Sunil Malhotra1, Naman Kamboj2, Kamal Swarn3, Arunim Swarup4
Promising outcome of intra-articular injections of hyaluronic acid for treatment in patients affected by periarthritis of shoulder joint. Frozen shoulder or adhesive capsulitis or shoulder periarthritis was defined in the seminal work of Reeves (1975) as a condition of uncertain aetiology characterised by spontaneous onset of pain with significant restriction of both active and passive range of movement of the shoulder. Shoulder periarthritis or primary adhesive capsulitis is a common shoulder condition characterised by painful loss of both active and passive range of motion in all planes of glenohumeral joint, especially external rotation. Although, the pathogenesis progresses through fibrosis and culminates in joint contractures. It is generally recognised as a self-limiting process with an unknown aetiology.
MATERIALS AND METHODS
60 patients assessed for frozen shoulder in the OPD of our department were divided in two groups of 30 each in the year 2016 and 2017. One group (PNH group) was treated with physiotherapy (in the form of shortwave diathermy and exercises), analgesics (NSAIDs) and 5 intra-articular injections of hyaluronic acid at weekly interval. The other group (PN group) was treated with physiotherapy (in the form of shortwave diathermy and exercises) and analgesics (NSAIDS) only. These patients were not given hyaluronic acid injections. These patients had a yearlong follow up at regular intervals (0 week, 6 weeks, 3 months, 6 months and 1 year). Data was analysed within groups with the help of constant score to assess the effects of each intervention on the outcome measures and between groups to compare the effects of the intervention.
Over the period of one year, PNH group showed improvement of 57.76 points, i.e. the difference of scores at 0 week and one year (81.03-23.27) compared to the PN group, which showed improvement of 54.20 points (76.40-22.2) over the period of one year. Statistical analysis showed that the improvement was not significant in PNH group compared to the PN group (p-value=0.322) at one year.
Hyaluronic injection into the glenohumeral joint significantly improves the shoulder range of motion, constant scores and pain at short-term follow up following treatment of shoulder periarthritis. PNH group has significantly better outcomes than PN group. Intra-articular hyaluronic injection was safe with no reported complications within this study.
Frozen Shoulder, Hyaluronic Acid Injections, Constant Score, PNH Group, PN Group.