Is intraarticular sodium hyaluronate injection an alternative treatment in patients with adhesive capsulitis?

Abstract

The aim of this study was to compare the efficacy of sodium hyaluronate (SH) injection with the most common treatment methods, intraarticular steroid injection and physical therapy modalities in patients with adhesive capsulitis (AC). A total of 95 shoulders of 90 patients were included in the study and were randomized in four groups. The patients were treated with SH injection (group 1), triamsinolone acetonide (group 2) or physical therapy modalities (group 3). Group 4 patients were served as controls. Pain severity, passive ranges of motion and functional considerations were measured before, and 15 days and 3 months after the treatments. In all treatment groups, there were significant improvements at both the 15th day and third month in all parameters (for each, p<0.001). The passive abduction values on the 15th day was found significantly higher in group 3 when compared with group 1 and controls (for each, p<0.001). At the third month, the passive abduction values of the groups 2 and 3 were improved when compared with the control group (p<0.001). Constant score was higher in group 3 on 15th day when compared with group 1. At the third month, all treatment groups were improved significantly compared with control group (p<0.001). We provided the best results in physical therapy modalities applied group for AC treatment. However, we think that SH injection may be administered as an alternative treatment method.

Therapeutic effects of hyaluronate injections in patients with chronic painful shoulder: A meta‐analysis of randomized controlled trials

“…Four trials (205 participants) were included in this portion of the study. Total functional scores were assessed by the total Constant-Murley score (2 trials) (36,38), the JOA score (2 trials) (11,26), and the ASES score (1 trial) (38). The trial reported by Sengul et al included assessment by both the total Constant-Murley and ASES scores; therefore, the trial results from Sengul et al were computed and calculated as a single summary effect (38).…”

“…The studies were distributed within the 95% CI axis (intercept Ϫ0.69 [95% CI Ϫ8.06, 6.68]; P ϭ 0.39) as determined by Egger's regression method, indicating that there was no publication bias. For comparison of HA with steroid injections, 5 trials (252 participants) were found: 1 trial compared HA plus triamcinolone acetate versus triamcinolone (10), 2 trials compared HA versus triamcinolone acetate (11,36), and 2 trials compared HA versus dexamethasone (32,34). The SMD for the change in intensity of functional scores with HA versus steroid injection was 0.39 (95% CI 0.07, 0.71; P ϭ 0.02) (Figure 4), which indicates that HA had favorable efficacy compared with steroid injection.…”

Management of frozen shoulder: a systematic review and cost-effectiveness analysis

“…Four studies reported that paracetamol of varying doses was available to participants: 1500 mg per day when needed in one study, 68 a supply (dose unspecified) in one study, 35 one to two tablets every 4-6 hours (a maximum of eight per day) in another study 41 and paracetamol when needed in the remaining study. 66 Another study stated that all participants were advised to continue NSAIDs. 42 One study did not report whether participants received concomitant treatment.…”

“…Four studies did not report the method of randomisation; 42,[66][67][68] therefore, it was unclear whether these were truly randomised studies as stated by the authors. In addition, in two of these studies it was unclear whether the intervention groups were comparable at baseline.…”

“…35 Five of the studies reported administering an intra-articular injection, 35,41,42,66,68 one of which compared an anterior and a lateral approach, 42 and in one study it was unclear. 67 The comparators were steroid injection plus physiotherapy, 35,41,67 placebo injection, 35,41,42,68 physiotherapy with 35,41 and without 66,67 placebo injection and home exercise alone. Five of the six trials evaluated a physical therapy regimen as part of the intervention.…”