Wednesday, September 5, 2012

Does Your Shoulder Keep You Up at Night?


Many shoulder problems cause difficult with sleep at night.  The #1 complaint that I hear in my practice is "I can't get comfortable at night."  In fact, my patients are often dragged in to see me by their spouse because their significant other tosses and turns all night!  Nighttime pain is often the most significant part of a problem with the shoulder.  Other complaints I often hear include difficulty with reaching above or behind, difficulty getting a bra on, or difficulty reaching into a back pocket.  Many times the pain radiates into the arm as well.

What causes nighttime pain?  One word: inflammation.  Inflammation is the root cause of many problems that affect the shoulder while resting.  Inflammation can  result from one of several different underlying problems.  Problems that cause inflammation include rotator cuff tears, "bone spurs", and arthritis in the shoulder.  Frozen shoulder also is the result of inflammation.  Of these, rotator cuff inflammation or tears are the most common.

What can we do about it?  This time, it's a two word answer: cortisone shot.  Although cortisone injections are not a cure-all, they are often very helpful with nighttime pain.  They may completely eliminate the problem, permanently.  In other cases, they may help for weeks or months.  Besides cortisone shots, other treatments for shoulder pain are available.  These include anti-inflammatory medication and physical therapy.  Rarely, surgery may be necessary to correct a significant problem, such as a severely torn rotator cuff tear or large bone spurs which cause friction and rubbing.  Even more rarely, a shoulder replacement may be the best option for a small group of patients.

Of course, an exam, x-rays, and sometimes MRI are all necessary to establish a diagnosis.  Making an appointment when things have been going on for more than a week or two is often helpful to nip the problem "in the bud" and prevent it from getting worse.  It is not normal for the shoulder to be painful, and successful treatments are available.

Written by Anthony Frisella, MD

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