Clinical aspects in the treatment of rotator cuff disorders with hyaluronic acid

P.A. Shesternya, D.V. Yurin

Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky, Krasnoyarsk

Pain in the shoulder region is one of the most common causes of health encounter. The clinician needs to identify the most common forms of shoulder lesions: tendinitis/myositis of the rotator cuff muscles, impingement-syndrome, adhesive capsulitis, bursitis. Experience with the use of hyaluronates in this category of patients is quite limited, clinical recommendations and generally accepted approaches to treatment are lacking.
Aim: to evaluate the efficacy and safety of intra-articular injections of sodium hyaluronate in the rotator cuff disorders.
Patients and Methods: a retrospective analysis of 27 patients (11 men and 16 women) with verified diagnosis impingement-syndrome of the shoulder. Patients who had arthritis of the shoulder joint or previous injury, rotator cuff tear or adhesive capsulitis were excluded. The average age was 52.8±10.5 years. All patients received three intra-articular injections of 2 ml —1% sodium hyaluronate in the shoulder joint weekly: group 1 — monotherapy, group 2 — advanced single injection of betamethasone 7 mg/1 ml in the subacromial bursa. Within 2.5 months follow-up pain on a visual analogue scale (VAS); the active range of motion (ROM) and requirement of non-steroidal anti-inflammatory drugs (NSAIDs) were assessed.
Results: initially patients of group 2 had higher pain intensity in comparison with group 1 — 84.3±8.6 vs 71.2±10.2 (p=0.004) and lower ROM — 79.5±8.2 vs 88.5±11.8 (p=0.059), respectively. Both treatment strategies were high effective. Groups 1 and 2 did not differ after 6 and 10 weeks: pain scale were 24.6±7.6 vs 18.1±8.9 (p=0,194) and 18.2±8.2 vs 15.6±8.5 (p=0,527); range of motion — 128.3±16.4 vs 139.2±9.2 (p=0.059) and 142.6±16.0 vs 145.2±8.7 (p=0.527), respectively. There were 4 (22.2%) patients refused and 12 (66.7%) reduced dosage of NSAID in the group 1, received injection of hyaluronate only.
Conclusion: intra-articular administration of sodium hyaluronate is an effective and safe treatment strategy of the rotator cuff disorders. An important component of the hyaluronate application is the lack of metabolic effects, which is extremely important for comorbid patients.

Key words: hyaluronic acid, hyaluronate, rotator cuff, impingement-syndrome, shoulder, Fermathron.
For citation: Shesternya P.A., Yurin D.V. Clinical aspects in the treatment of rotator cuff disorders with hyaluronic acid // RMJ. 2018. № 12(II). P. 87–90.