title: Effect of Intra-articular Hyaluronic Acid Injection on Hemiplegic Shoulder Pain After Stroke.
abstract: OBJECTIVE
  To evaluate the efficacy of intra-articular hyaluronic acid (IAHA) injection for hemiplegic shoulder pain (HSP) after stroke.
  
  
  METHODS
  Thirty-one patients with HSP and limited range of motion (ROM) without spasticity of upper extremity were recruited. All subjects were randomly allocated to group A (n=15) for three weekly IAHA injection or group B (n=16) for a single intra-articular steroid (IAS) injection. All injections were administered by an expert physician until the 8th week using a posterior ultrasonography-guided approach. Shoulder joint pain was measured using the Wong-Baker Scale (WBS), while passive ROM was measured in the supine position by an expert physician.
  
  
  RESULTS
  There were no significant intergroup differences in WBS or ROM at the 8th week. Improvements in forward flexion and external rotation were observed from the 4th week in the IAHA group and the 8th week in the IAS group. Subjects experienced a statistically significant improvement in pain from the 1st week in the IAS and from the 8th week in IAHA group, respectively.
  
  
  CONCLUSIONS
  IAHA seems to have a less potent ability to reduce movement pain compared to steroid in the early period. However, there was no statistically significant intergroup difference in WBS and ROM improvements at the 8th week. IAHA might be a good alternative to steroid for managing HSP when the use of steroid is limited.
authors.affiliation: Department of Rehabilitation Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Myung Hun
authors.identifier: 0000-0002-9694-5409
authors.initials: MH
authors.lastname: Jang
authors.affiliation: Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
authors.forename: Chang-Hyung
authors.identifier: 0000-0001-6460-6368
authors.initials: CH
authors.lastname: Lee
authors.affiliation: Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
authors.forename: Yong-Il
authors.identifier: 0000-0001-7894-0930
authors.initials: YI
authors.lastname: Shin
authors.affiliation: Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
authors.forename: Soo-Yeon
authors.identifier: 0000-0001-5679-0126
authors.initials: SY
authors.lastname: Kim
authors.affiliation: Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
authors.forename: Sung Chul
authors.identifier: 0000-0002-7740-8050
authors.initials: SC
authors.lastname: Huh
keywords: Adhesive capsulitis; Hyaluronic acid; Intra-articular injections; Stroke