Pain

• Pain from a torn rotator cuff is often felt in the back of the shoulder. That pain can seem to fade away when the patient keeps his arm "quiet" and does not swing it or throw a ball. However, when the patient raises his arm, the pain can be quite overwhelming. That pain can wake a person up at night. The patient is quiet when he goes to sleep but the movement of the arm during the sleeping process can shock the individual and cause him to wake up. Some patients will unconsciously shift into a position where they sleep on the injured shoulder at night, at least until the pain jars them awake.
  
  

Treatment

• When the shoulder is first injured, the best treatment is to move the arm as little as possible and to treat it with ice. If the patient is able to keep it immobile for 24 to 48 hours, the injury can be treated with ice. Put an ice pack on the injury for 15 minutes of every waking hour during the first 24 hours, then for 15 minutes during every other waking hour for the second full day. After that period, alternate ice and heat treatments every other hour. This should allow the patient to sleep with little pain barring any sudden movement during sleep.
  
  

Painkillers and Anti-Inflammatories

• The pain can be overwhelming with a rotator cuff injury and your doctor can prescribe a strong narcotic painkiller if over-the-counter medication does not help. This will be especially helpful if the patient has been waking up with significant pain in the middle of the night. The doctor can also prescribe an anti-inflammatory shot of cortisone to reduce swelling. Relieving the swelling will promote healing.
  
  

Physical Therapy

• It is important not to start exercise physical therapy too quickly after the injury. The delicate nature of the rotator cuff means that one significant tear may be obscuring smaller tears elsewhere in the shoulder. It is important to wait at least a week once the swelling has gone down and the initial surge of pain has disappeared. Stretching exercises are best. Refrain from weightlifting until you have gotten the approval from your doctor. You may feel soreness from the physical therapy at night, but this should be significantly less than the original level of pain.
  
  

Securing the Injury

• When the patient goes to sleep at night with a rotator cuff injury, it may be best to stabilize the arm between two bulky pads. Pillows will work fine if they are heavy enough but bolsters from a couch or sofa may work even better. Secure the arm between the two pillows and rest comfortably.