The source of shoulder pain in rheumatoid arthritis: Usefulness of local anesthetic injections.

Clinical symptoms and radiologic appearances are often poor indicators of the source of pain in the shoulder joint complex in patients with rheumatoid arthritis. In 75 rheumatoid shoulders, injections of 1 ml of 1 % local anesthetic were placed in the acromioclavicular joint, the subacromial bursa, and the glenohumeral joint, following a standard sequence. Forty-one shoulders were relieved of pain from subacromial or acromioclavicular injections even when there were advanced radiologic changes in the glenohumeral joint. However, if the sphericity of the humeral head had been lost, an injection of the glenohumeral joint usually confirmed this site as the source of pain. The results of local anesthetic injections allow decisions to be made about the most appropriate form of surgical or nonsurgical treatment.