• Bryan Morrow

Ouch! Why does my shoulder hurt at night?

The shoulder is the most flexible joint in the body. The shoulder has a greater range of motion than any other joint. The shoulder is also the most complex joint in our body. It is capable of providing stable motion due to a delicate relationship of the muscles, tendons and bones which comprise the shoulder.


Many types of injuries can affect the shoulder due to the complex structure of the shoulder. Sports injuries, chronic repetitive stress or accidents, and falls can cause shoulder pain. Even simple repetitive tasks such as painting, housecleaning, and gardening can cause our shoulder to hurt.


The "rotator cuff" is the group of 4 muscles and their tendons responsible for keeping the shoulder joint stable. Injuries to the rotator cuff are common—either from accident or trauma, or with repeated overuse of the shoulder. Risk of injury can vary, but generally increases as a person ages. Rotator cuff tears are more common later in life, but also can occur in younger people. Athletes and heavy laborers are often affected; older adults can injure the rotator cuff when they fall on or strain the shoulder. When left untreated, a rotator cuff tear can cause severe pain and a decrease in the ability to use the arm.


Physical therapists help people with rotator cuff tears address pain and stiffness, restore movement to the shoulder and arm, and improve their activities of daily living.


People with chronic rotator cuff injuries often have a history of rotator cuff tendon irritation that causes shoulder pain with movement. This condition is known as shoulder impingement syndrome.

Rotator cuff tears also may occur in combination with injuries or irritation of the biceps tendon at the shoulder, or with labral tears (to the ring of cartilage at the shoulder joint). Your physical therapist will explain the particular details of your rotator cuff tear.


How Does It Feel? People with rotator cuff tears can experience:

  • Pain over the top of the shoulder or down the outside of the arm

  • Shoulder weakness

  • Loss of shoulder motion

  • A feeling of weakness or heaviness in the arm

  • Inability to lift the arm to reach up, or reach behind the back

  • Inability to perform common daily activities due to pain and limited motion


How Is It Diagnosed? To help pinpoint the cause of your shoulder pain, your physical therapist will complete a thorough examination that will include learning details of your symptoms, assessing your ability to move your arm, identifying weakness, and performing special tests that may indicate a rotator cuff tear. For instance, your physical therapist may raise your arm, move your arm out to the side, or raise your arm and ask you to resist a force, all at specific angles of elevation.

In some cases, the results of these tests might indicate the need for a referral to an orthopedist or other professional for imaging tests, such as ultrasound imaging, magnetic resonance imaging (MRI), or a computed tomography (CT) scan.

How Can a Physical Therapist Help? Once a rotator cuff tear has been diagnosed, you will work with your orthopedist and physical therapist to decide if you should have surgery or if you can try to manage your recovery without surgery.

If you don't need surgery, your physical therapist will work with you to restore your range of motion, muscle strength, and coordination, so that you can return to your regular activities. In some cases, you may learn to modify your physical activity so that you put less stress on your shoulder.

If you decide to have surgery, your physical therapist can help you both before and after the procedure.

Regardless of which treatment you have—physical therapy only, or surgery and physical therapy—early treatment can help you speed the healing process and avoid permanent damage.

If You Have an Acute Injury If a rotator cuff tear is suspected following a trauma, seek the attention of a physical therapist or other health care provider to rule out the possibility of serious life- or limb-threatening conditions. Once serious injury is ruled out, your physical therapist will help you manage your pain and will prepare you for the best course of treatment. If You Have a Chronic Injury