Ann Rehabil Med.  2016 Oct;40(5):835-844. 10.5535/arm.2016.40.5.835.

Effect of Intra-articular Hyaluronic Acid Injection on Hemiplegic Shoulder Pain After Stroke

• Jang MH
• Lee CH
• Shin YI
• Kim SY
• Huh SC

• KMID: 2382915
• DOI: http://doi.org/10.5535/arm.2016.40.5.835

Abstract

OBJECTIVE
To evaluate the efficacy of intra-articular hyaluronic acid (IAHA) injection for hemiplegic shoulder pain (HSP) after stroke.
METHODS
Thirty-one patients with HSP and limited range of motion (ROM) without spasticity of upper extremity were recruited. All subjects were randomly allocated to group A (n=15) for three weekly IAHA injection or group B (n=16) for a single intra-articular steroid (IAS) injection. All injections were administered by an expert physician until the 8th week using a posterior ultrasonography-guided approach. Shoulder joint pain was measured using the Wong-Baker Scale (WBS), while passive ROM was measured in the supine position by an expert physician.
RESULTS
There were no significant intergroup differences in WBS or ROM at the 8th week. Improvements in forward flexion and external rotation were observed from the 4th week in the IAHA group and the 8th week in the IAS group. Subjects experienced a statistically significant improvement in pain from the 1st week in the IAS and from the 8th week in IAHA group, respectively.
CONCLUSION
IAHA seems to have a less potent ability to reduce movement pain compared to steroid in the early period. However, there was no statistically significant intergroup difference in WBS and ROM improvements at the 8th week. IAHA might be a good alternative to steroid for managing HSP when the use of steroid is limited.

Keyword

Adhesive capsulitis; Stroke; Hyaluronic acid; Intra-articular injections

MeSH Terms

Bursitis
Humans
Hyaluronic Acid*
Injections, Intra-Articular
Muscle Spasticity
Range of Motion, Articular
Shoulder Joint
Shoulder Pain*
Shoulder*
Stroke*
Supine Position
Upper Extremity
Hyaluronic Acid

Figure

• 

  Fig. 1 Participant flowchart of the study.

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  Fig. 2 Passive range of motion improvement at 1, 4, and 8 weeks after the intra-articular injection in the two groups (PP analysis, *p<0.016). Post hoc testing showed no statistical differences between the two groups over time (p>0.05). ROM, range of motion; WBS, Wong-Baker Scale; PP analysis, per protocol analysis.

• 

  Fig. 3 Pain improvement at 1, 4, and 8 weeks after the intra-articular injection in the two groups (PP analysis, *p<0.016). Post hoc testing showed no statistical differences between the two groups over time (p>0.05). WBS, Wong-Baker Scale; PP analysis, per protocol analysis.

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