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Nighttime pain occurs because lying flat removes the effect of gravity, allowing the upper arm bone to shift slightly and impinge on inflamed tendons. Additionally, decreased nighttime circulation increases fluid buildup and pressure within the joint. Sleeping slightly elevated or supported on your unaffected side with a pillow between your arm and chest helps reduce friction and relieves pressure.

Arthroscopic repair is indicated for large or full-thickness tears, acute trauma injuries, severe weakness affecting daily activities, or when non-surgical treatments fail to relieve persistent pain after 3 to 6 months. Early surgical intervention prevents tendon retraction and permanent muscle atrophy.

While partial-thickness tears or age-related degenerative wear can often be managed successfully without surgery through targeted physical therapy and anti-inflammatory treatment, full-thickness tears rarely heal on their own due to continuous tendon tension. Non-surgical treatment aims to strengthen surrounding shoulder muscles to restore pain-free movement.

Full recovery typically takes 4 to 6 months. Patients usually wear a protective sling for the first 4 to 6 weeks to protect the tendon reattachment. Structured physical therapy begins immediately with gentle passive motion, progressing to active strength rehabilitation around 3 months, with full clearance for daily lifting and sports achieved between 6 to 9 months.

Injections do not physically reattach or sew a torn tendon. However, cortisone injections provide rapid, short-term reduction of severe swelling and bursitis, while Platelet-Rich Plasma (PRP) therapy utilizes natural growth factors to stimulate biological healing in partial tears and chronic tendinopathy, providing long-term symptomatic relief.