placing a pillow or towel under the painful side to reduce the angle at which the arm is pressed may be helpful. After treatment, we check whether night pain and the range of motion for lifting the arm actually change.