TITLE

Treatment of Persistent Shoulder Pain with Sodium Hyaluronate: A Randomized, Controlled Trial

AUTHOR(S)
Blaine, Theodore; Moskowitz, Roland; Udell, James; Skyhar, Michael; Levin, Robert; Friedlander, Jeffrey; Daley, Michael; Altman, Roy
PUB. DATE
May 2008
SOURCE
Journal of Bone & Joint Surgery, American Volume;May2008, Vol. 90-A Issue 5, p970
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Presently, there are no approved nonoperative therapies for the ongoing treatment of persistent shoulder pain. Preliminary data suggest that intra-articular sodium hyaluronate injections may be beneficial for the treatment of persistent shoulder pain resulting from various etiologies. The present study evaluated the efficacy and safety of sodium hyaluronate (Hyalgan; molecular weight, 500 to 730 kDa) for these patients. Methods: Six hundred and sixty patients with persistent shoulder pain and limitation resulting from glenohumeral joint osteoarthritis, rotator cuff tear, and/or adhesive capsulitis who had had a failure of conventional therapy were enrolled in this double-blind, randomized, phosphate-buffered saline solution-controlled study, and 456 patients completed twenty-six weeks of follow-up. Patients were randomized to receive either five weekly intra-articular injections of sodium hyaluronate, three weekly intra-articular injections of sodium hyaluronate followed by two weekly intra-articular injections of saline solution, or five weekly intra-articular injections of saline solution. The main outcomes were improvement in terms of shoulder pain on movement at thirteen weeks after the initiation of treatment (as assessed with use of a 100-mm visual analog scale) and the treatment effect throughout twenty-six weeks. Results: For the overall intent-to-treat population, patients who were managed with sodium hyaluronate had greater pain relief than controls did; significant differences were noted at Week 7 (for the five-injection hyaluronate group), Week 17 (for the three and five-injection hyaluronate groups), and Week 26 (for the three-injection hyaluronate group). Analysis of the stratified populations clearly established that this effect was due to benefits experienced by the patients with osteoarthritis. The treatment effect through twenty-six weeks was significant in patients with osteoarthritis in the three-injection (p = 0.003) and five-injection (p = 0.002) groups, with no significant difference for either regimen in patients without osteoarthritis. The safety profile was very favorable, with no product-related serious adverse effects and no between-group differences for any reported adverse event. Conclusions: Although the primary end point of this study (that is, improvement in terms of shoulder pain at thirteen weeks) was not achieved, the overall findings, including secondary end points, indicate that sodium hyaluronate (500 to 730 kDa) is effective and well tolerated for the treatment of osteoarthritis and persistent shoulder pain that is refractory to other standard nonoperative interventions. Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.
ACCESSION #
32098315

 

Related Articles

  • Why does my should hurt?  // American Family Physician;11/1/1997, Vol. 56 Issue 7, p1811 

    Provides a general overview on shoulder pain. Common cause of shoulder pain; How to know if the rotator cuff is hurt; Management of shoulder pain; Types of injury that may need surgery.

  • Summaries for Patients. Corticosteroid Injections Versus Manual Physical Therapy for Treatment of the Shoulder Impingement Syndrome. Rhon, D. I.; Boyles, R. B.; Cleland, J. A. // Annals of Internal Medicine;8/5/2014, Vol. 161 Issue 3, pI-22 

    The article presents a study related to the comparison of corticosteroid injections with manual physical therapy for the treatment of the shoulder impingement syndrome. It reveals that under the study patients were randomly assigned to receive physical therapy for 3 weeks or 3 corticosteroid...

  • Don't Push Through the Pain of a Sore Shoulder.  // Cleveland Clinic Men's Health Advisor;Nov2015, Vol. 17 Issue 11, p4 

    The article discusses the causes and nonoperative and surgical treatments of shoulder pain. Comments from shoulder surgeon Eric Ricchetti on rotator cuff disease as the most common cause of shoulder pain are included. Other causes of shoulder pain includes bursitis and rotator cuff damage....

  • Conservative management of shoulder pain with common causes. Hyung Seok Nam; Shi-Uk Lee // Journal of the Korean Medical Association / Taehan Uisa Hyophoe ;Aug2014, Vol. 57 Issue 8, p661 

    Shoulder pain presents with varying etiology and pathophysiology. At the time of initial evaluation, conservative management is applied in most cases. The therapeutic approach should be based on the cause of pain, which should be determined by the appropriate evaluation. Recovery of range of...

  • Shoulder disorders -- part 1.  // GP: General Practitioner;1/6/2003, p45 

    Focuses on various shoulder disorders and their possible treatment. Causes of shoulder pain; Use of magnetic resonance imaging scan to investigate shoulder injury; Kinds of pain encountered by a patient suffering from frozen shoulder; Description of the treatment for rotator cuff disease.

  • Shouldering the pain. Pulkerson, John P. // Joe Weider's Muscle & Fitness;Mar97, Vol. 58 Issue 3, p196 

    Discusses exercises to strengthen rotator-cuff muscles. Common causes of shoulder pains; High-risk sports for athletes; Rotation exercises that reduce impingement and result in shoulder pains; Warm-ups and stretching; Management of shoulder pain; Medical consultation with an orthopedist for...

  • One-Year Outcome of Subacromial Corticosteroid Injection Compared With Manual Physical Therapy for the Management of the Unilateral Shoulder Impingement Syndrome: A Pragmatic Randomized Trial. Rhon, Daniel I.; Boyles, Robert B.; Cleland, Joshua A. // Annals of Internal Medicine;8/5/2014, Vol. 161 Issue 3, Following p161 

    Background: Corticosteroid injections (CSIs) and physical therapy are used to treat patients with the shoulder impingement syndrome (SIS) but have never been directly compared. Objective: To compare the effectiveness of 2 common nonsurgical treatments for SIS. Design: Randomized, single-blind,...

  • Lifestyle and metabolic factors in relation to shoulder pain and rotator cuff tendinitis: A population-based study. Rechardt, Martti; Shiri, Rahman; Karppinen, Jaro; Jula, Antti; Heliövaara, Markku; Viikari-Juntura, Eira // BMC Musculoskeletal Disorders;2010, Vol. 11, p165 

    Background: Shoulder pain is a common health problem. The purpose of this study was to assess the associations of lifestyle factors, metabolic factors and carotid intima-media thickness with shoulder pain and chronic (> 3 months) rotator cuff tendinitis. Methods: In this cross-sectional study,...

  • Patients with Workers' Compensation Claims Have Worse Outcomes After Rotator Cuff Repair. Henn, III, R. Frank; Kang, Lana; Tashjian, Robert Z.; Green, Andrew // Journal of Bone & Joint Surgery, American Volume;Oct2008, Vol. 90-A Issue 10, p2105 

    Background: Previous studies have demonstrated varying correlations between Workers' Compensation status and the outcome of rotator cuff repair. However, none of those studies have formally accounted for potential confounding factors with multivariable analysis. We hypothesized that patients...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics