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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 the rotator cuff. The rotator cuff is a muscle/tendon unit in the shoulder that makes it possible for you to raise your arm above your head.
There are three basic problems that can lead to rotator cuff-related pain at night:
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. (If you’re experiencing persistent shoulder pain, you can see an orthopedic specialist without an appointment at our walk-in Injury Center.)
Rotator cuff tendinitis is inflammation of the rotator cuff tendon and its overlying bursa (a fluid-filled sac that decreases friction between the bone, muscle, tendons, and skin). This type of inflammation is often the result of repeated overhead use of the arm (as in tennis or other overhand sports), a traumatic fall on the shoulder, or a bone spur that pinches the rotator 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 bursa sac.
A rotator cuff tear can occur after a traumatic fall, but it might also be the result of tendon degeneration as you age. Tears are commonly associated with a feeling of weakness as well as constant pain that worsens at night.
Typically, rotator cuff tears are treated conservatively at first with injections and physical therapy. 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 types of rotator cuff pain. It results from the formation of small calcium deposits inside 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 break up the blockage and relieve the associated pressure. Injections are usually very successful. However, a small percentage of cases require surgical excision of the deposits which is performed arthroscopically and on an outpatient basis.