To date, the use of superficial moist heat (hot packs) versus ice therapy for the relief of pain in the rheumatoid arthritic (RA) shoulder, and its effect on the range of motion, have not been adequately assessed. A controlled study was conducted to assess the effect of heat versus ice on the pain scores and range of motion in 18 RA subjects with shoulder pain. Patients were randomly assigned to two groups. Comparative data were obtained with a pretest/post-test design. Group 1 received moist heat treatments and performed a program of exercises for three weeks, whilst group 2 received ice treatments and followed a similar program of exercises. Evaluations by an independent evaluator, pre-and post-treatment, permitted a comparison to be made between the two treatments. Eight of the nine patients in the ice-treated group and seven of the nine in heat-treated group had a reduction in their pain scores (mean score 6.9 versus 5.7, an non-significant difference). The heat-treated group showed a greater increase in abduction and flexion than the ice-treated group -- the mean improvement being 26o and 12o versus 23o and 5o, respectively -- although this difference was not statistically significant. The functional levels of the groups were similar at the onset of the study and no statistical improvement was demonstrated at the conclusion. Our study demonstrates that no statistical differences were found between the two treatments (ice treatment versus moist heat) and that both can be used successfully in the management of the rheumatoid arthritic shoulder.

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