Intraarticular injection of sodium hyaluronate plus steroid versus steroid in adhesive capsulitis of the shoulder

Abstract

To determine the efficacy of a combined treatment--namely hyaluronan and corticosteroid injection plus physical exercises in the management of established idiopathic capsulitis of the shoulder--30 consecutive subjects with adhesive capsulitis were selected for the study. The diagnosis of adhesive capsulitis was established on the basis of a clinical history of spontaneous shoulder pain, shoulder examination showing passive limitation in conformity with capsular pattern, cervical examination excluding significant dysfunction of this area, plain radiographs excluding other significant shoulder diseases, or sonographic examination showing capsule shrinkage in affected joint. The patients were randomly allocated to receive intraarticular injections of sodium hyaluronate (20 mg) plus steroid (20 mg triamcinolone acetonide) and physiotherapy or intraarticular injections of steroid (20 mg triamcinolone acetonide) alone and physiotherapy. The intraarticular injections were performed at 15-day intervals in the first month and then monthly for 6 months. Physiotherapy was performed for 4-12 weeks. The results indicate an improvement of pain and joint motion after 6 months in all patients, especially in the patients treated with sodium hyaluronate. Intraarticular hyaluronan combined with triamcinolone acetonide and shoulder exercises may improve adhesive capsulitis. This drug possibly acts on shoulder tissue retraction by means of its influence on osmotic pressure and synovial fluid volume control.