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Agostini F, de Sire A, Paoloni M, Finamore N, Ammendolia A, Mangone M, Bernetti A. Effects of hyaluronic acid injections on pain and functioning in patients affected by tendinopathies: A narrative review. J Back Musculoskelet Rehabil 2022; 35:949-961. [PMID: 35213352 DOI: 10.3233/bmr-210309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Tendinopathies are overuse tendon injuries showing load-dependant pain, stiffness, weakness of movement in the affected area, and impairment in the movements. The scientific interest on the role of Hyaluronic Acid (HA) for the management of tendinopathies has been increased due to its anti-inflammatory and lubricative properties. OBJECTIVE To collect evidence regarding the effectiveness and safety of HA injections in reducing pain in patients affected by tendinopathies. METHODS A scientific literature search was conducted using the PubMed, Medline and PEDro electronic databases. The databases were searched since their inception until July 2021. The search was limited to English language articles. Different combinations of the terms and MeSH terms "tendinopathy", "tendinosis", "tendinitis", "hyaluronic acid", "hyaluronate", "infiltration", "hyaluronic injections", "viscosupplementation" connected with various boolean operators were used for other electronic databases. RESULTS One hundred and one records were identified from the selected databases plus three additional papers identified by the authors through other sources. After removing duplicated papers and title/abstract screening, 19 studies were included in our review (eight papers on shoulder, three on elbow, four on hand, one on knee, and three on ankle). CONCLUSION The results showed that none of the studies report severe adverse effects and most of them support the use of HA injections in tendinopathies, with a special attention to pain reduction and functional assessment. Further studies are warranted to better investigate effects and methods of administration of HA in tendinopathies.
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Affiliation(s)
- Francesco Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Marco Paoloni
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Nikolaos Finamore
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Antonio Ammendolia
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Massimiliano Mangone
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Andrea Bernetti
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy
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Khan M, Shanmugaraj A, Prada C, Patel A, Babins E, Bhandari M. The Role of Hyaluronic Acid for Soft Tissue Indications: A Systematic Review and Meta-Analysis. Sports Health 2022; 15:86-96. [PMID: 35114853 PMCID: PMC9808833 DOI: 10.1177/19417381211073316] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
CONTEXT Soft tissue injuries are often treated with injectables such as corticosteroids and platelet-rich plasma (PRP) to reduce inflammation and promote healing. There is increasing evidence examining the use of hyaluronic acid (HA) for the management of soft tissue injuries. OBJECTIVE To evaluate the treatment effect and role of HA for available soft tissue indications. DATA SOURCES A search of PubMed, MEDLINE, EMBASE, and CENTRAL from the inception date of each database through February 24, 2021, was conducted for all randomized controlled trials (RCTs) involving the use of HA for soft tissue indications. Two reviewers independently screened articles for eligibility and extracted data from included studies for analysis. We assessed risk of bias for all included studies and pooled outcomes using a fixed-effects model. Outcomes (ie, function and pain relief) were categorized to short-term (<6 weeks, 6-12 weeks) and mid-term (>12 weeks) data. We present effect estimates as mean differences (MDs) and standardized mean differences (SMDs) and present the estimate of effect of HA for available indications in relation to available comparators. STUDY DESIGN Meta-analysis of RCTs. LEVEL OF EVIDENCE Level 1. RESULTS Of the 6930 articles screened, 19 RCTs (n = 1629 patients) were eligible and included in this review. HA was evaluated across a variety of soft tissue indications including rotator cuff disease, elbow pain, ankle sprains, Achilles tendinopathy, patellar tendinopathy, and trigger finger. Of the 19 RCTs, 11 were placebo-controlled and 9 used active comparators (PRP, cortisone, prolotherapy, or extracorporeal shockwave therapy). The pooled treatment effect of HA across most soft indications against placebo and active comparators demonstrated benefit in short-term pain <6 weeks (MD visual analogue scale [VAS] 2.48, 95% CI 2.31-2.65) and 6 to 12 weeks (MD VAS 2.03, 95% CI 1.86-2.20). Mid-term pain relief also favored HA over comparators across indications >12 weeks from administration (MD VAS 3.57, 95% CI 3.35-3.78). High heterogeneity was present with rotator cuff (10 trials, I2 = 94%), and elbow tendinopathy (2 trials, I2 = 99%). We identified uncertain benefit for trigger finger (2 trials, I2 = 67%). Heterogeneity for ankle sprains, patellar tendinopathy and Achilles tendinopathy could not be assessed as they only had 1 trial each. CONCLUSION This systematic review and meta-analysis support HA's efficacy in the treatment of a variety of soft tissue indications. Understanding the relative effects of HA to other injectable modalities requires additional, large trials.
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Affiliation(s)
- Moin Khan
- Division of Orthopaedic Surgery,
Department of Surgery, McMaster University, Hamilton, Ontario, Canada,Department of Health Research Methods,
Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada,Moin Khan, MD, MSc, FRCSC,
McMaster University, St Joseph’s Healthcare Hamilton, 50 Charlton Avenue East,
Mary Grace Wing, Room G807, Hamilton, Ontario, L8N 4A6, Canada (
) (Twitter: @moinkhan_md)
| | - Ajaykumar Shanmugaraj
- Division of Orthopaedic Surgery,
Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Carlos Prada
- Division of Orthopaedic Surgery,
Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Ashaka Patel
- Schulich School of Medicine, Western
University, London, Ontario
| | - Eric Babins
- University of Calgary, Calgary,
Alberta, Canada
| | - Mohit Bhandari
- Division of Orthopaedic Surgery,
Department of Surgery, McMaster University, Hamilton, Ontario, Canada,Department of Health Research Methods,
Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Frizziero A, Vittadini F, Bigliardi D, Costantino C. Low Molecular Weight Hyaluronic Acid (500-730 Kda) Injections in Tendinopathies-A Narrative Review. J Funct Morphol Kinesiol 2021; 7:3. [PMID: 35076509 PMCID: PMC8788555 DOI: 10.3390/jfmk7010003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 11/25/2022] Open
Abstract
Tendinopathies are common causes of pain and disability in general population and athletes. Conservative treatment is largely preferred, and eccentric exercise or other modalities of therapeutic exercises are recommended. However, this approach requests several weeks of consecutive treatment and could be discouraging. In the last years, injections of different formulations were evaluated to accelerate functional recovery in combination with usual therapy. Hyaluronic acid (HA) preparations were proposed, in particular LMW-HA (500-730 kDa) for its unique molecular characteristics in favored extracellular matrix homeostasis and tenocyte viability. The purpose of our review is to evaluate the state-of-the-art about the role of 500-730 kDa in tendinopathies considering both preclinical and clinical findings and encourage further research on this emerging topic.
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Affiliation(s)
- Antonio Frizziero
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (D.B.); (C.C.)
| | - Filippo Vittadini
- Department of Physical and Rehabilitation Medicine, Casa di Cura Policlinico S. Marco, 30100 Venice, Italy;
| | - Davide Bigliardi
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (D.B.); (C.C.)
| | - Cosimo Costantino
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (D.B.); (C.C.)
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Sun X, Wang H, Zhang X, He B. Use of a Percutaneous Needle Release Technique for Trigger Thumb: A Retrospective Study of 11 Patients from a Single Center. Med Sci Monit 2021; 27:e931389. [PMID: 34615847 PMCID: PMC8507425 DOI: 10.12659/msm.931389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Trigger finger is a very common disorder that occurs in both adults and children. Trigger finger presents mainly as pain and limited movement of the affected digit. This report describes a modified percutaneous needle release and an evaluation of its clinical efficacy to treat trigger thumb. Material/Methods Trigger thumb of 11 patients was released percutaneously using a specially designed needle (0.8×100 mm) with a planus tip. Complete release was ensured when no more grating sound was heard and the needle moved freely at the tip. Pain-related functional score was evaluated preoperatively and at 3 months postoperatively. Resolution of Notta’s node, triggered or locked, Quinnell’s criteria, and patient satisfaction were also assessed at 3 months after the operation. Results After the percutaneous trigger thumb release, the overall visual analog scale (VAS) and pain-related functional scores declined significantly (P<0.01). There was no recurrence of thumb locking or triggering or Notta’s node. Only the first patient had incomplete release of the first annular pulley, and all patients showed high satisfaction with the procedure at 3 months after their operation. During the study, patients did not experience any complications such as inflammation, edema, or digital nerve injury. Conclusions This study demonstrated that the percutaneous technique is effective, less time-consuming, and safe for treating trigger thumb. Our release technique using a specially designed percutaneous needle is a valuable treatment for trigger thumb.
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Affiliation(s)
- Xianjie Sun
- Department of Orthopedics, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang, China (mainland).,Jiaxing Key Laboratory for Minimally Invasive Surgery in Orthopedics & Skeletal Regenerative Medicine, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang, China (mainland)
| | - Haidong Wang
- Department of Orthopedics, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing, Zhejiang, China (mainland)
| | - Xingen Zhang
- Department of Orthopedics, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang, China (mainland).,Jiaxing Key Laboratory for Minimally Invasive Surgery in Orthopedics & Skeletal Regenerative Medicine, Zhejiang Rongjun Hospital, Jiaxing, Zhejiang, China (mainland)
| | - Bangjian He
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China (mainland)
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Tanaka S, Uehara K, Sugimura R, Miura T, Ohe T, Tanaka S, Morizaki Y. Evaluation of the first annular pulley stretch effect under isometric contraction of the flexor tendon in healthy volunteers and trigger finger patients using ultrasonography. BMC Musculoskelet Disord 2021; 22:421. [PMID: 33957913 PMCID: PMC8101114 DOI: 10.1186/s12891-021-04299-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/27/2021] [Indexed: 12/05/2022] Open
Abstract
Background Isometric exercises for a flexed finger have been reported to be effective for treating trigger finger as the flexor tendon widens the space under the first annular (A1) pulley towards the palmar destination during the exercise. This study aimed to evaluate the structural changes during the A1 pulley stretch in healthy volunteers and patients with trigger finger using ultrasonography. Methods We enrolled 25 male and 14 female patients (39 middle fingers). The thickness of the subcutaneous tissue (parameter a), A1 pulley (parameter b), and the flexor tendon (parameter c) and the distance between the dorsal surface of the flexor tendon and the palmar surface of the metacarpal head (parameter d) were measured using ultrasonography of the metacarpophalangeal joint of the middle finger flexed at 45° at rest (pattern A) and under isometric contraction of the flexor tendon against an extension force of the proximal interphalangeal joint (pattern B). Results The average differences between patterns A and B in the healthy volunteers were 0.29 mm (parameter a; P = 0.02), 0.017 mm (parameter b; P = 0.63), 0.16 (parameter c; P = 0.26), and 0.41 (parameter d; P = 0.004), and those in patients with trigger finger were 0.22 mm (parameter a; P = 0.23), 0.019 mm (parameter b; P = 0.85), 0.03 mm (parameter c; P = 0.82), and 0.78 mm (parameter d; P < 0.001). The distance between the dorsal side of the A1 pulley and the palmar surface of the metacarpal head was also significantly increased by 0.57 mm (8.2%) in healthy volunteers (P < 0.001) and 0.81 mm (11%) in patients with trigger finger (P < 0.001). Conclusions In this study, the space under the A1 pulley was expanded under isometric contraction of the flexor tendon. These findings support the effectiveness of pulley stretch exercises for the trigger finger condition.
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Affiliation(s)
- Shinya Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kosuke Uehara
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Ryota Sugimura
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Toshiki Miura
- Department of Orthopaedic Surgery, JR General Hospital, Tokyo, Japan
| | - Takashi Ohe
- Department of Orthopaedic Surgery, NTT Medical Center Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yutaka Morizaki
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Niempoog S, Witoonchart K, Jaroenporn W. Hand Surgery in Thailand. J Hand Microsurg 2021; 13:35-41. [PMID: 33707921 DOI: 10.1055/s-0040-1721900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Modern hand surgery in Thailand started after the end of World War II. It is divided into 4 phases. In the initial phase (1950-1965), the surgery of the hand was mainly performed by general surgeons. In 1965-1975, which was the second phase, many plastic surgeons and orthopaedic surgeons graduated from foreign countries and came back to Thailand. They played a vital role in the treatment of the surgery of the hand and set up hand units in many centers. They also contributed to the establishment of the "Thai Society for Surgery of the Hand," which still continues to operate. In the third phase (1975-2000), there was a dramatic development of microsurgery because of the rapid economic expansion. There were many replantation, free tissue transfers, and brachial plexus surgeries in traffic and factory-related accidents. The first hand-fellow training program began in 1993. In the fourth phase (since 2000), the number of hand injuries from factory-related accidents began declining. But the injury from traffic accidents had been increasing both in severity and number. Moreover, the diseases of hand that relate to aging and degeneration had been on the rise. Thai hand surgeons have been using several state-of-the-art technologies such as arthroscopic and endoscopic surgery. They are continuing to invent innovations, generating international publications, and frequently being invited as speakers in foreign countries.
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Affiliation(s)
- Sunyarn Niempoog
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
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Shen PC, Chou SH, Lu CC, Fu YC, Lu CK, Liu WC, Huang PJ, Tien YC, Shih CL. Comparative effectiveness of various treatment strategies for trigger finger by pairwise meta-analysis. Clin Rehabil 2020; 34:1217-1229. [PMID: 32539454 DOI: 10.1177/0269215520932619] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the efficacy of various strategies in the treatment of trigger finger. DATA SOURCES A systematic literature search for randomized controlled trials to compare treatments for trigger finger was conducted through three online databases, Pubmed, Embase and Cochrane Library, from their inception dates to 22 May 2020. METHODS Relative risk (RR) with 95% confidence interval (CI) was used to evaluate the effect sizes in success rate for included articles. RESULTS Sixteen articles (n = 1185) were included in our meta-analysis. The results showed that the efficacy of steroid injection was significantly better than the placebo group at short-term follow-ups (RR = 19.00, 95% CI = 1.17-309.77 for one-week; RR = 3.70, 95% CI = 3.70, 95% CI = 1.61-8.53 for one-month), and then became non-significant at four months (RR = 3.21, 95% CI = 0.88-11.79). There was no significant difference in success rate between steroid injection and nonsteroidal anti-inflammatory drug injection, and between open surgery and percutaneous release at all the follow-ups. Only surgical treatment had significantly better efficacy in success rate than steroid injection at all follow-ups (RR = 0.48, 95% CI = 0.34-0.66 for one-month; RR = 0.87, 95% CI = 0.80-0.96 for three-month; RR = 0.58, 95% CI = 0.48-0.68 for six-month; RR = 0.38, 95% CI = 0.20-0.72 for 12-month). CONCLUSION There were no differences in efficacy between steroid injection and shockwave or nonsteroidal anti-inflammatory drug injection. The surgical treatments had the best efficacy among these treatments.
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Affiliation(s)
- Po-Chih Shen
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Shih-Hsiang Chou
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Cheng-Chang Lu
- College of Medicine, Kaohsiung Medical University, Kaohsiung.,Department of Orthopedics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung
| | - Yin-Chih Fu
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung.,College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Chun-Kuan Lu
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Wen-Chih Liu
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung.,Department of Orthopedics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung
| | - Peng-Ju Huang
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung.,College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Yin-Chun Tien
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung.,College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Chia-Lung Shih
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
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