Results of Ultrasound-Guided 3 Shoulder Injections with Synvisc and Steroids
| Outcome | Baseline (T0) | 4 weeks (T1) | 3 months (T2) | 6 months (T3) |
| VAS | 8.3 | 3 | ||
| ROM | 64 | 164 | ||
| % of patients with clinical improvement | --- | 83.3% | 50.0% | 38.9% |
Source: Adapted from Sorrentino1
“The aim of the study was to evaluate the outcomes of ultrasound (US)-guided viscosupplementation and intra-articular steroid injection in shoulder impingement syndrome (SIS) and arthrosynovitis (AS) in patients not eligible for surgery,” Dr. Sorrentino said.
The researchers treated 18 patients over a period of 20 months for symptomatic shoulder impingement syndrome and arthrosynovitis. The patients, who had a mean age of 70 years, were not eligible for surgery. Inclusion criteria included symptomatic shoulder impingement syndrome with complete full-thickness tear of the supraspinatus tendon with large tendon retraction in tendinopathy, arthrosynovitis, and not eligible for surgery.
The main outcome measures were 10-cm Visual Analogue Scale (VAS) score for pain and abduction/adduction range of movement (ROM), at baseline and at 4 weeks, 3 months, and 6 months after treatment.
The study subjects received 3 intra-articular US-guided shoulder injections of hyaluronic acid using a 7.5 MHz linear-array transducer with a 20-gauge spinal needle free-hand inserted with an antero-inferior approach. Injections were given one per week for 3 consecutive weeks. The 1st and 3rd injections were with low molecular weight (m-w) hyaluronic acid. The 2nd was with high m-w hyaluronic acid.
“Before the 1st viscosupplementation an intra-articular steroid injection was performed,” Dr. Sorrentino said.
Patients also received kinesiotherapy 3 times/week for 4 weeks. Clinical improvement was assessed comparing VAS score and ROM before (T0) and after treatments at 4 weeks (T1), 3 (T2) and 6 (T3) months.
The viscosupplementation and intra-articular steroid injection caused clinical improvement in 83.3% of cases at T1, with a reduction of VAS score to 3±0.5 and an improvement of ROM to 164±7° at T1. Improvement was sustained in half of patients at T2 and in 38.9% at T3.
“US-guided viscosupplementation with 3 alternate injections of hyaluronic acid and intra-articular injection of steroid are useful tools in treatment of patients with symptomatic SIS and AS, with a significant improvement of clinical status at follow-up in a little less than half of people,” Dr. Sorrentino concluded.
Reference
1. Sorrentino F, Iovane A, Nicosia A, et al. Ultrasound-guided viscosupplementation and intra-articular steroid injection in shoulder impingement syndrome and arthrosynovitis in patients not eligible for surgery. Presented at: Radiological Society of North America 2008 meeting, Chicago, December 01, 2008. Presentation no. SSE14-06.
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