Efficacy of ultrasound-guided intra-articular hyaluronic acid injection in the management of adhesive capsulitis: a randomized controlled trial
Clinical Snapshot
PICO Framework
| P — Population | 46 adults aged 40-70 years with clinically and radiologically confirmed frozen-phase adhesive capsulitis |
| I — Intervention | Three weekly ultrasound-guided intra-articular hyaluronic acid injections |
| C — Comparator | Supervised physical therapy twice weekly for six weeks |
| O — Outcomes | Shoulder Pain and Disability Index (SPADI) and shoulder range of motion at 4, 6, 8, and 26 weeks |
Bottom Line
This small RCT suggests ultrasound-guided hyaluronic acid injection and supervised physiotherapy produce equivalent improvements in pain and function for frozen shoulder patients. Both treatments achieved clinically meaningful benefits (>50% improvement in disability scores) maintained at 6 months. However, methodological limitations including unclear randomisation, small sample size, and lack of confidence intervals limit confidence in findings. The study's industry funding and commercial affiliations raise additional concerns. While results support either treatment approach, the evidence is insufficient to establish superiority of hyaluronic acid injection over standard physiotherapy. Given cost considerations in Australian practice, physiotherapy remains the logical first-line approach, with injection reserved for selected cases or patient preference.
Key Findings
P Value: All between-group comparisons p > 0.05
Effect Size: Hyaluronic acid: 62.6% SPADI improvement; Rehabilitation: 55.4% improvement
Primary Outcome: No significant between-group differences in SPADI scores at any time point (all p > 0.05)
Nnt Or Sensitivity: Cannot calculate NNT as both treatments showed equivalent efficacy
Confidence Interval: Not reported
Clinical Application
Both interventions are readily available in Australian practice with appropriate training Hyaluronic acid injections not PBS-subsidised for adhesive capsulitis; physiotherapy covered under Medicare CDM plans and private health insurance Adults with frozen-phase adhesive capsulitis seeking non-surgical management options
Abstract
OBJECTIVE: To compare the efficacy and safety of ultrasound-guided intra-articular hyaluronic acid injection versus supervised rehabilitation in patients with frozen-phase adhesive capsulitis. DESIGN: Single-center, parallel-group, randomized controlled trial with 26-week follow-up. SUBJECTS/PATIENTS: Forty-six adults aged 40-70 years with clinically and radiologically confirmed frozen-phase adhesive capsulitis. METHODS: Participants were randomly assigned to receive either three weekly ultrasound-guided intra-articular hyaluronic acid injections or supervised physical therapy twice weekly for six weeks. Outcomes assessed at baseline and at weeks 4, 6, 8, and 26 included the Shoulder Pain and Disability Index (SPADI) and shoulder range of motion. RESULTS: Both groups achieved significant within-group improvements in SPADI and range of motion over 26 weeks (all p < 0.01 vs. baseline). No statistically significant between-group differences were observed in total SPADI or its pain and disability subscales at any follow-up time point (all p > 0.05). At week 26, the hyaluronic acid group's mean total SPADI decreased from 43.0 ± 17.7 to 16.1 ± 12.8 (p < 0.01), while the rehabilitation group improved from 52.0 ± 18.4 to 23.2 ± 21.8 (p < 0.01). Pain subscores were reduced by 64.3% (hyaluronic acid) and 56.1% (rehabilitation); function subscores decreased by 60.9% and 54.8%, respectively (all p < 0.01). Both groups showed significant gains in active and passive flexion, abduction, and external rotation, without significant between-group differences (all p > 0.05). No treatment-related adverse events were observed. CONCLUSION: Ultrasound-guided hyaluronic acid injection and supervised rehabilitation produced comparable and clinically meaningful improvements in pain, function, and shoulder mobility in frozen-phase adhesive capsulitis.
References
- 1.Chang, C. Y., Chen, C. T., Lin, Y. H., Chiang, C. F., Mao, Y. W., & Chou, L. W. (2026). Efficacy of ultrasound-guided intra-articular hyaluronic acid injection in the management of adhesive capsulitis: a randomized controlled trial. Journal of Rehabilitation Medicine, 58, 44901. https://doi.org/10.2340/jrm.v58.44901
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