Shoulder pain at night or when lifting your arm: the causes
Putting on a jacket, reaching for a shelf, brushing your hair, sleeping on your side: the shoulder is involved in almost every movement of the day. When it becomes painful, daily life is quickly affected. In most cases this is not a serious illness but a problem with the tendons or the joint capsule.
The rotator cuff: the most common cause
The rotator cuff is a group of four muscles and their tendons that keep the arm bone well centred in the joint and stabilise the shoulder. According to the Swiss League against Rheumatism, rotator cuff problems are the most common shoulder condition.
Shoulder tendinitis: how to recognise it
The League typically describes:
- pain when the arm rises out to the side, around mid-height, from horizontal to a little above (the "painful arc");
- pain at night and difficulty lying on the affected shoulder;
- sometimes pain at rest, when a small gliding pouch above the tendon is irritated (bursitis).
People often speak of "shoulder tendinitis", but tendinopathy is the more accurate term: the tendon is not always inflamed. To understand why a tendon can stay painful, read our article Tendinopathy: why tendon pain persists and our Tendinitis page.
Frozen shoulder (adhesive capsulitis)
In frozen shoulder, the joint capsule becomes inflamed, then thickens and contracts. The shoulder becomes stiff, especially when turning the arm outwards, even when someone else tries to move it. According to the Swiss League against Rheumatism, most people affected are between 40 and 60 years old, and diabetes is one of the associated factors.
Frozen shoulder: how long it lasts, in three phases
The League describes a usual course in three stages:
- a painful, inflammatory phase of about 3 months, with strong pain, including at night;
- a stiffening phase of about 3 to 9 months, in which movement decreases;
- a recovery phase of about 9 to 18 months, in which movement slowly returns.
The long-term outlook is favourable in most cases, although some limitation may remain. This long course calls for patience and support adapted to each phase. In the vast majority of cases, movement gradually returns.
Warning signs: when to seek care without delay
Most shoulder pain is benign. The following signs, however, call for prompt or urgent medical advice:
Seek care immediately (emergency department) if you have:
- shoulder pain together with chest pain or tightness, breathlessness or sweating;
- a fall or blow with a deformed shoulder, or inability to move the arm;
- a red, hot, swollen shoulder with fever.
See your doctor promptly if:
- you suddenly can no longer lift your arm, especially after an effort or awkward movement;
- the pain comes with fever, night sweats or unexplained weight loss;
- you have a history of cancer and new, unusual pain or pain that does not settle at rest;
- the pain travels down the arm with tingling, numbness or weakness in the hand.
In the vast majority of cases, none of these signs is present.
Recommended first steps
Once warning signs have been ruled out, the Swiss League against Rheumatism notes that rotator cuff problems are treated first with physiotherapy, possibly with a steroid injection (infiltration) discussed with your doctor. Keeping the shoulder moving within the limits of pain, temporarily adapting overhead movements and avoiding complete immobilisation are useful basics.
What does the research say?
The League stresses that the history and clinical examination are essential, and that an MRI should not be the first or only examination. For frozen shoulder, the early painful phase is often treated with adapted pain relief, a steroid injection and physiotherapy. Medicines and steroid injections should always be discussed with your doctor.
The first consultation lasts 1 h 30 to 2 h (CHF 182). Bring your medical file, your examinations (MRI, ultrasound, reports) and a list of your medicines. We review your situation and build your plan together. Follow-up is then adapted to your progress. We work alongside your GP and the other professionals involved in your care, including your physiotherapist.
Which approaches can have a place at Centre Algos?
Depending on your situation, several approaches can be combined, alongside your medical care and physiotherapy:
- Naturopathy: sleep, diet, stress management and metabolic balance, to work on the lifestyle habits that can influence pain.
- Cupping: applied around the shoulder, neck and upper back, it can help release muscle tension.
- Percutaneous hydrotomy: subcutaneous micro-injections; it may be considered when the situation is suitable, after assessment, once warning signs have been ruled out and in agreement with your medical care. Price on quotation, set at the first consultation according to your situation.
Everyone responds differently: the aim is to regain comfort and movement in daily life, without promising a result.
When to seek care
What is happening in your case
This text describes general mechanisms. What explains your shoulder pain, in your specific situation, deserves a real conversation rather than a generic answer.
A question before you decide? Book a free 10-minute call to see whether our approach suits you.
