What can be worse than not being able to sleep because your shoulders are sore – what can you do? Am trying to put together a list. One author advises people to sleep on one’s back.I am not going to discuss frozen shoulder here – they are obvious because you can’t raise your arm up all the way – and injections to joint and nerve to shoulder, anti-inflammatory meds, combined with stretching helps considerably. injections discussed here:
At Last Some Sense In Shoulder Injections – Three Shots
The pain is bad with this condition and tramadol or morphine at bedtime might be necessary until resolved. Sleeping sitting up in recliner could help.
Article about subjects with frozen shoulder found celecoxib (celebrex) 100 twice daily relieved night pains in 71.4% of cases in 1-2 weeks:
Mod Rheumatol. 2014 Jan;24(1):144-9.
Comparative study of the clinical efficacy of the selective cyclooxygenase-2 inhibitor celecoxib compared with loxoprofen in patients with frozen shoulder.
Ohta S, Komai O, Hanakawa H.
For those with rotator cuff injuries, anti-inflammatory meds might also help.
The deltoid muscle also seems to get inordinately knotted and will need massage. I find some areas in deltoid so tight I now routinely inject 5% lidocaine into painful areas and the work it out – to help unknot them. Now injecting the skin above the nerves with D5W (I add 3% glucerin as Dr. Rosen had suggested) numbs the nerve as well – called neuroprolotherapy. An injection of local to quadrilateral space will nicely relax deltoid muscle so it can be worked out:
You can actually feel the nerves as thread so not hard to inject. Working out deltoid helps significantly.
Self massage of deltoid can be done nicely using a ball-peen hammer (warm under tap, little oil on skin)
However, the article on which this note is based refers to benefits of sleeping on one’s back:
Med Hypotheses. 2010 Apr;74(4):639-43.
Sleep position and shoulder pain.
Zenian J. abstract
Found sleeping on one’s back – ie.”decubitus” was the key to success.
- Their theory is people who are “dead weights” at night and don’t move much end up with pressure points that cause excessive pain in those spots. One would think this is predominantly deltoid but I have seen triceps muscles get inordinately sore especially in overweight individuals from laying on them too long.
- One bad pressure point is over the coracoid bone and if one sleeps on one’s stomach, one can get an anterior deltoid trigger as result (credit Dr. Chen Gunn there). coracoid pic here.
- I have actually see lateral end of scapular spine get sore in some cases, I suspect from sleeping on it as well. I t does seem to respond better to injections with bit of steroid in them so wonder if a local bursa is there…
Having said that, sometimes it feels better to rotate so you are on your scapular spine – – sort of half on your back and half on your side…
For direct pressure problems, better bedding helps. In:
B.H. Jacobson, H.A. Gemmell, B.M. Hayes and T.S. Altena, Effectiveness of a selected bedding system on quality of sleep, low back pain, shoulder pain, and spine stiffness, J Manipulative Physiol Ther 25 (2002), pp. 88–92. abstract here
Found use of special bedding reduced shoulder pains from 4.5/10 to 1.6/10 (61% improvement). I had a problem with sore shoulders and found the use of memory foam particularly helpful. You will not get a soft enough mattress by itself – who would buy a mattress that flattens out in 6-12 month? – ergo you need a memory foam topper.In:
Szollosi, T. Roebuck, B. Thompson and M.T. Naughton, Lateral sleeping position reduces severity of central sleep apnea/Cheyne–Stokes respiration, Sleep 29 (2006), pp. 1045–1051 – they used an airbag and got 32% improvement in pain. abstract here
Effect of prescribed sleep surfaces on back pain and sleep quality in patients diagnosed with low back and shoulder pain Original Research Article
Journal of Ergonomics In Press, July 2010
Bert H. Jacobson, Ali Boolani, Guy Dunklee, Angela Shepardson, Hom Acharya abstract here
Found memory foam significantly improved shoulder situation:
Memory foam can make it more difficult to roll over at night and that might mitigate its benefits.
Another bed treatment option was the use of woolen undergarments, 1 cm woolen bed pad, and a woolen pillow. It brought Fibromylagia pains from 7.9/10 to 1.3/10 after 6 weeks. Not sure how much for just shoulder but should help.
Kiyak, Emine Kara.
A new nonpharmacological method in fibromyalgia: the use of wool.
The Journal of Alternative and Complementary Medicine 15.4 (2009): 399-405.
- “composition of the woolen underwear was 75% merino wool and 25% acrylic fiber”
- 1-cm-thick woolen bed liner
- woolen pillow
- woolen quilt
- for 6 weeks.
- Felt helped by increased warmth, and cushioning.
- Felt this increased blood flow in skin
I added this Oct 2015 and I have to find a 1 cm woolen underlay – anyone know of a good place?
Shoulder problems depend on the condition and I will have to discuss each in turn
- Shoulder bursitis & tendonitis – as soon as you lie down, the shoulder bone comes up and grinds your impinged rotator cuff and bursas. Only way to help that is to sleep sitting up in a recliner chair. I heard of one baseball player who was told he would never play again due to a bad shoulder. He slept sitting up for a month and then went back to playing…
- Sleep shoulder syndrome – I read about this in the 1970’s and have not been able to find reference since. It referred to the tendency to sleep with one’s arm over one’s head and rest one’s head on the shoulder. This causes rather pronounced deltoid soreness. I’m surprised how many I have found once I asked for it. Only thing I have suggested is to put arm in a pillow that is not overhead and hope it keeps it down. I gather that has not been that successful…
- Subscapularis Triggers – I found this muscle was one of the biggest problems to me sleeping,
I found if I put my opposite thumb under my opposite shoulder blade about where drawn on pic; and rubbed back and forth 120 times, then the muscle would let loose some and I could sleep. Simon and Travell recommended putting a pillow between ribcage and arm in armpit to keep it stretched out a bit as well.
- Infraspinatus and posterior deltoid triggers – if you sleep with bad arm up and arm dragged across chest – that stretches it too much – a pillow to hold it up helps
Infraspinatus has been ascribed as a common cause of shoulder pain that’ “nonspecific” – ie. exam doesn’t point to much mechanically wrong. Recent I wrote about measure for dealing with it:
including rolling a lacrosse or hard ball across it:
- First rib and scalene complex pain – I had almost neuralgic pain on my shoulder tip. – curling your fingers just behind your first rib by the cervical spine and pulling it forward while resting in bed gradually bought me relief and I could instantly fall asleep.
Sometimes the second rib area becomes sore as well – the area is often elevated and needs to be pushed down. – Put the mid three fingers of your opposite arm on the back top of your shoulder – then lift the elbow of your opposite arm – it will automatically push your second rib area down. Following. sometimes the 2nd rib area become too anterior and massaging horizontally just below collar bone laterally until tenderness is gone, will help that. Rubbing the second rib level just under collar bone laterally by shoulder until not sore helped the shoulder tip in back too
- Collar bone AC joint – This is on tip of shoulder and can be tested:
Testing For Shoulder AC Joint Pains
If joint is unstable, push just in from joint and pushing from front to back – might help – if it does, it is definitely unstable and could benefit from sugar “prolotherapy” injections to tighten joint up.
- Cervical spine – facets, discs and nerves can all refer to shoulder. I found using the inflatable cervical traction unit for up to 20 minutes gave considerable relief and then people could sleep.. for unit see here Neck Cheap Home Cervical Traction . The most researched pillow for the neck is a water filled pillow.
- Carpal Tunnel Syndrome – there are a series of cases described where nocturnal shoulder pains was caused by carpal tunnel syndrome – medial nerve compression at the wrist:
Clinical Orthopaedics & Related Research: May 1973 – Volume 92 – Issue – ppg 227-230
Shoulder Pain as the Presenting Complaint in Carpal Tunnel Syndrome
Kummel, Bertram M. M.D.; Zazanis, George A. M.D. abstract here
You would think most would also have numbness in had too. Most responded to carpal tunnel wrist surgery though three had frozen shoulder issues too. B6 100 mg only a day is helpful for carpal tunnel:
Carpal Tunnel Syndrome and Vitamin B6 http://painmuse.org/?p=3351
Journal of Manipulative and Physiological Therapeutics Volume 35, Issue 5, June 2012, Pages 407–412
Association Between the Side of Unilateral Shoulder Pain and Preferred Sleeping Position: A Cross-Sectional Study of 83 Danish Patients
Bo Kempf, Alice Kongsted
- Study found 67% slept on the painful shoulder
- “76% slept on the side opposite their partner (P < .001).”
- Conjectured that all it would take to get better is to switch sides with your partner…
Sleeping the direction of your partner might expose one to higher CO2 levels and so people sleep away?
Another suggestion I came across was the use of a counter-irritant topical rubbed over shoulder at bedtime: – one mentioned was Icy hot.:
There are topical anti-inflammatory agents as well – voltaren cream, and Pennsaid lotion (voltaren in DMSO – prescription only)- I have no info on effects for shoulder pains.
Came across a great suggestion for hanging arm over bed edge – I had thought of it but this give a good pic of its mechanics..
“Loss of sleep from night pain that might tip the balance toward surgery is sometimes relieved by so simple a measure as rearrangement of pillows and hanging the limb out of bed.”
I felt the problem with my bed was the fact a hollow had developed where I lay. Having tried switching sides with my wife, I found the hollow allowed me to sleep on my stomach – – my favorite – pillow right side of chest. Left arm under body in the hollow. side pillow placed so my chin supported ( or cup my chin with right hand). You can make yourself a hollow by getting a thinner foam piece – fold it over and cut out a hollow in one half the foam to match where your arm would be…
While looking for a new mattress, came across this site:
How to Buy a Mattress
“If at least one of you spends a lot of time sleeping on your side, if you go with an innerspring mattress I recommend a Simmons Beautyrest. The coils are uniquely designed and are great for side-sleepers because they are “individual pocketed” rather than all connected together like on most beds. Also, if either of you move around a lot and disturb the other person, the Simmons Beautyrest will cut down on that disturbance some. Second choice would be a a Sealy Posturepedic, which is what I have. It is a brand more designed for back-sleepers, but they make great beds.”
I got a beautyrest but it flattens out within 6-12 months though the hollow does give my arm somewhere to lay. The arm would go numb if under me but this got better with the B6 100 mg/day.
* I have found soft pillows are critical for sleep and lay 3 small soft pillows I got from Walmart – overlapping by several inches. Then I sleep with shoulder on first one and second and head on 2nd and third. Sometimes I think a large soft pillow would be better but still looking for that. Celebrex 200 at night helps not only by being anti-inflammatory but also because it is a painkiller.
I sleep on my stomach with a side lying pillow propping me up some, or on my back.
I was amazed how important the skin nerves are to the shoulder pains – many actually down the arm to the elbow but seem to refer to elbow. Skin nerve desensitiztion took off after a study finding benefit in back pain:
Prolotherapy for recalcitrant lumbago.
Australas Musculoskeletal Med 2008;13(5):18-20.
If you transversely tug on the skin you will find tenderness. Injecting every cm with a bleb of D5W (I add 3% glycerin) will desensitize these nerves though will have to be repeated. Came across a video describing neural prolotherapy for just the elbow here:
There are multiple nerve bands that come down various bundles of the deltoid muscle – if you massage with the arm propped up you can feel them as tender strands. Injecting every cm with D5W- 3% glycerin helps there too.
I would follow those nerve trunks up to the shoulder or close too if tender.
I don’t go as deep as he does in the video but that’s just me. There are tracts coming down with the triceps posteriorly as well that need doing. On hefty people the triceps area become particularly sensitized and might include knots in muscle that need treating
I am still thinking of trying a waterbed…. – anyone had success there?
What sort of measures have helped others?
Addendum – I mentioned a mattress article above and author emailed me to say:
My name is Jen and I’m a writer at Jen Reviews. I was doing research on mattresses and just finished reading your wonderful blog post: http://painmuse.org/?p=331
In that article, I noticed that you cited a solid post that I’ve read in the past: http://www.getrichslowly.org/blog/2009/07/17/how-to-buy-a-mattress/
I just finished writing a guide that is even more detailed, updated and comprehensive on how to choose a mattress – 9 factors to consider according to science. It is over 7,000 words and packed with practical tips and advice. You can find it here:
If you like the guide we’d be humbled if you cited us in your article. Of course, we will also share your article with our 50k newsletter subscribers and followers across our social platforms.