Evaluating the Efficacy and Safety of adding Intra- Articular High Molecular Weight Hyaluronic Acid (Viscor® MW> 2000 KD) Injections in Comparison of Low Molecular Weight Hyaluronic Acid (Hyalgan® MW= 500-800 KD) and lidocaine In Frozen Shoulder conventional physical therapy (Adhesive Capsulitis)

Introduction: To compare the efficacy of ultrasound-guided intra-articular low molecular weight hyaluronic acid (HA) and lidocaine injection plus physical therapy (PT) with high molecular weight HA and lidocaine injection plus PT for the treatment of adhesive capsulitis(AC) of the shoulder. Method: 55 patients with AC were included to this randomized double blind study. They equally randomized to divide into the 2 treatment groups that each patients received a single injection: group 1, low molecular weight (500-700 kDa) hyaluronic acid (HA) and lidocaineinjections under US guidance; or group 2, high molecular weight (> 2000 kDa) HA and lidocaine injection under US guidance. All patients underwent standard physical therapy (PT) Patients were followed up 4 and 12 weeks after injection. The primary outcome was the visual analog scale(VAS). Secondary outcomes included OXFORD shoulder score, and active range of motion (ROM) of the shoulder (flexion, abduction, internal rotation, external rotation). Outcomes were measurement at baseline, 4 and 12 weeks after the injection. Inflammation signs and symptomswere checked at baseline of injection. Result and discussion: No significant differences were noted in demographic variables at baseline between groups. After treatment, OXFORD score, VAS score and active ROM were improved at 2 and 6 weeks in both groups but no significant differenceswere noted in OXFORD score and active ROM (at weeks 4 and 12) groups (all P> .05). VAS in the group 1 was significantly improved in 4weeks. However the result showed that VAS in group 2 was significantly better at week 12. Conclusions: This study was shown that intra-articular underUS-guided injection of LMW hyaluronic acid plus PT as effective as HMW hyaluronic acid plus PT in OXFORD score, and ROM; however it is more effective in pain relief than HMW hyaluronic acid.

کلیدواژه ها:

Adhesive capsulitis ، Frozen shoulder ، Hyaluronic acid ، Physical therapy ، Ultrasound guided