Treatment of the painful shoulder syndrome with amitriptyline and lithium carbonate.

Thirty-four patients with painful shoulder syndrome (PSS) were psychologically assessed and the results compared with those from a control group presenting other musculoskeletal disorders. A significantly greater prevalence of depression was found in the former group. Fifty-six patients with PSS were treated with only lithium and amitriptyline for four months; 44 patients showed marked clinical improvement and radiologic clearing of dystrophic calcification. Lithiumamitriptyline therapy, when compared with physiotherapy in another series of 11 patients, was found to be far superior. Some possible biochemical links between depression and PSS are outlined, and the theory that PSS may be a clinical entity of psychogenic origin is discussed.