Low Molecular-weight Hyaluronic Acid Versus Physiotherapy for the Treatment of Supraspinatus Tendinopathy: A Randomized Comparative Clinical Trial

Abstract

Introduction: The tendons of the rotator cuff are major sources of shoulder pain. This study aimed to compare the effects of low molecular-weight hyaluronic acid with physiotherapy (PT) in patients with supraspinatus tendinopathy (ST). Methods: We carried out a parallel two-group randomized comparative clinical trial in an outpatient clinic of physical medicine and rehabilitation at a teaching hospital. In total, 51 patients (31 women) aged 20 to 55 years with ST were randomly allocated to subacromial hyaluronate injection (n = 28) and PT (n = 23) groups. For the hyaluronate group, we administered a single injection of 2 mL (20 mg) hyaluronate 1% (500 to 700 kDa). For PT, we prescribed three sessions of treatment per week for 12 weeks, totaling 36 sessions including rotator cuff activation exercises. The primary outcome was shoulder pain in the visual analog scale. The secondary outcomes included the range of movement and the disability score of the shoulder, and a World Health Organization questionnaire on quality of life. We did the measurements at the baseline and at one, four, and 12 weeks after intervention. Results: The results showed that both interventions were beneficial in the management of ST. However, hyaluronate was more effective in reducing shoulder pain at rest and during activities (both P < 0.001, effect size = 0.52 and 0.68, respectively). The two interventions similarly decreased patients' disability (P = 0.196). Hyaluronate improved shoulder motion and the quality of life better than PT. Conclusion: In the treatment of ST, low molecular-weight hyaluronate is more effective than PT, at least for three months. Particularly, hyaluronate is more successful in alleviating pain.

The Role of Hyaluronic Acid for Soft Tissue Indications: A Systematic Review and Meta-Analysis

“…9,12,18,24 Additionally, we performed sensitivity analysis for missing SDs requiring calculations from alternative measures or estimations from trials within the same comparison. 5,9,12,13,18,20,24,31 Results of this analysis also found our findings to be robust and conservative VAS MD 2.85 [3.05-2.65] versus 2.48 [2.65-2.31].…”

“…Nineteen RCTs were eligible for inclusion in this systematic review ( Figure 1 ). 1 - 3 , 5 , 6 , 9 , 11 - 14 , 17 , 18 , 20 , 21 , 24 , 26 - 28 , 31 , 34 There was substantial agreement between the 2 reviewers at the title/abstract screening stage (κ = 0.77; 95% CI 0.74-0.80) and almost complete agreement at the full-text screening stage (κ = 0.82; 95% CI 0.73-0.92).…”

Low Molecular Weight Hyaluronic Acid (500–730 Kda) Injections in Tendinopathies—A Narrative Review

“…Rezasoltani et al compared the effects of LMW-HA injection with physiotherapy in patients with supraspinatus tendinopathy and concluded that injection therapy showed greater efficacy at a 3-month follow-up. In particular, hyaluronic acid is more successful in relieving pain [ 53 ].…”

“…Rezasoltani et al [ 53 ] and Blaine et al [ 48 ] confirmed the efficacy of low molecular weight hyaluronic acid (500–730 KDa) injection in pain relief and function amelioration.…”

“…Following the results just described where LMW-HA has shown the potential to determine amelioration of tendon behavior via change in tenocyte viability and proliferation and collagen composition were promoted clinical studies on human different tendon’s site (rotator cuff tendons, patellar tendon, Achilles tendon, etc.) with encouraging conclusions [ 47 , 48 , 49 , 50 , 51 , 52 , 53 ].…”