Ultrasound-guided viscosupplementation of subacromial space in elderly patients with cuff tear arthropathy using a high weight hyaluronic acid: prospective open-label non-randomized trial

Abstract

Objective

To assess if ultrasound (US)-guided viscosupplementation can reduce pain and improve function in elderly patients with cuff tear arthropathy.

Patients and methods

Ninety-three patients aged over 65 with grade 3 or above cuff tear arthropathy were included in this prospective open-label non-randomized trial. Institutional review board approval and informed consent were obtained. Thirty-three patients received intra-articular injections of sodium hyaluronate under US guidance. Sixty patients constituted the control group. Shoulder joint function was assessed with Constant scores (CS) and pain with a visual analogue scale (VAS).

Results

Compared with controls, treated patients reported a significant decrease in symptoms at 1 (mean CS 66 ± 3.1 vs 37 ± 6.9; mean VAS 1.9 ± 1.2 vs 6.9 ± 2.2), 2 (mean CS 65 ± 3.2 vs 35 ± 7.2; mean VAS 1.7 ± 1.2 vs 6.8 ± 2.5), 3 (mean CS 66 ± 3.4 vs 33 6.1; mean VAS 2.3 ± 1.2 vs 6.6 ± 1.9), and 4 (mean CS 62 ± 3.0 vs 34 ± 6.5; mean VAS 3.3 ± 1.4 vs 7.8 ± 3.1) months, p < 0.001. After 5 months there were no differences.

Conclusion

US-guided viscosupplementation is a beneficial therapeutic option in the first months of treatment

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. 1.

    Silverstein E, Leger R, Shea KP (2007) The use of intra-articular hylan G-F 20 in the treatment of symptomatic osteoarthritis of the shoulder: a preliminary study. Am J Sports Med 35:979–985

    Article  PubMed  Google Scholar 

  2. 2.

    American College of Rheumatology Subcommittee on Osteoarthritis Guidelines (2000) Recommendations for the medical management of osteoarthritis of the hip and knee. Arthritis Rheum 43:1905–1915

    Article  Google Scholar 

  3. 3.

    American Pain Society (2002) Guidelines for the management of pain in osteoarthritis, rheumatoid arthritis, and juvenile chronic arthritis. American Pain Society, Glenview. http://www.ampainsoc.org/. Accessed 10 March 2010

  4. 4.

    Bloom BS (1988) Direct medical costs of disease and gastrointestinal side effects during treatment for arthritis. Am J Med 84:20–24

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Moreland LW (2003) Intra-articular hyaluronan (hyaluronic acid) and hylans for the treatment of osteoarthritis: mechanism of action. Arthritis Res Ther 5:54–67

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Altman RD, Akermark C, Beaulieu AD et al (2004) Durolane International Study Group. Efficacy and safety of a single intra-articular injection of non-animal stabilized hyaluronic acid (NASHA) in patients with osteoarthritis of the knee. Osteoarthritis Cartilage 12:642–649

    Article  PubMed  Google Scholar 

  7. 7.

    Blaine T, Moskowitz R, Udell J et al (2008) Treatment of persistent shoulder pain with sodium hyaluronate: a randomized controlled trial. J Bone Joint Surg Am 90:970–979

    Article  PubMed  Google Scholar 

  8. 8.

    Wang CT, Lin J, Chang CJ et al (2004) Therapeutic effects of hyaluronic acid on osteoarthritis of the knee. A meta-analysis of randomized controlled trials. J Bone Joint Surg Am 86:538–545

    PubMed  Google Scholar 

  9. 9.

    Altman RD, Moskowitz R (1998) Intraarticular sodium hyaluronate (Hyalgan) in the treatment of patients with osteoarthritis of the knee: a randomized clinical trial. Hyalgan Study Group. J Rheumatol 25:2203–12, Erratum in: J Rheumatol 1999; 26:1216

    CAS  PubMed  Google Scholar 

  10. 10.

    Leardini G, Perbellini A, Franceschini M et al (1988) Intra-articular injections of hyaluronic acid in the treatment of painful shoulder. Clin Ther 10:521–526

    CAS  PubMed  Google Scholar 

  11. 11.

    Ramonda R, Franceschini M, Leardini G (1998) Treatment of shoulder periarthritis with hyaluronic acid. Riv Ital Biol Med 1(2 Suppl):51S

    Google Scholar 

  12. 12.

    Rovetta G, Monteforte P (1998) Intraarticular injection of sodium hyaluronate plus steroid versus steroid in adhesive capsulitis of the shoulder. Int J Tissue React 20:125–130

    CAS  PubMed  Google Scholar 

  13. 13.

    Itokazu M, Matsunaga T (1995) Clinical evaluation of high-molecular-weight sodium hyaluronate for the treatment of patients with periarthritis of the shoulder. Clin Ther 17:946–955

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Yamamoto R, Namiki O, Iwata H et al (1988) Randomized comparative study of sodium hyaluronate (SPH) on periarthritis of the shoulder. Jpn J Clin Pharmacol Ther 19:717–733

    Google Scholar 

  15. 15.

    Fernandez-Palazzi F, Viso R et al (2002) Intra-articular hyaluronic acid in the treatment of haemophilic chronic arthropathy. Haemophilia 8:375–381

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Tamai K, Mashitori H, Ohno W et al (2004) Synovial response to intraarticular injections of hyaluronate in frozen shoulder: a quantitative assessment with dynamic magnetic resonance imaging. J Orthop Sci 9:230–234

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Hamada K, Fukuda H, Mikasa M et al (1990) Roentgenographic findings in massive rotator cuff tears. A long-term observation. Clin Orthop Relat Res 254:92–96

    PubMed  Google Scholar 

  18. 18.

    Rockwood CA Jr, Williams GR Jr, Burkhead WZ Jr (1995) Debridement of degenerative, irreparable lesions of the rotator cuff. J Bone Joint Surg Am 77:857–866

    PubMed  Google Scholar 

  19. 19.

    Gartsman GM, Khan M, Hammerman SM (1998) Arthroscopic repair of full-thickness tears of the rotator cuff. J Bone Joint Surg Am 80:832–840

    CAS  PubMed  Google Scholar 

  20. 20.

    Itoi E, Tabata S (1992) Conservative treatment of rotator cuff tears. Clin Orthop Relat Res 275:165–173

    PubMed  Google Scholar 

  21. 21.

    Montgomery TJ, Yerger B, Savoie FH (1994) Management of rotator cuff tears: a comparison of arthroscopic debridement and surgical repair. J Shoulder Elbow Surg 3:70–78

    Article  Google Scholar 

  22. 22.

    Bianchi S, Martinoli C et al (eds) (2007) Ultrasound of the musculoskeletal system. Springer-Verlag, Berlin

  23. 23.

    Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164

    PubMed  Google Scholar 

  24. 24.

    Langley GB, Sheppeard H (1985) The visual analogue scale: its use in pain measurement. Rheumatol Int 5:145–148

    CAS  Article  PubMed  Google Scholar 

  25. 25.

    Beggs I, Bianchi S, Bueno A et al (2010) Musculoskeletal ultrasound technical guidelines. I. The shoulder. European Society of Musculoskeletal Radiology. http://www.essr.org/html/img/pool/shoulder.pdf. Accessed 10 March 2010

  26. 26.

    Niesel HC (1997) Local anesthetics: maximum recommended doses. Anaesthesiol Reanim 22:60–62

    CAS  PubMed  Google Scholar 

  27. 27.

    Serafini G, Sconfienza LM, Lacelli F et al (2009) Rotator cuff calcific tendonitis: short-term and 10-year outcomes after two-needle US-guided percutaneous treatment. Nonrandomized controlled trial. Radiology 252:157–162

    Article  PubMed  Google Scholar 

  28. 28.

    Arrich J, Piribauer F, Mad P et al (2005) Intra-articular hyaluronic acid for the treatment of osteoarthritis of the knee: systematic review and meta-analysis. CMAJ 172:1039–1043

    PubMed  Google Scholar 

  29. 29.

    Bellamy N, Campbell J, Robinson V et al (2006) Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database Syst Rev 19:CD005321

    Google Scholar 

  30. 30.

    Noël E, Hardy P, Hagena FW et al (2006) Efficacy and safety of Hylan G-F 20 in shoulder osteoarthritis with an intact rotator cuff. Open-label prospective multicenter study. Joint Bone Spine 76:670–673

    Article  Google Scholar 

  31. 31.

    Leardini G, Perbellini A, Franceschini M et al (1988) Intra-articular injections of hyaluronic acid in the treatment of painful shoulder. Clin Ther 10:521–526

    CAS  PubMed  Google Scholar 

  32. 32.

    Silverstein E, Leger R, Shea KP (2007) The use of intra-articular hylan G-F 20 in the treatment of symptomatic osteoarthritis of the shoulder: a preliminary study. Am J Sports Med 35:979–985

    Article  PubMed  Google Scholar 

  33. 33.

    Blaine T, Moskowitz R, Udell J et al (2008) Treatment of persistent shoulder pain with sodium hyaluronate: a randomized, controlled trial. A multicenter study. J Bone Joint Surg 90:970–979

    Article  PubMed  Google Scholar 

  34. 34.

    Yi TI, Kim ST, Kim DH et al (2006) Comparison of blind technique and ultrasonography guided technique of intra-articular injection of the shoulder. J Korean Acad Rehab Med 30:45–50

    Google Scholar 

  35. 35.

    Rutten MJ, Spaargaren GJ, van Loon T et al (2010) Detection of rotator cuff tears: the value of MRI following ultrasound. Eur Radiol 20:450–457

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Alberto Tagliafico.

Additional information

A. Tagliafico and G. Serafini contributed equally to this work.

Electronic supplementary material

Below is the link to the electronic supplementary material.

(MPG 1704 kb)

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Tagliafico, A., Serafini, G., Sconfienza, L.M. et al. Ultrasound-guided viscosupplementation of subacromial space in elderly patients with cuff tear arthropathy using a high weight hyaluronic acid: prospective open-label non-randomized trial. Eur Radiol 21, 182–187 (2011). https://doi.org/10.1007/s00330-010-1894-4

Download citation

Keywords

  • Viscosupplementation
  • Elderly
  • Cuff tear arthropathy
  • Hyaluronic acid
  • Ultrasound