Francesca Lacelli MD, Abstract Co-Author: Nothing to Disclose

Luca Maria Sconfienza MD, Presenter: Nothing to Disclose

Nadia Perrone MD, Abstract Co-Author: Nothing to Disclose

Carmelina Murolo, Abstract Co-Author: Nothing to Disclose

Enzo Silvestri MD, Abstract Co-Author: Nothing to Disclose

Giovanni Serafini MD, Abstract Co-Author: Nothing to Disclose

The massive rupture of the rotator cuff in elderly patients is not treated with a surgical approach. Our purpose was to test the effectiveness of an ultrasound-guided injection of hyaluronic acid in the subacromial space in patients affected by a massive rupture of the rotator cuff with a neo-articulation between acromion and humeral head.

IRB approval and patients’ informed consent were obtained. We studied 38 patients (28 females; mean age 72±7.6 years), who presented at our Department with a painful shoulder, in which the ultrasound examination demonstrated a massive rupture of the rotator cuff and a neo-articulation of the humeral head with the inferior surface of the acromion. Under ultrasound guidance (12-5 Mhz probe, iU22, Philips, The Netherlands), we injected 6mL of low molecular-weight hyaluronic acid (Hyalgan, Fidia, Italy) in the subacromial space. Patients were clinically evaluated before the procedure and at monthly follow-ups up to six months by means of a visual analogue scale (VAS). Wilcoxon test was used.

no immediate or delayed complication were observed. VAS score before treatment was 7.4±2.2. After the injection, VAS score was 1.8±1.2 at one month (p<.01), 1,7±1,0 at two months (p<.01), 2.1±1.2 at three months (p<.01), 2.6±1.1 at four months (p<.01), 3.9±1.8 at five months (p<.01), and 5.0±2.7 at six months (p=.04).

The viscosupplementation of the acromion-humeral neo-joint in patients affected by massive rupture of the rotator cuff is effective in shoulder pain reduction. This treatment could represent a low-cost non-invasive alternative to biceps tendon tenolysis, that usually leads to a quicker progression of humeral osteoarthritis. However, the evolution of VAS at different timepoints indicates that this treatment has a time-limited effectiveness despite of the significant difference with the baseline value.

In the short term, viscosupplementation of the subacromial space is effective in reducing shoulder pain in patients with massive rupture of the rotator cuff.

Lacelli, F, Sconfienza, L, Perrone, N, Murolo, C, Silvestri, E, Serafini, G, Ultrasound-guided Subacromial Injection of Hyaluronic Acid in the Treatment of Elderly Patients Affected by Massive Rupture of the Rotator Cuff.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9009871.html