Chronic Shoulder Pain

Significant reduction in pain for at least 6 months with two OSTENIL^® TENDON injections

Chronic shoulder pain is associated with a considerable impairment of the quality of life of affected patients. The main cause of chronic shoulder pain is traumatic injury of the rotator cuff tendons, and usually presents as a component of an impingement syndrome. In MRI or ultrasound examinations, signs of rotator cuff tendinitis are found in 70-90% of patients with chronic shoulder pain.

Chronic shoulder pain is one of the main reasons patients go to an orthopaedic or musculoskeletal specialist, therefore it's vital for MSK clinicians to be informed of the latest treatment options relevant to their practice.

Local injections of hyaluronic acid and platelet-rich plasma (PRP) are considered effective methods to treat chronic shoulder pain associated with damage to the rotator cuff tendons.

A recent study by Nesterenko et al. compared the efficacy and safety of treatment with hyaluronic acid (OSTENIL® TENDON) and PRP in patients with chronic shoulder pain with damage to the tendons of the rotator cuff.¹

The open-label study included a total of 100 patients with chronic shoulder pain persisting for at least 3 months (signs of tendinitis and/or degenerative changes in the rotator cuff tendons). 50 patients were given two OSTENIL^® TENDON injections (under ultrasound guidance in the region of the subacromial bursa) at an interval of one week; the other 50 patients were given PRP treatment (three injections at weekly intervals). Follow-up examinations were carried out 1, 3 and 6 months after treatment.

The following outcomes were used to assess effectiveness: Improvement in pain on a VAS scale, changes in the ASES (American Shoulder and Elbow Assessment) and CSS (Constant Shoulder Score) questionnaires. To assess the safety of treatment, an analysis was made of all adverse reactions that occurred during the injections and during the 6-month follow-up period.

In this study, there was significant improvement of the chronic shoulder pain in connection with the impingement syndrome of the rotator cuff both under treatment with OSTENIL^® TENDON and with PRP. Both products led to a significant reduction in pain intensity on the VAS and of functional impairment measured using the ASES and CSS scores. In addition, the extent of the therapeutic effect increased over time, reaching the maximum 6 months after treatment.

A good "response" to treatment (reduction of pain to the level of <40 mm VAS) was observed in around half the patients. After 6 months, 60% of the OSTENIL^® TENDON patients reported only moderate/slight pain (<40 mm VAS), in the PRP group this was reported by 48% of the patients. 

	In the course of the study, under treatment with OSTENIL® TENDON and PRP, there was a significant improvement (p<0.001) in chronic shoulder pain. Both products led to a significant reduction in pain intensity on the VAS after just one month. The results in the two groups were comparable. However, in the third month of follow-up, a significantly larger number of patients in the OSTENIL® TENDON group reported only moderate/slight pain.
With respect to functional impairment, measured using the ASES score and the CSS score, there was also statistically significant improvement in the findings (p<0.001).

In both groups, age-dependent effectiveness of the treatment was found. The changes in the intensity of pain and the ASES and CSS scores were significantly better in patients under age 45. This can be explained by the greater potential for regeneration in younger patients.

No serious adverse events occurred that required discontinuation of treatment. However, 40% of the patients reported pain during the first 3-4 days after the PRP injections. No adverse events occurred in the OSTENIL^® TENDON group. 

CONCLUSION: Two OSTENIL^® TENDON injections are just as effective as three injections of PRP. They lead to a significant improvement of pain and findings in the treatment of chronic shoulder pain associated with an impingement syndrome of the rotator cuff. This effect lasts for a period of at least six months.

CONCLUSION FOR CLINICAL PRACTICE:

• The treatment costs for two OSTENIL^® TENDON injections are considerably lower for patients.
• Treatment with OSTENIL^® TENDON is particularly suitable for patients who are not available for a long period (two injections of OSTENIL^® TENDON vs. three injections of PRP)
• Easy handling - more time for your patients: Treatment with OSTENIL^® TENDON is more efficient in terms of time and workload.

1.    V. A. Nesterenko, A. E. Karateev, M. A. Makarov, E. I. Byalik, S.A. Makarov, A. M. Lila Comparison of the efficacy of subacromial injection of platelet-rich plasma and hyaluronic acid for chronic shoulder pain caused by damage to the tendons of the muscles of the rotator cuff in a 6-month open-label clinical study. Rheumatology Science and Practice 2020;58(5):570-576.