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ESRA19-0602 Viscosupplementation of hyaluronic acid in the treatment of chronic shoulder pain. A case report
  1. LA Rodriguez Linares1 and
  2. R Vital Miranda2
  1. 1Hospital Sirio Libanes, Regional Anesthesia, Sao Paulo, Brazil
  2. 2HCRP USP, Pain, Brazil


Background and aims The shoulder is formed by a complex set of joints, muscles and ligaments that are sites of multifactorial pain syndromes and that has been gaining notoriety due to the excellent therapeutic results based on regenerative medicine.

Methods Case report

Results 70 years old, consultation with a complaint of shoulder pain for 3 years. At the physician’s office, the patient presented with severe pain in the right shoulder (EVA 9/10) with limited amplitude of movement in abduction, elevation and internal and external rotation, which prevented her from performing daily activities, but with preserved strength in the upper limbs for grasping objects. USG and shoulder RNM presenting subacromial bursitis, partial rupture of the supraspinatus, bicipital and subscapular tendon with degeneration of the acromioclavicular joint. In the present study, a supra-spinal nerve block (lidocaine 50 mg and clonidine 15mcg) and the application of hyaluronic acid (Synvisc) with 1% ropivacaine (20 mg in each site) were performed in the acromioclavicular joint and in the supraspinatus, subscapular and bicipital tendons. Due to the trapezius contracture, infiltration with lidocaine 10 mg of trigger point was also performed. The patient reports immediate pain relief with the procedures performed and returns with 7 days for reevaluation with total pain relief.

Conclusions Surgical treatment of shoulder disorders can evolve with structural correction of organic damage but with permanence of pain due to the complexity of the structures involved. Therefore, the use of analgesic blocks associated with hyaluronic acid ultrasound-guided infiltration is an effective tool in the treatment of tendinous microrrotes.

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