Patrick DenardDirector Oregon Shoulder Fellowship, Oregon Shoulder Institute · Director Oregon Shoulder Fellowship at Oregon Shoulder Institute

Why shoulder pain is often worse at night

27 Mar 2026 · 1 min

Watch on YouTube

0:46

In this brief explanatory video, a shoulder surgeon outlines the common reasons why patients experience increased shoulder pain during the night. He identifies three main contributors: (1) mechanical factors related to sleep position—lying directly on the shoulder or having the elbow press against the front of the shoulder can increase pressure; (2) reduced daytime distraction—during waking hours other activities mask the pain, making it feel more intense when the mind is at rest; and (3) circadian hormonal changes—nighttime drops in cortisol may allow a modest rise in inflammation, heightening pain. These mechanisms together explain why nighttime shoulder discomfort is a frequent complaint among his patients.

Chapters

If your shoulder pain hurts more at night, that's really common. Shoulder pain at night is one of those common reasons people see me as a shoulder surgeon, and they always want to know why. There's probably a couple of reasons. One can just be the mechanical aspect of sleeping, sleeping directly on the shoulder, or if they're laying on their back, the elbow comes toward the back and that may put more pressure in the front. Secondly, there may be some less distraction. During the day you're doing other things that are distracting you from the pain. Thirdly, there's thought to be some circadian relationship, that is, with your natural rhythm. Your cortisol, for instance, decreases at night. That may help change the inflammatory pathway, allowing inflammation to increase slightly. So all of these are potential reasons why shoulder pain can be worse at night.