More than 4 million patients seek care for shoulder pain annually in the U.S., many of them suffering from pain throughout the night. This pain can range from mild to excruciating, and it is almost always related to a problem with their rotator cuff. As noted in the diagram below, the rotator cuff is a muscle/tendon unit in the shoulder that allows one to elevate their arm above their head.
There are three basic problems that can lead to rotator cuff related pain at night:
- Rotator cuff tendinitis/bursitis
- Rotator cuff tear
- Calcific tendinitis of the rotator cuff
Rotator cuff tendinitis is an inflammation of the rotator cuff tendon and its overlying bursal sac as shown in the diagram below. Such inflammation can commonly occur from recurrent overhead use of the arm (as in tennis or other overhand sports), from a traumatic fall on the shoulder, or from a bone spur underneath the acromion bone that pinches the cuff.
Rotator cuff tendinitis/bursitis is most commonly treated with simple non-operative measures including ice, non-steroidal anti-inflammatory medications, physical therapy, or possibly a steroid injection into the bursal sac.
A rotator cuff tear can occur after a traumatic fall or from simple tendon degeneration with aging. Tears are commonly associated with weakness as well as constant pain which worsens at night.
Rotator cuff tears are often initially treated conservatively. However, if pain persists despite injection and physical therapy, rotator cuff tears require a small outpatient, arthroscopic procedure. Repair of the rotator cuff involves suturing the torn tendon down to its original position. This is typically followed by a sling for four weeks and several months of physical therapy.
Calcific tendinitis of the rotator cuff is by far and away the most painful of the three processes listed above. It results from the formation of small calcium deposits within the substance of the rotator cuff tendon. These deposits cause a pressure in the cuff tendon that results in constant excruciating pain. Nonoperative treatment almost always requires a cortisone injection into the deposit to disrupt the calcium deposit and relieve the associated pressure. Injection is usually very successful. However, a small percentage of cases require surgical excision of the deposits which is performed arthroscopically and on an outpatient basis.
In summary, the treatment of these rotator cuff conditions is always more successful by seeking early medical attention by your shoulder specialist. Delay in treatment can often result in a surgical procedure that easily could have been avoided.