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Therapeutic effects of hyaluronate injections in patients with chronic painful shoulder: A meta‐analysis of randomized controlled trials
Author(s) -
Saito Seiji,
Furuya Takefumi,
Kotake Shigeru
Publication year - 2010
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.20174
Subject(s) - medicine , placebo , randomized controlled trial , meta analysis , confidence interval , odds ratio , relative risk , adverse effect , surgery , physical therapy , alternative medicine , pathology
Objective To elucidate the therapeutic efficacy and safety of injection of hyaluronate (HA) for chronic painful shoulder. Methods The meta‐analysis comprised randomized controlled trials (RCTs) that compared the efficacy of HA injections with that of a placebo. Articles were retrieved through systematic searches of databases, including Medline, EMBase, and Japana Centra Revuo Medicina . The outcome end points were classified into 5 categories: pain, shoulder range of motion (ROM), total functional score, comparison between HA and steroid injections, and HA safety. The primary outcome measures of the efficacy of HA injections were the standardized mean differences (SMDs) and the relative risk (RR) or odds ratio (OR) between HA and placebo groups. Results Nineteen RCTs (2,120 participants) were pooled for the meta‐analysis. Injection of HA can decrease symptoms of chronic painful shoulder. An improvement was found in pain outcomes (SMD 0.39; 95% confidence interval [95% CI] 0.26, 0.53 and OR 1.84; 95% CI 1.49, 2.26) and total functional scores (SMD 0.36; 95% CI 0.01, 0.71), with few adverse events (RR 1.01; 95% CI 0.57, 1.77). Improvement in shoulder ROM was not effectively achieved. HA injection was modestly more effective than steroid injection, as estimated by the total functional score (SMD 0.36; 95% CI 0.02, 0.70), which indicated a likely benefit of injection of HA over steroid injection. Conclusion This meta‐analysis confirms that HA injection is effective in relief of pain and is a safe alternative therapy for chronic painful shoulder.