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Cipolletta E, Mashadi Mirza R, Di Matteo A, Di Carlo M, Grassi W, Filippucci E.

Clinical efficacy of ultrasound-guided hyaluronic acid injections in patients with supraspinatus tendon tear. Clin Exp Rheumatol. 2021 Jul-Aug;39(4):769-774.

doi: 10.55563/clinexprheumatol/cyiyy3. Epub 2020 Sep 4. PMID: 32896264.

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Key words:
hyaluronic acid, ultrasonography, interventional ultrasonography, supraspinatus tendon tear.

Objectives: 
To evaluate the clinical efficacy of ultrasound (US)-guided soft tissue adapted biocompatible hyaluronic acid (STABHA) injections in the subacromial-subdeltoid bursa of patients with supraspinatus tendon tear.

Methods:
 In this prospective study, patients with a symptomatic partial-thickness or small full-thickness supraspinatus tendon tear, diagnosed by US, were consecutively enrolled. Patients received one injection at baseline visit and one after 2 weeks and performed rehabilitation therapy. Clinical assessment was performed with visual analogue scale (VAS) for pain, Constant-Murley Scale (CMS), and patient reported efficacy on a 0-4 Likert scale. Patients were examined at baseline, at week 2 and at week 12.

Results:
Thirty patients were enrolled. Sixteen (53.3%) and 19 (63.3%) patients reported significant improvement at week 12 in pain and function, respectively. Reduction in VAS pain was statistically significant both at week 2 and at week 12 in comparison with baseline visit (mean-difference -27.2 and -36.8, respectively, p<0.01). The same trend was observed with CMS (mean-difference 17.7 and 19.8, respectively, p<0.01). At week 12, 18 patients (60.0%) reported a subjective improvement. At week 12, in non-responders (n=14) US detected inflammatory changes and/or progression of tendon tear in 7 (50.0%) patients and no relevant changes in 7 (50.0%).

Conclusions: 
US-guided STABHA injections followed by rehabilitation therapy were found effective in improving both pain and shoulder function at the 12-week follow-up. In half of the non-responders, US allowed the detection of US findings responsible for treatment failure.