Addition of lidocaine injection immediately before physiotherapy for frozen shoulder: a randomized controlled trial.

Wei-Chun Hsu,Lin-Fen Hsieh,Chun-Mei Tsai,Kuang-Hui Huang,Yi-Jia Lin,Tao-Liang Wang,Zheng Su

doi:10.1371/journal.pone.0118217

Abstract

The intraarticular injection of lidocaine immediately before a physiotherapy session may relieve pain during the stretching and mobilization of the affected joint in patients with a frozen shoulder, thus enhancing the treatment effect. To compare the effects of intraarticular injection of lidocaine plus physiotherapy to that of physiotherapy alone in the treatment of a frozen shoulder, a prospective randomized controlled trial was conducted in the rehabilitation department of a private teaching hospital. Patients with a frozen shoulder were randomized into the physiotherapy group or the lidocaine injection plus physiotherapy (INJPT) group. The subjects in the INJPT group underwent injection of 3 ml of 1% lidocaine into the affected shoulder 10 to 20 minutes before each physiotherapy session. In each group, the treatment lasted 3 months. The primary outcome measures were the active and passive range of motion of the affected shoulder. The secondary outcome measures were the results of the Shoulder Disability Questionnaire, the Shoulder Pain and Disability Index, and the 36-item Short-Form Health Survey (SF-36). The outcome measures were evaluated before treatment and 1, 2, 3, 4, and 6 months after the start of treatment. The group comparisons showed significantly greater improvement in the INJPT group, mainly in active and passive shoulder range of motion in flexion and external rotation and improvements in pain and disability (P < 0.05); however, no significant group difference was seen in the SF-36 results. The intraarticular injection of lidocaine immediately before a physiotherapy session might be superior to physiotherapy alone in the treatment of a frozen shoulder.Trial RegistrationClinicalTrials.gov NCT01817348

Highlights

Frozen shoulder, or adhesive capsulitis of the shoulder, is a common clinical condition characterized by insidious and progressive pain and the loss of active and passive range of motion (ROM) of the glenohumeral joint
The purpose of this study was to compare the efficacy of intraarticular injection of lidocaine plus a physiotherapy program (INJPT) to physiotherapy alone (PT) in the treatment of a frozen shoulder
The baseline characteristics of the participants in the PT and injection plus physiotherapy (INJPT) groups are listed in Table 1; no significant differences in the demographic or baseline measurements were found (Table 1)

Summary

Introduction

Adhesive capsulitis of the shoulder, is a common clinical condition characterized by insidious and progressive pain and the loss of active and passive range of motion (ROM) of the glenohumeral joint. The ROM of the shoulder is usually limited to a capsular pattern (mainly external rotation, followed by abduction and flexion; internal rotation is the least commonly involved). Passive movements at or beyond the range limits are painful and resisted movements are not necessary to reproduce or aggravate the pain. The annual incidence of frozen shoulder is 3% to 5% in the general population and as high as 20% in people with diabetes [1]. A considerable proportion of patients with a frozen shoulder are treated with physiotherapy, nonsteroidal antiinflammatory drugs (NSAIDs), intraarticular injection of corticosteroids, and, recently, intraarticular injection of hyaluronate [4,5,6,7]. More aggressive interventions, such as hydrodilation, manipulation under anesthesia, and arthroscopic or open capsule release, have been performed [8,9,10,11]

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Conclusion