The Efficacy of Local Anesthetics to Reduce Shoulder Pain Post-Steroid Injections
The Efficacy of Local Anesthetics to Reduce Shoulder Pain Post-Steroid Injections
The specific aim of this prospective study is to determine whether local anesthetics prior to
 subacromial steroid injections reduce pain and consequently if they are cost-effective in the
 treatment for shoulder pathology.
Shoulder pain is a common problem that can be estimated to be prevalent in up to 15 percent
 of the patient population registered to general practices and is second only to back pain in
 patients seeking treatment for musculoskeletal issues in the primary care setting. As a
 common source of distress, shoulder pain contributes significantly to health care costs.

 Rotator cuff disease due to impingement, tendonitis or bursitis is a frequent cause of
 shoulder pain and dysfunction. Initial treatment consists of a conservative approach of
 activity modification, oral nonsteroidal anti-inflammatory drugs (NSAIDs) and supervised
 physical therapy. However, if the patients' symptoms persist, subacromial injections of a
 local anesthetic such as lidocaine, and a corticosteroid may be indicated as a sequential
 treatment option.

 The steroid injection itself can be a painful process, so administering a local anesthetic
 prior to the steroid injection is thought to mitigate pain or reduce possible discomfort
 during and immediately following the procedure. Though there is evidence advocating for the
 benefits of combining local anesthetics and corticosteroids for the treatment of subacromial
 pathologies, it is not conclusive whether local anesthesia significantly enhances the pain
 relieving effect of steroids. Should local anesthesia not have a significant impact on the
 patient's pain intensity, then the use of corticosteroids alone could potentially result in
 reduced costs in care.
Inclusion Criteria:

 -  Ages 18 to 70 years old

 -  Shoulder pain lasting at least 4 weeks

 -  Inability to use arm with restriction of movement and loss of full function.

 -  Able to understand study and provide voluntary, written informed consent

 Exclusion Criteria:

 -  Less than 18 or greater than 70 years old

 -  Contraindications of previous injections and previous shoulder surgery

 -  Unable to understand consent form (in the opinion of the PI)

 -  Non-English speaking individuals

 -  Medication contradictions to lidocaine, corticosteroids