Ultrasound (US)-guided injections of hyaluronic acid and steroids can reduce pain and restore function in patients with some inoperable shoulder problems, Fortunato Sorrentino, MD, and colleagues from the University of Florence, Italy, reported at the Radiological Society of North America meeting.1
Results of Ultrasound-Guided 3 Shoulder Injections with Synvisc and Steroids
| Outcome |
Baseline (T0) |
4 weeks (T1) |
3 months (T2) |
6 months (T3) |
| VAS |
8.3 |
3 |
|
|
| ROM |
64 |
164 |
|
|
| % of patients with clinical improvement |
--- |
83.3% |
50.0% |
38.9% |
Source: Adapted from Sorrentino1
“The aim of the study was to evaluate the outcomes of ultrasound (US)-guided viscosupplementation and intra-articular steroid injection in shoulder impingement syndrome (SIS) and arthrosynovitis (AS) in patients not eligible for surgery,” Dr. Sorrentino said.
The researchers treated 18 patients over a period of 20 months for symptomatic shoulder impingement syndrome and arthrosynovitis. The patients, who had a mean age of 70 years, were not eligible for surgery. Inclusion criteria included symptomatic shoulder impingement syndrome with complete full-thickness tear of the supraspinatus tendon with large tendon retraction in tendinopathy, arthrosynovitis, and not eligible for surgery.
The main outcome measures were 10-cm Visual Analogue Scale (VAS) score for pain and abduction/adduction range of movement (ROM), at baseline and at 4 weeks, 3 months, and 6 months after treatment.
The study subjects received 3 intra-articular US-guided shoulder injections of hyaluronic acid using a 7.5 MHz linear-array transducer with a 20-gauge spinal needle free-hand inserted with an antero-inferior approach. Injections were given one per week for 3 consecutive weeks. The 1st and 3rd injections were with low molecular weight (m-w) hyaluronic acid. The 2nd was with high m-w hyaluronic acid.
“Before the 1st viscosupplementation an intra-articular steroid injection was performed,” Dr. Sorrentino said.
Patients also received kinesiotherapy 3 times/week for 4 weeks. Clinical improvement was assessed comparing VAS score and ROM before (T0) and after treatments at 4 weeks (T1), 3 (T2) and 6 (T3) months.
The viscosupplementation and intra-articular steroid injection caused clinical improvement in 83.3% of cases at T1, with a reduction of VAS score to 3±0.5 and an improvement of ROM to 164±7° at T1. Improvement was sustained in half of patients at T2 and in 38.9% at T3.
“US-guided viscosupplementation with 3 alternate injections of hyaluronic acid and intra-articular injection of steroid are useful tools in treatment of patients with symptomatic SIS and AS, with a significant improvement of clinical status at follow-up in a little less than half of people,” Dr. Sorrentino concluded.
Reference
1. Sorrentino F, Iovane A, Nicosia A, et al. Ultrasound-guided viscosupplementation and intra-articular steroid injection in shoulder impingement syndrome and arthrosynovitis in patients not eligible for surgery. Presented at: Radiological Society of North America 2008 meeting, Chicago, December |