When shoulder pain isn’t “just how you slept”

Shoulder pain is something almost everyone experiences at some point. Fortunately, most aches fade within a few days. But what happens when an achy shoulder persists, and the pain is more than just a bad night's sleep or a short-term injury?

Lindsay Hussey-Andersen, MD, orthopaedic surgeon at Loma Linda University Health, breaks down what's normal, what's not, and when it's time to seek professional help.

Normal vs concerning pain

Not all shoulder pain is a cause for alarm. According to Hussey-Andersen, shoulder pain is one of the most frequent musculoskeletal complaints seen in primary care.

"Sleeping on your shoulder funny, or overusing it, can cause soreness," she says. "Those normal aches and pains typically don't last more than a few days and often get better with rest, activity modification, or anti-inflammatories."

Daily activities, playing sports, and jobs that involve repetitive motion or heavy lifting are often common causes of short-term shoulder strain.

However, pain becomes concerning when it lingers or interferes with daily life. Warning signs include:

• Pain that lasts more than a week without improvement
• Limited range of motion
• Noticeable weakness
• Difficulty performing everyday activities
• Discomfort that disrupts sleep

Common shoulder pain

Rotator cuff

One of the leading causes of shoulder pain is a rotator cuff tear. Tears in the rotator cuff, which is a group of muscles and tendons that stabilize the shoulder, tend to develop gradually.

"The majority of rotator cuff tears are from wear and tear over time," Hussey-Andersen says. "It's repetitive microtrauma that builds up over decades."

These injuries are more common in adults over 40 and may cause pain deep in the shoulder or down the upper arm, as well as difficulty lifting the arm away from the body. And general weakness, especially when reaching overhead.

"Symptoms from smaller tears can improve significantly with treatments like physical therapy and anti-inflammatories," Hussey-Andersen says. "Big tears aren't going to repair themselves and may need surgery to reattach the tendon to the bone."

Labral tears

For younger, more active individuals, labral tears are more common. The labrum is a ring of cartilage that stabilizes the shoulder joint. These shoulder injuries are most often associated with dislocations.

"If the shoulder comes out of place, it's usually very obvious," Hussey-Andersen says. "Patients often can't move it and need help getting it back in."

While a first dislocation may be treated without surgery, repeated dislocations increase the risk of long-term damage, including arthritis.

Arthritis

Shoulder arthritis tends to appear later in life, though it can go unnoticed for years. It's not uncommon for people to have severe arthritis and only notice symptoms -- such as stiffness, pain that worsens at night, and difficulty sleeping -- for a few months.

Treatment starts conservatively, but for severe cases, shoulder replacement may be an option, though Hussey-Anderson says it's an elective surgery.

"If the shoulder pain is affecting quality of life or independence, it's worth considering surgery."

Frozen shoulder

Frozen shoulder, also known as adhesive capsulitis, tends to come on suddenly, with patients waking up with severe pain and gradually losing motion. Over time, the joint stiffens significantly, making even simple movements difficult.

Frozen shoulders are more common in people with conditions like diabetes or thyroid disorders and can take up to a year or more to fully resolve. However, with physical therapy and anti-inflammatory injections, the condition does improve without surgery.

When to get professional help

While not all shoulder pain requires a doctor's visit, it's worth getting checked out when pain is persistent, worsening, function-limiting, or occurs after a fall.

"There aren't many true shoulder emergencies, but injuries after a fall should be evaluated sooner rather than later," Hussey-Anderson says.

For more information about shoulder pain treatment, visit our website here.