Shoulder impingement syndrome (SIS), a chronic shoulder pain condition, often stems from repetitive overhead activities. In the current report, the author presents 2 cases of SIS. In the first, a woman with a history of SIS found that physical therapy and subacromial steroid injections, while effective, were problematic for long-term use. Previous use in the author’s practice demonstrated convenient shoulder pain relief using the heated lidocaine 70 mg-tetracaine 70 mg topical patch. She initially used the heated lidocaine-tetracaine patch twice daily and tapered over 4 weeks to as-needed use for successful pain control. In the other case, a female adolescent athlete with a history of SIS tried, on the recommendation of the author, using the heated transdermal patch instead of steroid injections. Her pain was successfully controlled during activity and at rest with 12 hours-on/12 hours-off patch application. The heated lidocaine-tetracaine topical patch may be an early conservative treatment for patients with acute pain from SIS and warrants examination in controlled studies.

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