[Column] Shoulder Pain at Night: It May Be a Sign of Disease, Not Just Aging

Park Minsik, Orthopedic Specialist at Saeheung Hospital

As society enters a super-aged era, the importance of living a healthy life is growing. In particular, shoulder pain is a common condition that causes significant discomfort in daily life for many middle-aged and elderly individuals. Many people dismiss it as simple "frozen shoulder" or "shoulder stiffness" and leave it untreated, only to see the condition worsen over time.

Did you know that persistent shoulder pain that keeps you awake at night may actually be a problem with the tendons inside your shoulder? Let's dispel some misconceptions about rotator cuff tears and learn accurate information and effective management strategies.

Pain that worsens at night is a warning sign of a rotator cuff tear. Our shoulders are composed of four tendons, known as the rotator cuff, which play a crucial role in arm movement. When these tendons are damaged or torn, it can cause serious problems with shoulder function. Rotator cuff tears typically present with the following symptoms.

The first symptom is a throbbing shoulder pain. The pain intensifies when you lift your arm overhead or move it at certain angles. It is characterized by a dull or aching pain that starts deep within the shoulder.

The second symptom is nighttime pain and sleep disturbances. The pain often becomes worse at night than during the day, making it difficult to get a good night's sleep. It may also be hard to lie on the affected shoulder, further disrupting rest.

The third symptom is a limited range of motion and loss of strength in the shoulder. Movements such as raising your arm above your head or reaching behind your back become difficult. For example, washing your hair, changing clothes, or lifting certain objects may be challenging, and you may feel a loss of strength in the shoulder.

Sometimes, severe shoulder pain may temporarily improve, but this does not mean the tendon damage has healed; it simply means the symptoms have subsided for a while. If left untreated, the tear can progress, so caution is necessary.

Rotator cuff tears can occur for various reasons, but they can largely be classified into three categories.

The first is degenerative changes. As we age, the tendons naturally weaken and lose elasticity. This makes them more susceptible to damage from even minor impacts and is one of the main reasons rotator cuff tears are common among middle-aged and older adults.

The second is repetitive use of the shoulder. Occupations that require repeated arm movements (such as volleyball, tennis, swimming, or other sports that heavily use the shoulder), as well as poor posture or habits in daily life, place continuous stress on the tendons and can cause damage.

The third is trauma and accidents. Tendon tears can result from trauma, such as falling suddenly, lifting heavy objects in a way that strains the shoulder, or receiving a direct blow during sports activities.

So, how should rotator cuff tears be treated and managed?

Treatment plans for rotator cuff tears should be tailored based on the size of the tear, the patient's age, and activity level.

If the tear is minor or in its early stages, conservative treatments are prioritized. Medication and injection therapies help reduce inflammation and pain and support tendon recovery. Physical therapy and rehabilitation exercises, under the guidance of a specialist, are essential for strengthening the shoulder muscles and restoring joint mobility. Consistent management also helps prevent re-tearing. Correcting lifestyle habits is important, such as maintaining proper posture, avoiding activities that strain the shoulder, and making stretching a daily routine.

If pain persists despite non-surgical treatments, or if the tear is large and significantly limits shoulder function, surgery may be considered.

Arthroscopic rotator cuff repair is a minimally invasive procedure that reduces skin incisions and uses an arthroscope to accurately repair the torn tendon. After surgery, it typically takes about three months for the tendon to fully heal, followed by approximately six months of systematic rehabilitation to achieve complete recovery of shoulder function.

Shoulder pain is no longer just a "sign of aging" but a significant health issue that can determine your quality of life. If you have any suspicious symptoms, do not hesitate to consult an orthopedic specialist for an accurate diagnosis and treatment, so that your precious shoulders can support a healthy life in old age. Wishing you a speedy return to an active daily life with healthy shoulders.