25% dextrose and .1% lidocaine injected in the shoulder entheses (ligament and tendon insertions on the periosteum).

.1% lidocaine injected in the shoulder entheses (ligament and tendon insertions on the periosteum).

.1% lidocaine injected subcutaneously above the shoulder entheses (ligament and tendon insertions on the periosteum).

25% dextrose and .1% lidocaine injected in the rotator cuff ligaments and tendons.
shoulder injections: injections of 1 mL of solution in the following tendons: supraspinatus, infraspinatus, teres minor ( on greater tuberosity), subscapularis ( on lesser tuberosity), long tendon of biceps ( on supra-glenoid tubercle), short tendons of biceps on coracoid process, and the inferior glenohumeral ligament, anteriorly and posteriorly. If symptomatic the insertion of the teres minor and the triceps on the scapula.

25% Dextrose in Ligaments and Tendons

.1% lidocaine injected in the shoulder ligaments and tendons
shoulder injections: injections of 1 mL of solution in the following tendons: supraspinatus, infraspinatus, teres minor ( on greater tuberosity), subscapularis ( on lesser tuberosity), long tendon of biceps ( on supra-glenoid tubercle), short tendons of biceps on coracoid process, and the inferior glenohumeral ligament, anteriorly and posteriorly. If symptomatic the insertion of the teres minor and the triceps on the scapula.

.1% Lidocaine in Ligaments and Tendons

.1% lidocaine injected subcutaneously above the ligaments and tendons of the shoulder.
shoulder injections: injections of 1 mL of solution subcutaneously above the following tendons: supraspinatus, infraspinatus, teres minor ( on greater tuberosity), subscapularis ( on lesser tuberosity), long tendon of biceps ( on supra-glenoid tubercle), short tendons of biceps on coracoid process, and the inferior glenohumeral ligament, anteriorly and posteriorly. If symptomatic above the insertion of the teres minor and the triceps on the scapula.

.1% Lidocaine Subcutaneous

Total

Sex: Female, Male

Shoulder symptom duration

Subject marks his pain level at rest, at work, doing sports on a 10 cm scale. The maximum pain level among the 3 different activities was recorded.

25% dextrose and .1% lidocaine injected in the shoulder entheses (ligament and tendon insertions on the periosteum).
25% dextrose in shoulder entheses: injections of 1 mL of 25% dextrose and .1% lidocaine solution in the following tendons: supraspinatus, infraspinatus, teres minor ( on greater tuberosity), subscapularis ( on lesser tuberosity), long tendon of biceps ( on supra-glenoid tubercle), short tendons of biceps on coracoid process, and the inferior glenohumeral ligament, anteriorly and posteriorly. If symptomatic the insertion of the teres minor and the triceps on the scapula.

25% Dextrose in Shoulder Entheses

.1% lidocaine injected in the shoulder entheses (ligament and tendon insertions on the periosteum).
.1% lidocaine in shoulder entheses: injections of 1 mL of .1% lidocaine 'ssolution in the following tendons: supraspinatus, infraspinatus, teres minor ( on greater tuberosity), subscapularis ( on lesser tuberosity), long tendon of biceps ( on supra-glenoid tubercle), short tendons of biceps on coracoid process, and the inferior glenohumeral ligament, anteriorly and posteriorly. If symptomatic the insertion of the teres minor and the triceps on the scapula.

.1% Lidocaine in Shoulder Entheses

.1% lidocaine injected subcutaneously above the shoulder entheses (ligament and tendon insertions on the periosteum).
.1% lidocaine subcu. above shouldr enth.: injections of 1 mL of .1% lidocaine solution subcutaneously, above the following tendons: supraspinatus, infraspinatus, teres minor ( on greater tuberosity), subscapularis ( on lesser tuberosity), long tendon of biceps ( on supra-glenoid tubercle), short tendons of biceps on coracoid process, and the inferior glenohumeral ligament, anteriorly and posteriorly. If symptomatic, above the insertion of the teres minor and the triceps on the scapula.

.1% Lidocaine Subcu. Above Shouldr Enth.

Visual Analog Pain Scale 0= no Pain 10 = Maximum Pain

Subject marks his pain level at rest, at work, doing sports on a 10 cm scale. Maximum of pain scores rest, work, sport recorded. Calculated as pain at baseline - pain at 3 months. VAS scale is from 0 = no pain to 10 = maximum pain

Change From Baseline of Visual Analog Pain Scale at 3 Months

Participants were asked about pain at rest, at work, doing sports. The maximum pain reported on a scale ranging from 0 (no pain at all) to 10 (extreme pain) was recorded for each participant. Maximum of pain scores rest, work, sport recorded. Calculated as pain at baseline - pain at 9 months.

Change From Baseline in Maximum Pain Score at 9 Months

From Brose et al. "shoulder ultrasound abnormalities, physical examination findings, and pain in manual wheelchair users with spinal cord injury" Arch Phys Med Rehabil 2008 Nov, 89: 2086-93 appendix 2. rates biceps tendinopathy (0-6), supraspinatus tendinopathy (0-5), greater tuberosity the cortical surface (0-3), dynamics supraspinatus impingement (0-3), dynamic subscapularis/ biceps/ coracoid impingement (0-3). The total score ranged from 0 to 20 with higher scores indicating a worse outcome. The change was calculated by taking the final score - the baseline score.

Rotator Cuff Ultrasound, Ultrasound Shoulder Pathology Rating Scale

From Steven W. Brose, DO, Michael L. Boninger, MD, Bradley Fullerton, MD, Thane McCann, MD, From: Jennifer L. Collinger, BSE, Bradley G. Impink, BSE, Trevor A. Dyson-Hudson, MD Shoulder ultrasound abnormalities, physical examination findings, and pain in manual wheelchair users with spinal cord injury. Arch Phys Med Rehabil 2008 Nov; 89:2086-93, appendix 1 12 parameters of shoulder examination: Biceps tendon/bicipital groove tenderness, Supraspinatus tendon/greater tuberosity tenderness Acromioclavicular joint tenderness Resisted external rotation. Resisted internal rotation. Supraspinatus test. Painful Arc Test. Neer impingement sign. Hawkins-Kennedy impingement sign. O'Brien Active Compression Test for AC Joint Pathology O'Brien Active Compression Test for Labral Pathology impingement sign. each test scored 0 = no pain, 1 = tenderness, 2 = pain. All 12 scores added. Range 0-24. Higher scores = more pathology

Physical Examination of the Shoulder Scale

http://www.dash.iwh.on.ca/assets/images/pdfs/DASH_quest06.pdf 30 questions assessing ability to use shoulder in everyday activities, each question scored 1 to 5, where one is normal, no problem and five is unable to perform. No data was collected at 9 months. The score ranges from 30 to 150. Higher scores represent worse outcomes.

Disabilities of the Arm Shoulder and Hand Questionnaire

Phone call asking how satisfied were they with their treatment 10 = extremely satisfied, 0 = extremely dissatisfied )

Nine Month Satisfaction Questionnaire

Total amount of narcotic pain medication prescribed. Data were not collected at 1,2,3 and 6 months.

Total Prescription Pain Medication Used

Subject marks his pain level at rest, at work, doing sports on a 10 cm scale.

Visual Analog Pain Scale

Subject marks his pain level at rest, at work, doing sports on a 10 cm scale. Maximum of pain scores rest, work, sport is recorded.

Delayed Treatment Period

Active Treatment Period

Nine Month Follow-up

Dr. Helene Bertrand, M.D., CCFP, LM

.1% lidocaine injected subcutaneously above the ligaments and tendons of the shoulder.
shoulder injections: injections of 1 mL of solution in the following tendons: supraspinatus, infraspinatus, teres minor ( on greater tuberosity), subscapularis ( on lesser tuberosity), long tendon of biceps ( on supra-glenoid tubercle), short tendons of biceps on coracoid process, and the inferior glenohumeral ligament, anteriorly and posteriorly. If symptomatic the insertion of the teres minor and the triceps on the scapula.

Rotator Cuff Tendinitis

injections of 1 mL of 25% dextrose and .1% lidocaine solution in the following tendons: supraspinatus, infraspinatus, teres minor ( on greater tuberosity), subscapularis ( on lesser tuberosity), long tendon of biceps ( on supra-glenoid tubercle), short tendons of biceps on coracoid process, and the inferior glenohumeral ligament, anteriorly and posteriorly. If symptomatic the insertion of the teres minor and the triceps on the scapula.

25% dextrose in shoulder entheses

injections of 1 mL of .1% lidocaine 'ssolution in the following tendons: supraspinatus, infraspinatus, teres minor ( on greater tuberosity), subscapularis ( on lesser tuberosity), long tendon of biceps ( on supra-glenoid tubercle), short tendons of biceps on coracoid process, and the inferior glenohumeral ligament, anteriorly and posteriorly. If symptomatic the insertion of the teres minor and the triceps on the scapula.

.1% lidocaine in shoulder entheses

injections of 1 mL of .1% lidocaine solution subcutaneously, above the following tendons: supraspinatus, infraspinatus, teres minor ( on greater tuberosity), subscapularis ( on lesser tuberosity), long tendon of biceps ( on supra-glenoid tubercle), short tendons of biceps on coracoid process, and the inferior glenohumeral ligament, anteriorly and posteriorly. If symptomatic, above the insertion of the teres minor and the triceps on the scapula.

.1% lidocaine subcu. above shouldr enth.

Describes musculoskeletal anatomy, common injuries, current treatments, possible use of prolotherapy, review of literature, study consent form

Dr. Helene Bertrand Inc., 220-1940 Lonsdale Avenue

Active shoulder clinics, West Vancouver sports and orthopedic physiotherapy, 210- 575 16th Street

Study of 25% Dextrose Injections in Shoulder Ligaments and Tendons to Promote Their Healing

Rotator Cuff Tendinopathy: A Randomized and Blinded Comparison of Superficial and Deep Injection Methods

The de-identified database Is now available on request to Doctor Helene Bertrand at heleneb@mail.UBC.ca

Helene Bertrand

M.D., C.M, CCFP

University of British Columbia

WorkSafe BC

Participants were randomly allocated into 3 groups to receive injections of 25% dextrose in .1% lidocaine or .1% lidocaine in the shoulder entheses, the 3rd group received .1% lidocaine subcutaneously above the shoulder entheses.

For the 25% dextrose and .1% lidocaine and the .1% lidocaine enthesis injections, only the pharmacist knew the contents of each participant's numbered bottle. For the .1% subcutaneous injections, both the pharmacist and the physician where aware of the contents. There was a small c on the label. Only one participant asked the meaning of this letter, and he was told it stood for "contents".

bursitis/köklük

Study of 25% Dextrose Injections in Shoulder Ligaments and Tendons to Promote Their Healing

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