Original article| Volume 93, ISSUE 6, P957-964, June 2012

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Addition of Intra-articular Hyaluronate Injection to Physical Therapy Program Produces No Extra Benefits in Patients With Adhesive Capsulitis of the Shoulder: A Randomized Controlled Trial

Published:February 24, 2012DOI:


      Hsieh L-F, Hsu W-C, Lin Y-J, Chang H-L, Chen C-C, Huang V. Addition of intra-articular hyaluronate injection to physical therapy program produces no extra benefits in patients with adhesive capsulitis of the shoulder: a randomized controlled trial.


      To compare the efficacy of intra-articular hyaluronic acid (HA) injections plus physical therapy (PT) with that of PT alone for the treatment of adhesive capsulitis (AC) of the shoulder.


      Prospective, randomized controlled trial.


      Rehabilitation and orthopedics department of a private teaching hospital.


      Patients (N=70) with AC of the shoulder were randomly placed into either of the following treatment groups: group 1, HA injections with PT (HAPT group); or group 2, PT alone (PT group).


      The patients in group 1 received intra-articular glenohumeral joint injections of HA, 20mg, once per week for 3 consecutive weeks and also participated in a PT program for 3 months. The patients in group 2 received PT alone.

      Main Outcome Measures

      Active and passive range of motion (ROM) of the affected shoulder, pain, disability, and quality of life.


      Both groups experienced improvements in terms of pain, disability, and quality of life after the treatments; furthermore, the active and passive ROM improved linearly with increasing treatment duration. When the groups were compared, no significant group effect was found for any of the outcome measurements.


      Intra-articular HA injections did not produce added benefits for patients with AC of the shoulder who were already receiving PT. Thus, the use of intra-articular HA injections for patients with AC of the shoulder should be carefully assessed to reduce unnecessary medical expenditures.

      Key Words

      List of Abbreviations:

      AC (adhesive capsulitis), HA (hyaluronic acid), PT (physical therapy), ROM (range of motion), SDQ (Shoulder Disability Questionnaire), SF-36 (Medical Outcomes Study 36-Item Short-Form Health Survey), SPADI (Shoulder Pain and Disability Index)
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