These authors conducted a literature review on the effects of hyaluronic acid (HA) in patients with glenohumeral osteoarthritis.
Injection of HA resulted in the reduction of visual analog scale pain score at 3 months by 26.2 mm and at 6 months by 29.5 mm.
However similar clinical improvements were noted with control injections (steroids, saline), suggesting that these improvements may not be related to to the HA.
One study compared the effect of HA injection vs. phosphate buffered saline; the findings did not reach statistical significance.
Another study found a small, but statistically insignificant difference.
Another reported an insignificant between-group difference between HA and control in the reduction of VAS pain.
Another compared HA to corticosteroid therapy and reported nonsignificant differences between
groups with respect to pain relief.
groups with respect to pain relief.
Adverse events were not common but included swelling and mild pain at the injection site, local effusion, lethargy, and face rash.
Comment: We have not found a role for injections of any kind in the management of arthritis. There is a lack of evidence that they provide sustained benefit and they carry the risk of infection and increase the risk of periprosthetic infection as well.
Here's an instructive case.
We were recently consulted by a man in his 40s who had a painful shoulder after a motor vehicle accident in the past. A year and a half ago he had these x-rays showing mild arthritis and limited motion of his shoulder.
He then presented to us with a completely stiff shoulder and these x-rays.
A year ago he had an injection into his shoulder, after which his shoulder pain increased dramatically. He then underwent an arthroscopic washout for a shoulder joint infection that he thinks may have been due to staphylococcus.
He then presented to us with a completely stiff shoulder and these x-rays.
We plan a debridement with cultures, a primary hemiarthroplasty and intravenous Vancomycin and Ceftriaxone.
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We have a new set of shoulder youtubes about the shoulder, check them out at this link.
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We have a new set of shoulder youtubes about the shoulder, check them out at this link.
Be sure to visit "Ream and Run - the state of the art" regarding this radically conservative approach to shoulder arthritis at this link and this link
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