Continuous cervical epidural analgesia for rehabilitation after shoulder surgery: a retrospective evaluation.

BACKGROUND: Patients with frozen shoulder who fail conservative therapy need surgical treatment and aggressive post-operative rehabilitation. OBJECTIVE: To evaluate the effect of continuous cervical epidural analgesia on pain scores and range of motion of the shoulder joint in patients undergoing surgery for treatment of refractory frozen shoulder. METHODS: Twenty-one patients with refractory frozen shoulder who had failed conservative treatment and undergone surgical procedure (manipulation under anesthesia or capsular release) were identified and the data were collected retrospectively. These patients had cervical tunneled epidural catheter (TEC) placement for continuous infusion of a mixture of low-dose narcotic and local anesthetics at the time of surgery and were discharged home with the catheter in place. They were then involved in an active physical therapy program to increase the range of motion of the affected shoulder joint. The patients (N = 21) were followed for a median of 4.7 weeks. They were assessed for range of motion, function, visual analog pain scores (VAS), and opiate use before the surgery and after tunneled epidural catheter removal. RESULTS: Statistically significant changes from the time of placement to the time of removal of the tunneled epidural catheter (TEC) were observed for VAS pain score and range of motion of the shoulder in forward flexion, external rotation, and internal rotation. The mean rate of change among the patients for pain score, forward flexion, external rotation, and internal rotation was also computed. The mean change per week in each of these 4 measurements significantly differed from zero. 33 percent of the patients returned to work within one week. CONCLUSION: Our data show that the continuous infusion of epidural opioids and local anesthetics through a tunneled cervical epidural catheter during the rehabilitation phase after shoulder surgery for adhesive capsulitis may be a safe and effective tool for post-operative pain control and to facilitate rehabilitation.

Subacromial corticosteroid injection for poststroke shoulder pain: a retrospective chart review.

OBJECTIVE: To assess the effectiveness of subacromial corticosteroid injections for the treatment of poststroke shoulder pain. DESIGN: Retrospective chart review. SETTING: Ambulatory setting, university-affiliated hospital. PARTICIPANTS: People (N=60) with stroke-associated hemiparesis and pain in the involved shoulder. INTERVENTIONS: Electronic medical records of stroke survivors with shoulder pain in the hemiparetic limb treated with a subacromial corticosteroid injection by a practitioner between January 1, 2005, and June 30, 2007, were reviewed. Patients who had a documented preinjection pain score on the day of injection by using a 0 to 10 numeric rating scale and a postinjection pain score within 16 weeks of injection were included. MAIN OUTCOME MEASURES: Pre- and postinjection scores were compared by using the paired t test. Treatment success was defined as a minimum of 2-point absolute or 30% relative pain reduction. Linear and logistic regression analyses were used to identify predictors of pain reduction and treatment success, respectively. RESULTS: Patients experienced an absolute pain reduction of 2.6+/-3.7 (95% confidence interval, 1.7-3.6; P<.001) and a relative pain reduction of 32.9%+/-53.6%. Fifty-three percent experienced the minimum 2-point absolute pain reduction, whereas 45% experienced the minimum 30% relative pain reduction. Linear regression analyses identified the preinjection pain score as a predictor of absolute pain reduction and concomitant outpatient occupational or physical therapy as a predictor of both absolute and relative pain reduction. No other factors were predictive of pain reduction or treatment success. CONCLUSIONS: Subacromial corticosteroid injection is associated with a significant reduction in poststroke shoulder pain. However, controlled trials are needed to show a cause-and-effect relationship and rule out spontaneous recovery, placebo effect, and other confounds.