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

Brian Forsythe, Avinesh Agarwalla, Richard N Puzzitiello, Bhavik H Patel, Yining Lu, Nikhil N Verma, Anthony A Romeo, Brian J Cole, Brian Forsythe, Avinesh Agarwalla, Richard N Puzzitiello, Bhavik H Patel, Yining Lu, Nikhil N Verma, Anthony A Romeo, Brian J Cole

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).

Keywords: Constant-Murley; rotator cuff tears; shoulder; subacromial injection.

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: B.F. has received research support from Arthrex and Stryker; educational support from Medwest, Smith & Nephew, and Ossur; consulting fees from Arthrex, DJO, Smith & Nephew, Ossur, Sonoma Orthopedics, and Stryker; speaking fees from Arthrex; honoraria from Arthrosurface; and royalties from Elsevier and Arthrex; and has stock options in Jace Medical. N.N.V. has received research support from Arthrex, Arthrosurface, DJO, Ossur, Athletico, ConMed Linvatec, Miomed, and Mitek; consulting fees from Minivasive, Orthospace, Smith & Nephew, Medacta, and Arthrex; speaking fees from Pacira and Arthrex; and royalties from Arthroscopy, Smith & Nephew, and Vindico Medical–Orthopaedics Hyperguide; and has stock options in Cymedica, Minivasive, and Omeros. A.A.R. has received consulting fees and royalties from Arthrex. B.J.C. has received research support from Aesculap/B.Braun, Arthrex, Geistlich, Sanofi-Aventis, and Zimmer; educational support from Medwest; consulting fees from Arthrex, Genzyme, Pacira Pharmaceuticals, Anika Therapeutics, Vericel, Zimmer Biomet, Bioventus, Geistlich Pharma, Smith & Nephew, Acumed, and Flexion Therapeutics; speaking fees from Arthrex, Carticept Medical, Pacira Pharmaceuticals, and Lifenet Health; royalties from Arthrex, DJO, Elsevier, and Operative Techniques in Sports Medicine; honoraria from Vericel; hospitality payments from Lifenet Health, Geistlich Pharma, and GE Healthcare; and has stock options in Aqua Boom, Biometrix, Giteliscope, Ossio, and Regentis. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

© The Author(s) 2020.

Figures

Figure 1.
Figure 1.
Ultrasound imaging of lidocaine injection into the subacromial space (study group).
Figure 2.
Figure 2.
Ultrasound imaging of needle with empty syringe entering the subacromial space (control group).
Figure 3.
Figure 3.
CONSORT (Consolidated Standards of Reporting Trials) flow diagram illustrating the inclusion of patients for final analysis.

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Source: PubMed

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