Sodium Hyaluronate Injection For Supraspinatus Tendinitis Rotator Cuff

Both Hyaluronate Injection and physiotherapy work for isolated simple supraspinatus tendonitis though the former would be easier – but more expensive…

Rheumatol Int. 2010 Jul 31. [Epub ahead of print]
Short- and long-term results of clinical effectiveness of sodium hyaluronate injection in supraspinatus tendinitis.
Ozgen M, Fırat S, Sarsan A, Topuz O, Ardıç F, Baydemir C.  abstract here

• Supraspinatus tendonitis is the number one rotator cuff injury and the hardest (in my hands) to treat. It is small and very often is a partial tear and so I feel uncomfortable about injecting potentially tear promoting steroid into it. (with no tear could be injected parallel to it though)
  

• Tests include:
  Neer:
  
• Hawkin’s test:
  
• Resisted lateral abduction test:
  
• Pain at supraspinatus insertion:
  
• Helpful diagnostic symptoms:
  • shoulder pain
  • Painful arc
  • night pain
• Group 1 – Hyaluronate injection – G-F 20 injection (one example is Synvisc-One)- injected with posterior approach using 21 gauage needle [ I have used 2 “- 25 gauge needles with durolane for knees – it’s slower but still ok]  – 2 mls weekly X3

• Group 2 – Physio:which included:
  • hot packs – sililca gel fiber bags – towel wrapped 20 min
  • ultrasound – 1.5 watts for 5 min
  • TNS – 60 hertz – 60 usec pulses – for 20 min
  • Exercises:
    One article they refer to has pics:
    Bang MD, Deyle GD (2000) Comparison of supervised exercise with and without manual physical therapy for patients with shoulder impingement syndrome.
    J Orthop Sports Phys Ther 30:126–137 – below are THEIR exercises (present article very vague about this):
    • Shoulder stretches: – held for 30 sec – repeated 2 more times with 10 sec breaks

• Shoulder exercises 4 require the use of Theratubing (Hygenic Corporation) with 6 different strengths

-“3 sets of 10 repetitions with a 60-second rest period between each set.” – work up on                           strengths of tubes and avoid exercise causing significant flare.
– seated press-up and the elbow push-up – need stable chair and a mat -“performed                          to  fatigue or for a maximum of 25 repetitions”

Results: each resulted in resolution of pain by the 3rd week and this relief persisted for 4 years.

Comments- they took pure supraspinatus tendonitis MRI cases without any evidence of tears, neck problems, or RA / ankylosing spondylitis. They avoided any chronic cases by excluding anyone who had had prior therapy.  Study is seriously marred by the fact there is no control group – people who easily might have just gotten better on their own!

This makes this study a serious disappointment – they wanted to get good results so they set it up so that only easy cases were selected. It would have been more realistic if they included cases with partial tears of supraspinatus because pure cases with no tears are not the ones we have trouble treating.

I had to laugh over their statement, “Systematic reviews of clinical trials on shoulder disorders show little benefit from NSAIDs and steroid injections” – this is true because they are One Shot Wonder studies – Sorry, one shot cures only exist in fantasy land – which they must know because they gave THREE shots of Hyaluronate.  I have discussed the need for multiple injections to obtain results here:
At Last Some Sense In Shoulder Injections – Three Shots

In real life shoulder problems are more extensive   ie –  with some neck signs (I see the article they refer to for exercises, included Maitland mobs to neck and thorax, as in real cases these areas are involved)   – so in real life, the injections would be an add-on and probably not get anywhere as good results as they got.  Too bad though..

I have asked the authors to comment though they are from Turkey…

Anyone had experience with this?