Effectiveness of combined extracorporeal shock-wave therapy and hyaluronic acid injections for patients with shoulder pain due to rotator cuff tendinopathy: a person-centered approach with a focus on gender differences to treatment response

Abstract

Background: Rotator cuff (RC) tendinopathy is a common shoulder pain condition. Extracorporeal shockwave therapy (ESWT) and hyaluronic acid peritendinous injection are viable treatment options for RC tendinopathy.The aim of this study is to evaluate the response in two different therapeutic rehabilitative approaches, the combined treatment ESWT plus hyaluronic acid injections (E + Hy) compared to ESWT alone (ESWT-al), in a cohort of patients with RC tendinopathy according to gender differences.Methods: This is a retrospective longitudinal cohort study of patients with painful RC tendinopathy. Patients that had received a clinical evaluation, a shoulder ultra sound examination, as well as the Shoulder Pain and Disability Index (SPADI) questionnaire, and the Numerical Rating Scale (NRS) for pain at baseline, 1-month (T1) and 2-month followups (T2) were included.Results: Medical records of 53 patients were analyzed. In the comparison between baseline to T1 and similarly from baseline to T2, a statistically significant reduction has been reported in the NRS (p < 0.001) and in the SPADI (p < 0.001) in the entire study group. At T1, patients in the E + Hy compared to ESWT-al group, showed a slight but statistically significant reductions in both NRS and SPADI score, while these changes were more evident at T2 (p < 0.001). Interestingly, a gender dimorphism in NRS and in SPADI was found, with female patients that apparently responded better to the combined E + Hy compared to ESWT-al approach. Conclusion:This retrospective cohort study suggests that the combination of ESWT plus HyA injections seems to be more effective than ESWT alone in RC tendinopathy in both genders. Moreover, in ESWT alone treatment, male

Safety of Epidural Hyaluronic Acid Injections in Managing the Symptoms of Lumbar Foraminal Stenosis: A Prospective Preliminary Study

“…Fourth, the double size of particles (HMW has very good rheological properties due to LMW, which triggers endogenous HA production by stimulation of fibroblasts). Lastly, participants in previous studies showed very good tolerance of the product administered together with PRP and no cytotoxic effect [ 25 , 26 , 27 , 28 ].…”

The Effect of Combining Hyaluronic Acid and Human Dermal Fibroblasts on Tendon Healing

“…Furthermore, the presence of infection in both group A (with HDFs) and group B (without HDFs) can be considered evidence that it was because of the multiple surgical procedures performed in a stressful environment, rather than an experimental or culture technique of the HDFs. Moreover, as the safety of HDFs and HA has already been proven by numerous clinical studies, 25,33 we assumed that the rabbits’ death was not related to safety issues.…”

Real-Time Muscle Activity and Joint Range of Motion Monitor to Improve Shoulder Pain Rehabilitation in Wheelchair Basketball Players: A Non-Randomized Clinical Study

“…Moreover, sEMG is simple to use, since mDurance provides a step-by-step guide that practically explains and graphically represents on the tablet screen all the procedures, from applying the sensors to reading the final results. Therefore, sEMG could provide the opportunity to improve the effectiveness of home-based shoulder rehabilitation protocols, whose current main limitation is the difficulty of carrying out the exercises correctly, and therefore by the slowness in achieving the relative benefits [ 34 , 35 , 36 , 37 ].…”