Sodium Hyaluronate Superior to Steroid and ESWT

Sodium hyaluronate tendinopathy injections found to be superior to corticosteroid injections or shockwave therapy

Have you ever considered Sodium Hyaluronate injections to treat tendinopathy, instead of corticosteroid injections (CSI) or Extracorporeal Shock Wave Therapy (ESWT)? Here are some considerations and comparative studies:


Several recent studies have raised questions regarding the use of corticosteroid injections for treating tendinopathy, specifically in relation to the potentially toxic effect it exerts on tendinous tissue.¹ 

CSI vs Placebo:

A meta-analysis by Krogh et al.² to assess the comparative effectiveness and safety of injection therapies in patients with lateral epicondylitis, showed that corticosteroid injections are no more effective than placebo, but that Sodium Hyaluronate (SH) is. 

CSI vs Sodium Hyaluronate (SH):

Gorelick et al.³ investigated the effectiveness of SH for the treatment of lateral epicondylitis, both as a single treatment intervention, but also in combination with steroid, versus steroid alone. The study concluded that an injection with SH (OSTENIL® TENDON) alone was significantly superior to treatment with corticosteroid alone for the treatment of tennis elbow. The effect of the combined treatments, SH and steroid, was similar to the effect of the SH alone, but with more steroid - associated adverse effects. The effect of the SH alone treatment lasted for a period of at least one year. (Fig 1 + 2)

Dash score graph Significant reduction in DASH score at one year between treatments with hyaluronate as a single injection or in combination with steroid versus steroid alone. P<0.001
Fig 1
VAS Score graph Significant reduction in VAS score at one year between treatments with hyaluronate as single or in combination with steroid vs steroids alone P<0.001
Fig 2


A further study by Gorelick et al.4 investigated the effect of the OSTENIL® TENDON treatment for problems with the Achilles tendon. The SH group was superior to the corticosteroid group at all intervals during the study. Superiority achieved statistical significance after 6 and after 12 months. Even at one year following the end of treatment, pain scores in the SH group continued to decrease, whereas pain scores in the steroid group gradually increased at six months following treatment. The effect of corticosteroid treatment corresponded to the effect of conservative treatment in the long term.  

ESWT vs Sodium Hyaluronate (SH):

A randomized clinical efficacy and safety study was undertaken by N. Lynen et al., comparing OSTENIL® TENDON with Extracorporeal Shockwave Therapy (ESWT) for treating painful Achilles tendinopathy.5 The study showed SH to be superior to ESWT and concluded that "Two peritendinous HA injections resulted in significant symptomatic pain relief and improvement in function in patients with Achilles midportion tendinopathy, with a low risk for AEs."


OSTENIL® injections are classed as a Class III medical device, not a prescription only medicine (POM). Therefore, Extended Scope Physiotherapists and other clinicians who have had training in intra-articular injections don’t need to have a prescribing license in order to administer viscosupplementation injections. 

For OSTENIL® TENDON peritendinous injections, however, we recommend the use of ultrasound visualising equipment to ensure correct placement of the hyaluronan, thus ensuring the best possible treatment outcome.


If you would like to evaluate sodium hyaluronate as a treatment option for tendinopathy at your clinic, and would like to speak with one of our area representatives, then please respond by email to
We look forward to hearing from you. 


1. Osborne H (2010): Stop injecting corticosteroid into patients with tennis elbow, they are much more likely to get better by themselves! J Sci Med Sport 13: 380-381.
2. Krogh TP, Bartels EM, Ellingsen T, Stengaard Pedersen K, Buchbinder R, et al. (2013): Comparative effectiveness of injection therapies in lateral epicondylitis: A systematic review and network meta-analysis of randomized controlled trials. Am J Sports Med 41: 1435-1446.
3. Gorelick L, Gorelick AR, Saab A, Ram E, Robinson D (2015): Lateral Epicondylitis Injection Therapy: A Safety and Efficacy Analysis of Hyaluronate versus Corticosteroid Injections. Adv Tech Biol Med 3: 130.
4. Gorelick L et al.; Single Hyaluronate Injection in the Management of Insertional Achilles Tendinopathy in Comparison to Corticosteroid Injections and Non-invasive Conservative Treatments, Sch Bull,: Jul 2015, 16-20.
5. Lynen N et al.: Comparison of Peritendinous Hyaluronan Injections Versus Extracorporeal Shock Wave Therapy in the Treatment of Painful Achilles' Tendinopathy: A Randomized Clinical Efficacy and Safety Study. Arch Phys Med Rehabil. 2017 Jan;98(1):64-71.

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