Effectiveness of Intra-Articular Hyaluronic Acid on Patients Suffering From Painful Shoulder

Abstract

This work was a retrospective, observational study to analyse the effectiveness of viscosupplementation in terms of pain relief and function improvement in a cohort of patients suffering from shoulder pain and treated under usual clinical practice conditions. The population included patients with painful shoulder, stiffness grades I/II and intact rotator cuff or with partial thickness tear. Previous hyaluronic acid or corticosteroid injections, passive mobilization or shoulder infections were not permitted. Patients received 3-5 injections of medium molecular weight hyaluronic acid and efficacy was assessed at the end of treatment and at 3 and 6 months. Effectiveness was evaluated using the Constant scale, physician and patient global assessments. In total 180 patients were analysed with a mean age of 49.1 years and 52.2% were female. More than 50% presented 2 relevant symptoms, being pain present at baseline in 82.2% followed by stiffness (57.2%) and instability (5.6%). Mean Constant value was 53.8 points. A mean improvement of 14.3 points was observed at the end of treatment, 28.2 at 3 months and 37.9 at 6 months (p<0.001 versus baseline at all-time points). Constant condition at the end of treatment was excellent in 3.3% of patients, good in 70.6% and fair in 26.1% whereas at 6 months it was excellent in nearly 100% patients in agreement with patient and physician assessments. These results suggest that viscosupplementation constitute a conservative and minimally invasive approach to manage shoulder pain with effects lasting for at least 6 months.