Introduction The treatment of rotator cuff tendinopathy typically revolves around a combination of a subacromial bursa corticosteroid injection and rotator cuff strengthening with physical therapy.
The treatment of rotator cuff tendinopathy typically revolves around a combination of a subacromial bursa corticosteroid injection and rotator cuff strengthening with physical therapy. Recently, studies have been looking at the role of hyaluronate in treating the symptoms of rotator cuff tendinopathy. Hyaluronic acid (HA) is naturally found in synovial fluid and is a high molecular weight polysaccharide.
Repetitive mechanical stress across the shoulder can lead to tendinosis of the rotator cuff. This microtrauma can lead to adhesions, fibrosis, and necrosis within the tendon. Hyaluronic acid has been found to have antifibrotic properties, as well as anti-inflammatory effects.
Studies have also found that HA injections can also upregulate vascular endothelial growth factor, which can accelerate tendon healing. Research has also found that low molecular weight (LMW) HA can act as an antioxidant and has the potential for free radical scavenging. Clinical Vignette A 58 year old female comes to the office with right shoulder pain.
Her symptoms have failed to improve with physical therapy. An MRI shows distal supraspinatus hypertrophy and subacromial bursitis consistent with rotator cuff tendinopathy. The patient is interested in injection options.
Which of the following is true regarding injections of hyaluronic acid into the subacromial bursa? A) Low molecular weight hyaluronic acid is a well tolerated injection in to the subacromial bursa B) Physical therapy has been found to be superior to hyaluronic acid injections in to the subacromial bursa C) Hyaluronic acid can only be injected in to the glenohumeral joint as it will cause tendon degeneration with a subacromial injection D) Injection of high molecular weight hyaluronic acid was found to be superior to low molecular weight hyaluronic acid in terms of pain relief Evidence A recent study published in the Clinical Journal of Sports Medicine in November 2021 compared low and high molecular weight hyaluronate subacromial injections for the treatment of shoulder tendinopathy. The higher weighted hyaluronate weighs 2000kDa and the low weight HA between 80-800 kDa.
If you are experiencing symptoms that may be related to hyaluronic acid and rotator cuff tendonitis, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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