Shoulder pain at night: causes, what helps and when to see a GP

The NHS specifically records night pain as a feature of frozen shoulder, where it says pain can be worse at night and disturb sleep.

The NHS pages used for this guide do not explain the mechanism of night pain in detail, so it is best treated as a pattern that points a clinician towards a few possible causes rather than as a diagnosis on its own. The key question is what sits behind the pain, and that is usually decided from the history, an examination and sometimes a scan.

The NHS pairs shoulder symptoms with possible causes. Pain and stiffness that do not go away over months or years suggest frozen shoulder or arthritis (osteoarthritis or rheumatoid arthritis). Pain that is often worse while using the arm or shoulder suggests tendonitis, bursitis or impingement. A tingling, numb or weak arm, or a shoulder that clicks or locks, can suggest instability, sometimes because of hypermobility. Sudden, very bad pain, difficulty moving the arm, or a change in shape suggests a dislocated shoulder, a broken bone or a torn tendon. Pain on top of the shoulder where the collarbone meets the shoulder points to the acromioclavicular joint.

Frozen shoulder is the cause the NHS most clearly links with night pain. It happens when the tissue around the shoulder joint becomes inflamed, then tightens and shrinks. It is often not clear why, but it can follow an injury or surgery that stops you moving the arm normally and is linked with diabetes. The two main symptoms are pain, which can be worse at night, and stiffness that makes the shoulder difficult to move.

• Frozen shoulder: pain that may be worse at night, plus increasing stiffness.

• Arthritis: long-standing pain and stiffness.

• Tendonitis, bursitis and impingement: pain often worse with use of the arm.

• Shoulder instability: clicking, locking, weakness or tingling.

The NHS says you usually need to follow self-care for 2 weeks before shoulder pain starts to ease. It recommends staying active and gently moving the shoulder, trying shoulder exercises for 6 to 8 weeks to stop pain returning, standing and sitting with good posture, resting the arm on a cushion in your lap and using pain relief such as paracetamol and ibuprofen so you can keep moving. Heat or cold packs, wrapped in a tea towel, can be used for up to 20 minutes at a time.

It advises against stopping using the shoulder completely, doing things that seem to make it worse, making up strenuous exercises or using heavy gym equipment. For frozen shoulder it adds that keeping the shoulder still will make the pain worse. A pharmacist can suggest the most suitable painkiller, including creams or gels, and when to see a GP.

Sleep position is something many people experiment with. The NHS pages read for this guide do not give sleep-position advice, so it is reasonable to try whatever lets you rest without forcing the shoulder into a painful position, and to ask a physiotherapist for tailored suggestions.

See a GP if shoulder pain is getting worse or does not improve after 2 weeks, or if it is very difficult to move your arm or shoulder. For frozen shoulder, the NHS also advises seeing a GP if pain and stiffness do not go away or the pain is so bad it makes it hard to move.

Ask for an urgent GP appointment or call NHS 111 if you have sudden or very bad shoulder pain, you cannot move your arm, the arm or shoulder has changed shape or is badly swollen, pins and needles do not go away, there is no feeling in the arm or shoulder, it is hot or cold to touch, the pain began after an injury such as a fall, you have severe pain in both shoulders, or you feel feverish or unwell. The NHS says these can be signs of something serious such as a broken or dislocated bone or a torn tendon.

What treatment you need depends on the cause. The NHS says a health professional will examine you and may arrange tests such as an X-ray. Treatment can include stronger medicine or injections to ease pain and swelling, physiotherapy or exercises to do at home, advice on things to avoid, and referral to a specialist for tests or treatment.

For frozen shoulder the NHS describes three steps: pain relief, stronger pain relief including a steroid injection if needed, and getting movement back with gentle exercises and physiotherapy, which usually lasts at least 6 weeks. Stronger pain relief is generally used for a short time because of side effects. If you are still in pain after physiotherapy ends, go back to your GP or MSK service for more physiotherapy or another treatment.

Shoulder pain can be slow to resolve. The NHS says it can take 6 months or longer to recover, and that frozen shoulder can last months or years but the pain and stiffness will usually go away eventually. Persisting with exercises, and returning for review if you are still struggling, are the two most useful habits.

Physiotherapy is available through the NHS, though the NHS notes waiting times can be long, and you can also pay to see a physiotherapist privately. Private care may reduce waiting time and offer more sessions, but the exercises and the decisions about injections or referral follow the same principles. Choose a physiotherapist registered with the Chartered Society of Physiotherapy, as the NHS suggests.