Subacromial Bursa Injection of Hyaluronate with Steroid in Patients with Peri-articular Shoulder Disorders

Seung Deuk Byun, Dong Hwi Park, Won Duck Choi, Zee Ihn Lee, Seung Deuk Byun, Dong Hwi Park, Won Duck Choi, Zee Ihn Lee

Abstract

Objective: To investigate the additive effect of sono-guided subacromial bursa injection of hyaluronate with steroid in patients with peri-articular shoulder disorders.

Method: This prospective randomized controlled trial involved 26 patients who had shoulder pain. Group A, consisting of 13 patients, was treated with a sono-guided subacromial bursa injection containing a mixture of 0.5% lidocaine (5 ml) and triamcinolone 40 mg (1 ml), followed by injection with sodium hyaluronate (2 ml) once a week for 3 weeks. The other 13 patients (Group B) were treated with a sono-guided subacromial bursa injection containing a mixture of 0.5% lidocaine (5 ml) and triamcinolone 40 mg (1 ml) once a week for 3 weeks. The effects were assessed using a visual analogue scale (VAS) of shoulder pain, active range of motion (AROM), shoulder function assessment scale (SFA), shoulder disability questionnaire (SDQ) at study entry and every week from first injection until 4 weeks after the 1(st) injection (= 2 weeks after 3(rd) injection).

Results: (1) Demographic features and all parameters measured before injection did not show a significant difference between the 2 groups. (2) Statistically significant improvements were shown in VAS, SFA, SDQ during the 1(st), 2(nd), and 4(th) week after the first injection in both groups (p<0.05). (3) SFA showed significant improvement at 1 week after injection only in group A (p<0.05). (4) AROM of internal rotation showed significant improvement at week 4 after the 1(st) injection only in group A (p<0.05).

Conclusion: Subacromial bursa injection of hyaluronate with steroid in patients with peri-articular shoulder disorders has additive effects on functional improvement of the affected shoulder, including the AROM of internal rotation.

Keywords: Bursa injection; Peri-articular shoulder disorder; Sodium hyaluronate; Steroid.

Figures

Fig. 1
Fig. 1
Figure shows ultrasound guided subacromial/subdeltoid bursa injection. The needle tip is positioned at subacromial/subdeltoid bursa (A). Subacromial/subdeltoid bursa is dilatated due to the injection materials (B).
Fig. 2
Fig. 2
Figure shows the changes of visual analogue scale (VAS) after 3 consecutive injections. *p<0.05 pre-injection vs 2 weeks after 3rd injection. †p<0.05 pre-injection vs 1 week after 1st injection. ‡p<0.05 1 week after 1st injection vs 1 week after 2nd injection. §p<0.05 1 week after 2nd injection vs 2 weeks after 3rd injection.
Fig. 3
Fig. 3
Figure shows the changes of shoulder function assessment scale (SFA) after 3 consecutive injections. *p<0.05 pre-injection vs 2 weeks after 3rd injection. †p<0.05 preinjection vs 1 week after 1st injection. ‡p<0.05 1 week after 1st injection vs 1 week after 2nd injection. §p<0.05 1 week after 2nd injection vs 2 week after 3rd injection.
Fig. 4
Fig. 4
Figure shows the changes of shoulder disability questionnaire (SDQ) after 3 consecutive injections. *p<0.05 pre-injection vs 2 weeks after 3rd injection. †p<0.05 pre-injection vs 1 week after 1st injection. ‡p<0.05 1 week after 1st injection vs 1 week after 2nd injection. §p<0.05 1 week after 2nd injection vs 2 weeks after 3rd injection.
Fig. 5
Fig. 5
Figure shows the changes of AROM of shoulder flexion after 3 consecutive injections. *p<0.05 pre-injection vs 2 weeks after 3rd injection. †p<0.05 pre-injection vs 1 week after 1st injection. ‡p<0.05 1 week after 1st injection vs 1 week after 2nd injection. §p<0.05 1 week after 2nd injection vs 2 weeks after 3rd injection.
Fig. 6
Fig. 6
Figure shows the changes of AROM of shoulder abduction after 3 consecutive injection. *p<0.05 pre-injection vs 2 weeks after 3rd injection. †p<0.05 pre-injection vs 1 week after 1st injection. ‡p<0.05 1 week after 1st injection vs 1 week after 2nd injection. §p<0.05 1 week after 2nd injection vs 2 weeks after 3rd injection.
Fig. 7
Fig. 7
Figure shows the changes of AROM of shoulder abduction after 3 consecutive injection. *p<0.05 pre-injection vs 2 weeks after 3rd injection. †p<0.05 pre-injection vs 1 week after 1st injection. ‡p<0.05 1 week after 1st injection vs 1 week after 2nd injection. §p<0.05 1 week after 2nd injection vs 2 weeks after 3rd injection.
Fig. 8
Fig. 8
Figure shows the changes of AROM of shoulder external rotation after 3 consecutive injection. *p<0.05 pre-injection vs 2 weeks after 3rd injection. †p<0.05 pre-injection vs 1 week after 1st injection. ‡p<0.05 1 week after 1st injection vs 1 week after 2nd injection. §p<0.05 1 week after 2nd injection vs 2 weeks after 3rd injection.
Fig. 9
Fig. 9
Degree of changes in measurement values (VAS, SFA, SDQ, AROM) of the 2 groups. *p<0.05 steroid vs steroid plus hyaluronate.

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