Effect of Intra-articular Hyaluronic Acid Injection on Hemiplegic Shoulder Pain After Stroke

Jang, Myung Hun; Lee, Chang-Hyung; Shin, Yong‐Il; Kim, Soo-Yeon; Huh, S.C.

doi:10.5535/arm.2016.40.5.835

Cited by 8 publications

(6 citation statements)

References 30 publications

(28 reference statements)

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“…This immediate effect of the TA group was similar to previous studies. [ 26 , 27 ] In addition, there was no significant difference in the degree of improvement between the TA and PDRN groups until 4 weeks after the second injection, compared with their pre-injection results. These results may indicate that PDRN and TA have similar onset time and duration of therapeutic effects for HSP, until at least 4 weeks after 2 consecutive injections.…”

Section: Discussionmentioning

confidence: 91%

The effectiveness of 2 consecutive intra-articular polydeoxyribonucleotide injections compared with intra-articular triamcinolone for hemiplegic shoulder pain

Park

Cho

et al. 2017

Medicine

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The aim of this study was to investigate the effects of intra-articular injection of polydeoxyribonucleotide (PDRN), compared with intraarticular triamcinolone (TA) injection, in subacute stroke patients with hemiplegic shoulder pain (HSP).Participants were subacute stroke patients with HSP who had undergone 2 consecutive intra-articular injections of TA or PDRN.Numeric rating scale (NRS) and passive range of motion (PROM) of hemiplegic shoulder were evaluated until 4 weeks after 2nd injection.In the results, there were significant improvements in all PROM measures 2 weeks after the second injection, compared with pre-injection results, in both groups (P < .05). In the PDRN group, however, none of the PROM measures were significantly improved at 3 and 4 weeks after the second injection, compared with pre-injection results (P ≥ .05). When comparing pre-injection results with those at 4 weeks after the second injection, all PROM and NRS measures in the TA group were more improved than in the PDRN group, but this was not statistically significant (P ≥ .05).In conclusion, considering the systemic side effects of steroids, especially among patients with diabetes or metabolic syndrome, PDRN seems to be a worthwhile treatment option for HSP, although PDRN does not seem to have an equivalent persistence effects when compared with TA.

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Section: Discussionmentioning

confidence: 91%

The effectiveness of 2 consecutive intra-articular polydeoxyribonucleotide injections compared with intra-articular triamcinolone for hemiplegic shoulder pain

Park

Cho

et al. 2017

Medicine

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“…In the 17 enrolled articles [ 11 , 12 , 14 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 ], five trials compared intra-muscular BoNT injections with a placebo [ 12 , 35 , 36 , 37 , 38 ], one trial compared intramuscular BoNT injections with intra-articular corticosteroid injections [ 40 ], one trial compared intra-muscular BoNT injections with SSNB [ 39 ], one trial compared intra-bursal BoNT injections with intra-bursal corticosteroid injections [ 34 ], three trials compared intra-articular/bursal corticosteroid injections with a placebo [ 43 , 44 , 45 ], one trial compared SSNB with intra-articular corticosteroid injections [ 46 ], three trials compared SSNB with a placebo [ 11 , 41 , 42 ], one trial compared HA injections with a placebo [ 14 ], and one trial compared HA injections with intra-articular corticosteroid injections [ 33 ]. Most of the included studies were double- or triple-blinded RCTs [ 12 , 14 , 35 , 36 , 37 , 38 , 39 ...…”

Section: Resultsmentioning

confidence: 99%

“…Assessment of pain was not available at the fourth week in three studies [ 35 , 40 , 45 ], and between the 4th and 24th weeks in three studies [ 38 , 42 , 43 ]. Injection guidance were based on ultrasonography in seven studies [ 11 , 14 , 33 , 34 , 39 , 42 , 44 ], electromyography in three studies [ 12 , 37 , 38 ], fluoroscopy in one study [ 46 ] and landmark in six studies [ 35 , 36 , 40 , 41 , 43 , 45 ]. The details of the interventions are listed in Table 2 .…”

Section: Resultsmentioning

confidence: 99%

Comparative Effectiveness of Injection Therapies for Hemiplegic Shoulder Pain in Stroke: A Systematic Review and Network Meta-Analysis

Chiu

Chang

et al. 2021

Pharmaceuticals

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Hemiplegic shoulder pain (HSP) hampers post-stroke functional recovery and is not well managed with conservative treatments. This systematic review aimed to examine the various injection therapies for HSP and investigate their effectiveness at different time points. The protocol of this meta-analysis was registered on INPLASY with a registration number of INPLASY202180010. PubMed, EMBASE, and Scopus were searched from their inception to 4 August 2021 for the clinical studies investigating comparative effectiveness of different injection regimens for treating hemiplegic shoulder pain in patients with stroke. The primary outcome was the weighted mean difference (WMD) on the visual analog scale (VAS) of pain reduction in the fourth-week and between the fourth and twenty-fourth weeks. Ranking probabilities of the WMD for each treatment were obtained using simulations. Seventeen studies with 595 participants were included. The network meta-analysis showed that at the fourth-week, intra-muscular botulinum toxin (BoNT) injections and suprascapular nerve blocks (SSNB) were superior to a placebo, with WMDs of 1.55 (95% CI, 0.09 to 3.01) and 1.44 (95% CI, 0.07 to 2.80), respectively. SSNB possessed the highest probability (53.3%) and appeared to be the best treatment in the fourth-week, followed by intra-muscular BoNT injections (42.6%). Intramuscular BoNT injections were better than the placebo, with a WMD of 1.57 (95% CI, 0.30 to 2.84) between the 4th and 24th weeks. Intramuscular BoNT injections had the highest probability (79.8%) as the best treatment between the 4th and 24th weeks. SSNB was likely to rank first in relieving HSP at the fourth post-treatment week, whereas intra-muscular BoNT injections had the highest probability to achieve the best treatment effectiveness in the post-injection period between the fourth and twenty-fourth weeks. However, as some of the included studies used a non-randomized controlled design, more randomized controlled trials are needed in the future to validate and better understand the short- and long-term efficacy of different injection therapies for management of HSP.

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“…The HA group reported significantly less pain at night. 11 Sodium HA (20 mg) administered by injection together with triamcinolone acetonide (20 mg) in addition to physiotherapy appeared to provide a greater degree of pain relief and mobility in AC than injected triamcinolone in association with Table 1. The pathophysiological research of adhesive capsulitis.…”

Section: Clinical Research Into Hamentioning

confidence: 93%

Pathophysiology of adhesive capsulitis of shoulder and the physiological effects of hyaluronan

Yuan¹,

Zhang²,

Li³

2017

Eur J Inflamm

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Adhesive capsulitis, commonly described as “frozen shoulder,” is experienced as chronic soreness and discomfort accompanied by an increasing inability to use and manipulate the joint, which can cause disability and interfere with normal activities. The onset of the condition is sudden and the origins obscure. The more we know about how this condition arises and evolves in the human body, the better the medical profession can provide effective management and amelioration. In examining the pathology and pathophysiology of adhesive capsulitis, we found recent evidence that intra-articular use of hyaluronan can provide effective relief. In this letter, we summarized this research to obtain a better understanding of the pathophysiology of adhesive capsulitis and the effects of hyaluronan.

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Effect of Intra-articular Hyaluronic Acid Injection on Hemiplegic Shoulder Pain After Stroke

Cited by 8 publications

References 30 publications

The effectiveness of 2 consecutive intra-articular polydeoxyribonucleotide injections compared with intra-articular triamcinolone for hemiplegic shoulder pain

The effectiveness of 2 consecutive intra-articular polydeoxyribonucleotide injections compared with intra-articular triamcinolone for hemiplegic shoulder pain

Comparative Effectiveness of Injection Therapies for Hemiplegic Shoulder Pain in Stroke: A Systematic Review and Network Meta-Analysis

Pathophysiology of adhesive capsulitis of shoulder and the physiological effects of hyaluronan

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