Effectiveness of hyaluronic acid administration in treating adhesive capsulitis of the shoulder: a systematic review of randomized controlled trials.

Lin-Chien Lee,Tao-Hsin Tung,Fu-Kong Lieu,Hung-Lin Lee

doi:10.1155/2015/314120

Abstract

Introduction. Adhesive capsulitis (AC) of the shoulder presents with an insidious onset of pain and progressive limitation of shoulder movement. Objectives. To investigate whether intra-articular hyaluronic acid (HA) administration alone is superior to conventional therapies and whether the addition of intra-articular HA administration to conventional therapies improves clinical outcomes in patients with AC. Methods. The PubMed, EMBASE, CINAHL, and Cochrane Library electronic databases were searched without language restrictions in July 2014 with a priori defined inclusion and exclusion criteria. Results. Four randomized controlled trials (273 participants, 278 shoulders) were included in this review. Two trials compared intra-articular HA administration with conventional therapies and 2 trials evaluated intra-articular HA administration as an addition to conventional therapies. Pain and shoulder function/disability outcomes in the HA injection group were not superior to those achieved in the conventional therapy groups. No significant differences in pain or shoulder function/disability outcomes were noted between the groups with and without adjunctive HA administration. Conclusions. Intra-articular HA administration alone is not superior to conventional AC treatments, and the addition of intra-articular HA administration to conventional therapies does not provide significant added benefits. HA administration in AC patients who are receiving conventional therapies should be evaluated to avoid unnecessary medical expenditure.

Highlights

Adhesive capsulitis (AC) of the shoulder presents with an insidious onset of pain and progressive limitation of shoulder movement
Two trials investigated the effectiveness of intra-articular hyaluronic acid (HA) administration in comparison with conventional therapies, and the other 2 investigated the effectiveness of intra-articular HA administration as an adjunct therapy
In short-term follow-up assessments less than 3 months after administration, 2 of the included trials showed that the clinical effectiveness of intra-articular HA administration in terms of pain and shoulder function/disability was not superior to corticosteroid administration [12, 22], and this conclusion is supported by a recent systematic review

Summary

Introduction

Adhesive capsulitis (AC) of the shoulder presents with an insidious onset of pain and progressive limitation of shoulder movement. To investigate whether intra-articular hyaluronic acid (HA) administration alone is superior to conventional therapies and whether the addition of intra-articular HA administration to conventional therapies improves clinical outcomes in patients with AC. Pain and shoulder function/disability outcomes in the HA injection group were not superior to those achieved in the conventional therapy groups. Intra-articular HA administration alone is not superior to conventional AC treatments, and the addition of intra-articular HA administration to conventional therapies does not provide significant added benefits. Adhesive capsulitis (AC) of the shoulder manifests as an insidious onset of shoulder pain and the progressive limitation of active and passive shoulder movement, resulting in a marked disability and difficulty with daily activities. The natural course of primary AC is not well established, and the clinical diagnosis is based on patient history and physical examination [4]

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Discussion

Conclusion