Clinical Function Improves After Subacromial Injection of Local Anesthetic in Full-Thickness Rotator Cuff Tears: A Randomized Control Trial

Abstract

Background: Rotator cuff pathology is the most common cause of shoulder pain in adults, accounting for nearly 70% of shoulder-related visits to clinicians. However, physical examination findings may be limited because of pain or patient inhibition. Purpose: To establish whether a relationship exists between pain, range of motion, and strength in patients with a full-thickness rotator cuff tear. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A single-blind, randomized controlled study of 40 patients undergoing rotator cuff repair for full-thickness rotator cuff tears was performed. Patients were randomized to receive either a subacromial 10-mL 2% lidocaine injection or a sham injection, with no contents being injected into the subacromial space. Before the injection, patients were assessed using a visual analog scale for pain (VAS-Pain) as well as the Constant-Murley subjective questionnaire and objective physical examination. The examination was repeated 10 minutes after injection and 6 months postoperatively. VAS-Pain after injection was not assessed. The assessment at 6 months was performed to demonstrate improvement of rotator cuff function after operative management. Statistical analysis included Student t and chi-square tests as well as multivariate binomial logistic regression analyses to identify predictors for improvement after injection. Results were considered significant if P < .05. Results: Range of motion, strength, and Constant-Murley score significantly improved after a subacromial lidocaine injection ( P < .05). Range of motion, strength, Constant-Murley score, and VAS-Pain significantly improved at final follow-up compared with the preinjection assessment for both groups ( P < .05); however, there was no difference ( P > .05) between groups at 6 months postoperatively. Conclusion: After subacromial lidocaine injections, patients exhibited modest but significant improvements in range of motion, strength, and the Constant-Murley score. Pain may limit range of motion and strength in patients with full-thickness rotator cuff tears independent of the mechanical impact of the tear itself. Registration: NCT02693444 ( ClinicalTrials.gov identifier).

Prognostic factors for improvement of shoulder function after arthroscopic rotator cuff repair: a systematic review

“…We excluded two recent studies including patients with revision repairs or nonoperative treatment. 5 , 24 Screening of the titles and abstracts of cited and citing references of included records and 18 topical records 7 , 8 , 9 , 15 , 23 , 24 , 26 , 30 , 35 , 40 , 42 , 55 , 58 , 60 , 70 , 71 , 72 , 73 did not yield any additional studies that met our inclusion criteria. A full description of included studies (studied population, outcomes, statistical analyses, and reported effect estimates) is available in Supplemental Tables 1-3 .…”

A Historical Analysis of Randomized Controlled Trials in the Management of Pain in Rotator Cuff Tears

“…By the final follow-up, 212 patients were lost. A total of 74 of the 79 studies were single-centered [ 1 , 2 , 5 , 6 , 7 , 8 , 9 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , ...…”

Magnetic Resonance Imaging Evaluation of Tendon Integrity Initially After Arthroscopic Rotator Cuff Repair: Single Row Versus Suture Bridge Technique

“…Rotator cuff tear (RCT) is common in the elderly leading to loss of athletic ability and weakened strength, which has a signi cant impact on daily activities [1,2]. Generally, the clinical effect of surgical repair of rotator cuff injury is excellent.…”