From the Clinical Biomechanics and Ergonomics Research Center (Rezasoltani, Dadarkhah, Rousta, Vashaei), Faculty of Medicine, Aja University of Medical Sciences, Department of Clinical Pharmacy (Esmaily), School of Pharmacy, Shahid Beheshti University of Medical Sciences, and Pharmaceutical Sciences Research Center (Mohebbi), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
J Am Acad Orthop Surg. 2021 Oct 1;29(19):e979-e992. doi: 10.5435/JAAOS-D-20-01014.
The tendons of the rotator cuff are major sources of shoulder pain. This study aimed to compare the effects of low molecular-weight hyaluronic acid with physiotherapy (PT) in patients with supraspinatus tendinopathy (ST).
We carried out a parallel two-group randomized comparative clinical trial in an outpatient clinic of physical medicine and rehabilitation at a teaching hospital. In total, 51 patients (31 women) aged 20 to 55 years with ST were randomly allocated to subacromial hyaluronate injection (n = 28) and PT (n = 23) groups. For the hyaluronate group, we administered a single injection of 2 mL (20 mg) hyaluronate 1% (500 to 700 kDa). For PT, we prescribed three sessions of treatment per week for 12 weeks, totaling 36 sessions including rotator cuff activation exercises. The primary outcome was shoulder pain in the visual analog scale. The secondary outcomes included the range of movement and the disability score of the shoulder, and a World Health Organization questionnaire on quality of life. We did the measurements at the baseline and at one, four, and 12 weeks after intervention.
The results showed that both interventions were beneficial in the management of ST. However, hyaluronate was more effective in reducing shoulder pain at rest and during activities (both P < 0.001, effect size = 0.52 and 0.68, respectively). The two interventions similarly decreased patients' disability (P = 0.196). Hyaluronate improved shoulder motion and the quality of life better than PT.
In the treatment of ST, low molecular-weight hyaluronate is more effective than PT, at least for three months. Particularly, hyaluronate is more successful in alleviating pain.
肩袖肌腱是肩部疼痛的主要来源。本研究旨在比较低分子质量透明质酸与物理疗法（PT）在肩袖肌腱炎（ST）患者中的疗效。
我们在一家教学医院的物理医学和康复门诊进行了一项平行的、两组随机对照临床试验。共有 51 名（31 名女性）年龄在 20 至 55 岁之间的 ST 患者被随机分配至肩峰下透明质酸注射（n = 28）和 PT（n = 23）组。对于透明质酸组，我们给予单次注射 2 毫升（20 毫克）1%透明质酸（500 至 700 kDa）。对于 PT，我们规定每周进行三次治疗，共 12 周，总计 36 次治疗，包括肩袖激活运动。主要结局是视觉模拟量表的肩部疼痛。次要结局包括运动范围和肩部残疾评分，以及世界卫生组织生活质量问卷。我们在基线和干预后 1、4 和 12 周进行了测量。
结果表明，两种干预措施都有利于 ST 的治疗。然而，透明质酸在减轻休息和活动时的肩部疼痛方面更为有效（均 P < 0.001，效应大小分别为 0.52 和 0.68）。两种干预措施同样降低了患者的残疾程度（P = 0.196）。透明质酸改善肩部运动和生活质量的效果优于 PT。
在 ST 的治疗中，低分子质量透明质酸比 PT 更有效，至少在三个月内如此。特别是，透明质酸在缓解疼痛方面更为成功。
