Morning Shoulder Pain When Waking Up

Morning Shoulder Pain When Waking Up

If your shoulder hurts after sleeping, it could be just a fluke caused by a suboptimal sleeping position. But if you have persistent shoulder pain while sleeping, it may be a sign that something is seriously wrong and needs attention. Shoulder issues often originate in the thorax and upper spine, and you may need physical therapy to correct your posture and alignment.

Morning Shoulder Pain When Waking Up

Not all shoulder pain is serious, but it is not normal to wake up with shoulder pain on a daily basis. If you work out regularly, lift heavy weights or participate in overhead sports like tennis, golf, baseball or swimming, it is not unusual to have some delayed onset muscle soreness in your shoulders from time to time. But if the pain is persistent, it could indicate an overuse injury that may worsen over time if not attended to.

If you have persistent morning shoulder pain, sleeping position could be an underlying cause. Side sleepers may place pressure on muscles and nerves during the night that affect the shoulder, but the pain is likely to subside once the pressure is relieved. Even back sleepers can compress muscles and nerves if they sleep with one arm overhead.

Nevertheless, if your shoulder hurts after sleeping day after day and the pain becomes progressively worse, it could indicate a condition that needs attention before it causes serious problems.

Morning Shoulder Pain When Waking Up

Conditions that Cause Shoulder Pain when Waking Up

If you wake up in pain, there is a good chance that you are not getting the deep sleep you need to function throughout the day. But persistent shoulder pain is not likely to get better on its own. A good chiropractor or physical therapist can help you identify the underlying cause of your shoulder pain and provide a treatment plan to get rid of it.

Common causes of morning shoulder pain include:

  • Rotator cuff tendinosis. The tendons that attach your rotator cuff muscles to bone can become inflamed or injured from physical overuse, but they can also experience wear and tear from poor posture and imbalanced muscle tension that creates misalignment in the upper body. Both issues respond well to physical therapy.

  • Rotator cuff tear. The rotator cuff can become ruptured from overuse, or from being out of shape and overloading the muscles to lift or move a heavy object.

  • Tendinosis calcarea. This condition is commonly seen in patients between the ages of 30 and 50. It is characterized by a buildup of calcium deposits in the tendon tissue of the rotator cuff.

  • AC joint degeneration. The acromioclavicular (AC) joint is the junction of the clavicle (collarbone) and the scapula (shoulder blade). Pain can arise from injury or overuse. Progressive degeneration of the joint can cause shoulder pain when waking up.

Conditions that Cause Shoulder Pain when Waking Up
  • Bursitis in the sub acromial or sub deltoid space. Bursae are small fluid-filled sacs that keep soft tissues from rubbing against bones. The bursae can become inflamed, causing shoulder pain while sleeping,

  • Frozen shoulder. This painful condition severely restricts your shoulder range of motion, making it difficult or impossible to reach overhead.

  • Restricted thoracic mobility. Reduced mobility in the thoracic spine due to sedentary lifestyle or overtraining can inhibit the ability of your spine and rib cage to move freely, causing you to use your shoulders in ways they were never meant to be used.

  • Scapular dyskinesis. When the muscles that control your shoulder blade movement become weak or imbalanced, it creates instability that can cause shoulder pain.

  • Shoulder impingement. Sometimes the structures that surround and support your shoulder can become misaligned and inflamed, putting pressure on nerves and soft tissue and preventing them from gliding freely in the shoulder girdle.

  • Osteoarthritis. OA of the shoulder occurs when the cartilage at the end of bones wears thin, causing inflammation, aching, pain and stiffness.

Diagnosing Shoulder Pain

Diagnosing Shoulder Pain

With so many things that can potentially cause shoulder pain while sleeping, it is critical to get an accurate diagnosis, to rule out potentially harmful conditions and pinpoint the problem for effective treatment.

Differential Diagnosis

A differential diagnosis rules out certain rare conditions that can be the underlying cause of your shoulder pain, such as:

  • Rheumatoid arthritis. The highly inflammatory nature of RA can make the shoulder sensitive to any type of compression.

  • Bone cancer. While rare, bone cancer in any area of the body can be lethal if not treated.

  • Deltoid tendinosis. Degeneration of the deltoid tendons can be both painful and debilitating, causing ongoing pain that worsens over time.

Diagnostic Ultrasonography

Diagnostic Ultrasonography

High resolution diagnostic ultrasound can be a useful tool for identifying the source of shoulder pain. Ultrasound allows us to see inside the shoulder region in real time, with the patient in motion. It lets us rule out certain conditions, so we can get to the bottom of your shoulder pain and dysfunction.

Shoulder Pain Treatment Options

Once the underlying cause of your shoulder pain has been identified, a customized treatment plan can be designed to rehabilitate your shoulder region and restore functional movement.

Shoulder pain treatment options may include a combination of therapies, including:

  • Extracorporeal shock wave therapy (ESWT)

  • Massage therapy

  • Manual therapies

  • Ultrasound guided dry needling

  • Physical therapy exercises

  • Dynamic neuromuscular stabilization (DNS)

Shoulder Pain Treatment Options

Shoulder Pain Treatment in NYC

The shoulder pain specialists at NYDNRehab use the most advanced technologies and innovative therapies to pinpoint the cause of shoulder pain and treat it at its source. Our sports medicine team works with athletes to rehabilitate overuse and traumatic injuries, and get them back in play as quickly as possible. Non-athletes can get relief from pain and dysfunction, and learn how to avoid shoulder issues in the future.

You don’t have to wake up with shoulder pain. Early treatment can keep your condition from getting worse, and put you on the path to fluid pain-free movement, so you can get back to doing the things you love.

Range of Available Unique Physical Therapy Treatments at Nydnrehab


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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