Addition of Lidocaine Injection Immediately before Physiotherapy for Frozen Shoulder: A Randomized Controlled Trial

<div><p>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 (<i>P</i> < 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.</p><p>Trial Registration</p><p>ClinicalTrials.gov <a href="https://clinicaltrials.gov/ct2/results?term=LIN+FEN+HSIEH&Search=Search" target="_blank">NCT01817348</a></p></div

Comparisons of the active and passive ROMs between the groups.

<p>Shown as bar charts for (a) flexion, (b) abduction, (c) external rotation, and (d) internal rotation for active ROM and for (e) flexion, (f) abduction, (g) external rotation, and (h) internal rotation for passive ROM with the corresponding standard deviations represented as error bars. An asterisk indicates significant differences between groups (<i>P</i><0.008). For the evaluation times (evaluation times: before and 1, 2, 3, 4, and 6 months after the start of treatment), a right arrow above the graph indicates a significant, linearly increasing trend, whereas a left arrow indicates a significant, linearly decreasing trend (<i>P</i><0.025). (Black bar: the PT group; gray bar: the INJPT group). Group differences were analyzed using Mann-Whitney <i>U</i> test. Treatment time effects were analyzed using Friedman's test for two groups respectively. Abbreviations: PT, physical therapy; INJPT, injection plus physical therapy.</p

Demographic and clinical characteristics of the subjects.

<p>Demographic and clinical characteristics of the subjects.</p

The consolidated standards for reporting trials: a flow diagram of the study.

<p>Abbreviations: PT, physiotherapy group; INJPT, lidocaine injection plus physiotherapy group.</p