Gracitelli Mauro E, Zanesco Leonardo, Checchia Caio, Assad Isabela, Nunes Lino da Silva Lucas, Assunção Jorge, Vasques Thais, Malavolta Eduardo A
Orthopedics, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, BRA.
Orthopedics, Hospital do Coração (HCor), São Paulo, BRA.
Cureus. 2025 Apr 16;17(4):e82376. doi: 10.7759/cureus.82376. eCollection 2025 Apr.
Background Rotator cuff syndrome, including tendinopathy and partial-thickness tears, is a common cause of shoulder pain. While conservative management remains the first-line treatment, subacromial hyaluronic acid (HA) injections have been proposed as an alternative for patients with persistent symptoms. Methods This retrospective case series evaluated the clinical outcomes of subacromial HA injections in adults diagnosed with rotator cuff syndrome, presenting with tendinopathy or partial-thickness tears on MRI. Patients received two HA injections, two weeks apart. The primary outcome was the improvement in the American Shoulder and Elbow Surgeons (ASES) score. Secondary outcomes included the Single Assessment Numeric Evaluation (SANE) score and pain reduction using the visual analog scale (VAS). Assessments were conducted at baseline and at one, three, six, and 12 months post-injection. Results A total of 41 patients (68 shoulders) were included, with a mean age of 50.1 ± 14.5 years; 53.6% were female. The ASES score improved from 45.5 ± 17.2 at baseline to 63.4 ± 25.1 at 12 months (p < 0.001). The SANE score increased from 61% ± 17 to 76% ± 19 (p = 0.013), while VAS decreased from 6.3 ± 1.9 to 4.3 ± 3.0 (p < 0.001). There was no difference in the ASES, SANE, and VAS scores between the tendinopathy and partial tear groups at any moment. Conclusion Subacromial HA injections resulted in clinically and statistically significant improvement in ASES, SANE, and VAS scores at 12 months. The treatment provided consistent symptom relief and functional improvement over time, with no reports of complications.
背景 肩袖综合征，包括肌腱病和部分厚度撕裂，是肩部疼痛的常见原因。虽然保守治疗仍然是一线治疗方法，但对于症状持续的患者，已有人提出肩峰下注射透明质酸（HA）作为一种替代治疗方法。方法 本回顾性病例系列评估了肩峰下注射HA对诊断为肩袖综合征的成年人的临床疗效，这些患者在MRI上表现为肌腱病或部分厚度撕裂。患者接受两次HA注射，间隔两周。主要结局是美国肩肘外科医师（ASES）评分的改善。次要结局包括单项评估数字评定（SANE）评分以及使用视觉模拟量表（VAS）评估的疼痛减轻情况。在基线时以及注射后1、3、6和12个月进行评估。结果 共纳入41例患者（68个肩部），平均年龄为50.1±14.5岁；53.6%为女性。ASES评分从基线时的45.5±17.2提高到12个月时的63.4±25.1（p<0.001）。SANE评分从61%±17提高到76%±19（p=0.013），而VAS评分从6.3±1.9降至4.3±3.0（p<0.001）。在任何时刻，肌腱病组和部分撕裂组之间的ASES、SANE和VAS评分均无差异。结论 肩峰下注射HA在12个月时导致ASES、SANE和VAS评分在临床和统计学上有显著改善。随着时间的推移，该治疗提供了持续的症状缓解和功能改善，且无并发症报告。
