The long-term effects of hyaluronic acid on hemiplegic shoulder pain and injury in stroke patients

Huang, Yu‐Chi; Leong, Chau-Peng; Tso, Hui-Hsin; Chen, Mei-Ju; Liaw, Mei-Yun; Hsieh, Han-Chin; Wang, Lin-Yi; Hsu, Chia-Hao

doi:10.1097/md.0000000000012078

Cited by 7 publications

(15 citation statements)

References 33 publications

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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%

“…On the other hand, BoNT injections are beneficial for decreasing chronic shoulder pain, possibly through inhibition of the release of pain mediators [ 13 ]. Corticosteroid injections have long been used to treat painful shoulders owing to their anti-inflammatory potential, while intra-articular hyaluronic acid (HA) injections might prevent adhesions and reduce synovitis inside the glenohumeral joint [ 14 ]. Until now, no meta-analysis has been conducted to investigate which injection regimen is the best for the management of HSP.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…The allocation of the participants to the different groups will occur using a simple lottery procedure. Treatment codes (active or sham stimulation) will be placed in opaque envelopes [ 47 , 48 ]. A researcher not involved in the evaluations or treatment will be responsible for the random allocation of the participants to two groups: 1) active tDCS combined with physical therapy for the upper limbs using a “mini-bike”; or 2) sham tDCS combined with physical therapy for the upper limbs using a “mini-bike”.…”

Section: Methodsmentioning

confidence: 99%

Effects of transcranial direct current stimulation on the rehabilitation of painful shoulder following a stroke: protocol for a randomized, controlled, double-blind, clinical trial

Souza¹,

Corrêa²,

Agnol³

et al. 2019

Trials

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BackgroundShoulder pain is reported to be one of the major challenges faced in the functional recovery of patients in rehabilitation following a stroke. In such cases, transcranial direct current stimulation (tDCS) has been used as an additional therapeutic tool for improvements in central and peripheral pain. The aim of the proposed study is to evaluate the effect of tDCS when combined with upper limb physical therapy on pain intensity and functional improvement in stroke survivors with shoulder pain in the hemiplegic limb.MethodsA randomized, placebo-controlled, double-blind, clinical trial is proposed. The volunteers will be randomly allocated to receive passive movement on the upper limb, which will be performed by the therapist for 20 min followed by either active tDCS or sham tDCS (current stimulation for 30 s) during simultaneous physical activity of the upper limb (“mini-bike”) for 20 min, totaling 40 min of intervention performed in 10 consecutive sessions. The anode electrode will be positioned over the primary motor cortex with a current of 2 mA and the cathode electrode will be positioned in the supraorbital region contralateral to the anode. The primary outcome will be shoulder pain intensity, which will be measured using the visual analog scale (VAS) on three occasions: 1) pre-intervention; 2) after 10 interventions (5 weekly sessions, for 2 weeks); and 3) 30 days after the end of the interventions. The secondary outcomes will be motor performance, upper limb function, and quality of life.Trial registrationBrazilian Registry of Clinical Trials, RBR-8F5MNY. Registered on June 2, 2017.Electronic supplementary materialThe online version of this article (10.1186/s13063-019-3266-y) contains supplementary material, which is available to authorized users.

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“…Huang и соавт. [20] оценили результаты применения ГлК у 18 пациентов с гемиплегией, у которых развилась ХБОП, вызванная поражением сухожилий мышц ротаторов. В контрольную группу вошли 9 больных, получивших инъекции ФР.…”

Section: терапияunclassified

Comparison of the effectiveness of subacromial administration of platelet-rich plasma and hyaluronic acid in chronic shoulder pain caused by damage to the tendons of the rotator cuff muscles according to a 6-month open clinical study

Нестеренко¹,

Каратеев²,

Макаров³

et al. 2020

Naučno-praktičeskaâ revmatologiâ

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Local injections of platelet-rich plasma (PRP) and hyaluronic acid (HLA) are considered an effective method for treating chronic shoulder pain (CSP) associated with damage to the tendons of the rotator cuff muscles (RCM).The aim of the study is to compare the effectiveness and safety of local therapy of PRP and HLA in patients with CSP caused by damage to the tendons of the RCM muscles.Materials and methods. The study included 100 patients (54% women and 46% men, average age 51.5±15.1 years) with CSP (persisting for ≥3 months) associated with damage and tendinitis of the supraspinatus, subacute, scapular or small round muscle, confirmed by magnetic resonance imaging or ultrasound (ultrasound). The patients were randomized into two groups of 50 people who were treated with PRP (three injections at 7-day intervals) or HLA (two injections at 7-day intervals). The injections were performed under ultrasound control in the subacromial SAC. The results of the study were evaluated by the dynamics of pain intensity (on a visual analog scale, up to 100 mm) and functional disorders (ASES and CSS indices) after 1, 3 and 6 months.Results. Against the background of the use of PRP and HLA, there was a significant improvement in the condition of patients, while both drugs showed approximately the same effectiveness. The severity of VAS pain decreased from 56.8±15, respectively, after 6 months.5 and 57.6±17.8 mm to 31.8±27.8 and 30.2±26.3 mm, ASES-c 55.8±15.9 and 53.6±14.7 to 74.6±22.4 and 77.3± 22.4, CSS-c 59.2±14.4 and 47.8±16.9 to 69.9±17.3 and 65.6±19.2. the Dynamics of all these indicators in comparison with the baseline level was statistically significant (p<0.001). Number of patients with moderate / mild pain (<40 mm VAS) after 6 months. after the introduction of PRP and HLA was 48% and 60%, requiring regular NSAID intake 30% and 28%, respectively. In all parameters, the difference in the effectiveness of PRP and HLC was not statistically significant (p>0.05). The effectiveness of PRP and HLA (in terms of pain dynamics, ASES, and CSS) was significantly higher in individuals younger than 45 years, compared to older patients. The tolerability of therapy was good – after the introduction of PRP, 40% of patients had a short-term (3–4 days) increase in pain, which did not require the use of additional analgesics or interruption of treatment. No serious adverse reactions were observed when using PRP and HLA.Conclusion. OTP and GLA are effective and safe in the treatment of CSP associated with damage to the tendons of the RCM muscles. The dynamics of pain intensity and functional status after the use of these drugs did not differ. Treatment of PRP and HLA is more effective in people younger than 45 years.

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The long-term effects of hyaluronic acid on hemiplegic shoulder pain and injury in stroke patients

Abstract: Subacromial HA injections might provide longer HSP reduction and decrease in hyperemia reactions at the long head of biceps tendon and subscapularis tendon in stroke patients with HSP and tendon injury.

Cited by 7 publications

References 33 publications

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

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

Effects of transcranial direct current stimulation on the rehabilitation of painful shoulder following a stroke: protocol for a randomized, controlled, double-blind, clinical trial

Comparison of the effectiveness of subacromial administration of platelet-rich plasma and hyaluronic acid in chronic shoulder pain caused by damage to the tendons of the rotator cuff muscles according to a 6-month open clinical study

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