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

Overview

Journal Orthop J Sports Med

Specialty Orthopedics

Date 2020 Jan 15

PMID 31934594

Citations 2

Authors

Brian Forsythe

Avinesh Agarwalla

Richard N Puzzitiello

Bhavik H Patel

Yining Lu

Nikhil N Verma

Anthony A Romeo

Brian J Cole

Affiliations

Soon will be listed here.

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 and chi-square tests as well as multivariate binomial logistic regression analyses to identify predictors for improvement after injection. Results were considered significant if < .05.

Results: Range of motion, strength, and Constant-Murley score significantly improved after a subacromial lidocaine injection ( .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 ( .05); however, there was no difference ( .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).

Citing Articles

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

Stojanov T, Audige L, Modler L, Aghlmandi S, Appenzeller-Herzog C, Loucas R JSES Int. 2023; 7(1):50-57.

PMID: 36820428 PMC: 9937854. DOI: 10.1016/j.jseint.2022.09.003.

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

Berton A, Longo U, De Salvatore S, Sciotti G, Santamaria G, Piergentili I J Clin Med. 2021; 10(18).

PMID: 34575180 PMC: 8470804. DOI: 10.3390/jcm10184072.

References

Tashjian R, Henn R, Kang L, Green A . Effect of medical comorbidity on self-assessed pain, function, and general health status after rotator cuff repair. J Bone Joint Surg Am. 2006; 88(3):536-40. DOI: 10.2106/JBJS.E.00418. View

Michener L, McClure P, Sennett B . American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: reliability, validity, and responsiveness. J Shoulder Elbow Surg. 2002; 11(6):587-94. DOI: 10.1067/mse.2002.127096. View

Dang A, Davies M . Rotator Cuff Disease: Treatment Options and Considerations. Sports Med Arthrosc Rev. 2018; 26(3):129-133. DOI: 10.1097/JSA.0000000000000207. View

Ben-Yishay A, Zuckerman J, Gallagher M, Cuomo F . Pain inhibition of shoulder strength in patients with impingement syndrome. Orthopedics. 1994; 17(8):685-8. DOI: 10.3928/0147-7447-19940801-06. View

Constant C, Murley A . A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987; (214):160-4. View

Chalmers P, Ross H, Granger E, Presson A, Zhang C, Tashjian R . The Effect of Rotator Cuff Repair on Natural History: A Systematic Review of Intermediate to Long-Term Outcomes. JB JS Open Access. 2018; 3(1):e0043. PMC: 6132904. DOI: 10.2106/JBJS.OA.17.00043. View

Abechain J, Godinho G, Matsunaga F, Netto N, Daou J, Tamaoki M . Functional outcomes of traumatic and non-traumatic rotator cuff tears after arthroscopic repair. World J Orthop. 2017; 8(8):631-637. PMC: 5565495. DOI: 10.5312/wjo.v8.i8.631. View

Kim H, Teefey S, Zelig A, Galatz L, Keener J, Yamaguchi K . Shoulder strength in asymptomatic individuals with intact compared with torn rotator cuffs. J Bone Joint Surg Am. 2009; 91(2):289-96. PMC: 2663343. DOI: 10.2106/JBJS.H.00219. View

Cvetanovich G, Gowd A, Liu J, Nwachukwu B, Cabarcas B, Cole B . Establishing clinically significant outcome after arthroscopic rotator cuff repair. J Shoulder Elbow Surg. 2019; 28(5):939-948. DOI: 10.1016/j.jse.2018.10.013. View

10.

Chen Y, Chen S, Qiao Y, Ge Y, Li H, Chen J . A Long Preoperative Duration of Symptoms Is Associated With Worse Functional Outcomes After 1-Stage Arthroscopic Treatment of Rotator Cuff Tears With Shoulder Stiffness. Am J Sports Med. 2017; 45(10):2336-2344. DOI: 10.1177/0363546517707202. View

11.

Kukkonen J, Joukainen A, Lehtinen J, Mattila K, Tuominen E, Kauko T . Treatment of Nontraumatic Rotator Cuff Tears: A Randomized Controlled Trial with Two Years of Clinical and Imaging Follow-up. J Bone Joint Surg Am. 2015; 97(21):1729-37. DOI: 10.2106/JBJS.N.01051. View

12.

Wylie J, Bershadsky B, Iannotti J . The effect of medical comorbidity on self-reported shoulder-specific health related quality of life in patients with shoulder disease. J Shoulder Elbow Surg. 2010; 19(6):823-8. DOI: 10.1016/j.jse.2009.11.052. View

13.

Levy O, Haddo O, Massoud S, Mullett H, Atoun E . A patient-derived Constant-Murley score is comparable to a clinician-derived score. Clin Orthop Relat Res. 2013; 472(1):294-303. PMC: 3889436. DOI: 10.1007/s11999-013-3249-3. View

14.

Yian E, Ramappa A, Arneberg O, Gerber C . The Constant score in normal shoulders. J Shoulder Elbow Surg. 2005; 14(2):128-33. DOI: 10.1016/j.jse.2004.07.003. View

15.

Tallia A, Cardone D . Diagnostic and therapeutic injection of the shoulder region. Am Fam Physician. 2003; 67(6):1271-8. View

16.

Chalmers P, Cvetanovich G, Kupfer N, Wimmer M, Verma N, Cole B . The champagne toast position isolates the supraspinatus better than the Jobe test: an electromyographic study of shoulder physical examination tests. J Shoulder Elbow Surg. 2015; 25(2):322-9. DOI: 10.1016/j.jse.2015.07.031. View

17.

Jeong J, Song S, Yoo J, Park K, Lee S . Comparison of outcomes with arthroscopic repair of acute-on-chronic within 6 months and chronic rotator cuff tears. J Shoulder Elbow Surg. 2016; 26(4):648-655. DOI: 10.1016/j.jse.2016.09.032. View

18.

Dunn W, Kuhn J, Sanders R, An Q, Baumgarten K, Bishop J . Symptoms of pain do not correlate with rotator cuff tear severity: a cross-sectional study of 393 patients with a symptomatic atraumatic full-thickness rotator cuff tear. J Bone Joint Surg Am. 2014; 96(10):793-800. PMC: 4018774. DOI: 10.2106/JBJS.L.01304. View

19.

van Kampen D, van den Berg T, van der Woude H, Castelein R, Scholtes V, Terwee C . The diagnostic value of the combination of patient characteristics, history, and clinical shoulder tests for the diagnosis of rotator cuff tear. J Orthop Surg Res. 2014; 9:70. PMC: 4237868. DOI: 10.1186/s13018-014-0070-y. View

20.

Yamaguchi K, Ditsios K, Middleton W, Hildebolt C, Galatz L, Teefey S . The demographic and morphological features of rotator cuff disease. A comparison of asymptomatic and symptomatic shoulders. J Bone Joint Surg Am. 2006; 88(8):1699-704. DOI: 10.2106/JBJS.E.00835. View