March 13th, 2004
AOSSM Specialty Day

A Prospective, Randomized, Double-Blind, Pilot Study Comparing Synvisc (Hylan G-F 20) and Celestone (Betamethasone) Injections for Treatment of Shoulder Impingement

Authors:
  1. Kenneth R. Zaslav MD, Advanced Orthopedic Centers, Richmond, VA
  2. Prue Keith, Advanced Orthopedic Centers, Richmond, VA
  3. Francisco Soza, Advanced Orthopedic Centers, Richmond, VA
  4. Jose Alemparte, Advanced Orthopedic Centers, Richmond, VA
Objective:  Although steroid injection with physical therapy is well established for the treatment of shoulder impingement, recurrent steroid injections into tendon areas can be catabolic. The objective of this study was to compare the efficacy and safety of one injection of Synvisc (hylan G-F 20) to one injection of Celestone (betamethasone) into the subacromial space for the treatment of grade 1-2 shoulder impingement.
Methods:  In this prospective, randomized, double-blind, pilot study, patients from a busy shoulder practice were enrolled if they exhibited positive Neer impingement sign and had a positive Neer impingement injection test with 5 cc of xylocaine. Patients with any clinical signs of instability, or SLAP lesion or rotator cuff full thickness tear demonstrated by MRI were excluded. Patients were randomized to a single injection of either Celestone (1 cc) with 1 cc of xylocaine or Synvisc (2 cc), into the subacromial space and placed in a standard impingement physical therapy program. Visual analogue pain scale (VAS; 1-15) and presence or absence of a Neer impingement sign were assessed pre-injection and 6 weeks after injection.
Results:  Of the 36 enrolled patients, 5 were excluded (MRI positive rotator cuff tears) and 1 was lost to follow up. Of the 30 patients who completed, 16 received Synvisc and 14 Celestone. A beneficial treatment response was observed for both treatments. Mean VAS scores decreased from 9.7 to 3.3 in the Synvisc group, and from 8.7 to 3.3 in the Celestone group. The majority of patients in both groups had successful conservative management of their impingement symptoms and negative impingement signs with treatment: 68% (11/16) of Synvisc-treated patients and 65% (9/14) of Celestone-treated patients. No complications were reported with either injection.
Conclusions:  This small but well controlled, prospective, pilot study of a pure impingement patient cohort indicates that a single injection of Synvisc or Celestone into the subacromial space are equally effective for the treatment of grade 1-2 impingement with no untoward sequelae. Further larger, longitudinal studies are needed to investigate any potential longer term benefits of hyaluronan and its cost-benefit ratio compared to steroid use.
Keywords:
  1. Clinical Medicine
  2. Tendon
 Categories:
  1. CLINICAL: Shoulder - AC Joint