Effects of supplementing extracorporeal shockwave therapy to hyaluronic acid injection among patients with rotator cuff lesions without complete tear: a prospective double-blinded randomized study.

BACKGROUND

The study investigates the combined efficacy of subacromial hyaluronic acid (HA) injections and extracorporeal shockwave therapy (ESWT) in managing rotator cuff lesions without complete tears.

MATERIALS AND METHODS

Eligible patients were randomized into three groups: three HA injections combined with two sham ESWT (HA), three HA injections combined with one ESWT and one sham ESWT (HA + 1 ESWT), or three HA injections combined with two ESWT (HA + 2 ESWT) with an allocation ratio of 1:1:1. Visual Analogue Scale (VAS), Constant-Murley Score (CMS), range of motion (ROM), and muscle power of shoulder abduction (MP) were assessed preintervention and at 1, 3, 6, and 12 months postinitial HA injection. Shoulder MRI was conducted before and 12 months after the intervention.

RESULTS

All pertinent parameters showed no significant between-group differences at baseline but demonstrated significant within-group improvement throughout the study. The HA + 1 ESWT group demonstrated superior improvements in MP ( P =0.011) and CMS ( P =0.018) at 1 month, and in MP ( P =0.014) and CMS ( P =0.005) at 6 months, compared to the HA group. The HA + 2 ESWT group showed greater improvements in FF ( P =0.027), IR ( P =0.019), and SROM ( P =0.025) at 1 month, and in ABD ( P =0.022) at 6 months, compared to the HA group. Notably, the HA + 2 ESWT group exhibited greater improvements in FF ( P =0.013), IR ( P =0.019), and SROM ( P =0.025) at 1 month, and in FF ( P =0.007) at 3 months, than the HA + 1 ESWT group. Moreover, no deterioration in tendinopathy grading or tear status occurred in the HA + 1 ESWT group on MRI scans.

CONCLUSION

ESWT provides additional benefits when combined with HA injections for patients with rotator cuff lesions lacking complete tears.