Hyaluronic Acid Injections for the Shoulder

April 24, 2018

scott

Today the following question was sent to me:

Do you have any experience with SynVisc for shoulder and if so, what have been the results?

The use of gel injections, or viscosupplementation injections, or hyaluronic acid injections (all the same thing) for the knee has become common practice in orthopedics. There are several brands of this injectable hyaluronic acid on the market today that have been proven to help with pain from osteoarthritis of the knee. These are all FDA approved, as the clinical trials that brought them to market were done in the knee. A few have tried to evaluate using hyaluronic acid in the shoulder, but there is yet to be a really great study that shows it is of benefit in the shoulder.

Gel Injections:
How quickly do they work?
Gel Injections for Knee Osteoarthritis

In the design of such treatments, one must understand that for every shoulder that could benefit from such an injection, there are likely 50 knees that would as well. If a company can sell 50 syringes for the knee, and only 1 for the shoulder, it makes sense the research dollars are put into the knee.

Despite the lack of concrete evidence of success in the shoulder, I think there are a few considerations. First, The shoulder joint is lined with cartilage just like the knee. Similar large forces are exerted across its surface when used. It naturally makes biologic sense that if it is effective in the knee, the results in the shoulder may be similar. There is no increased risk of injection in the shoulder than in the knee. As a treatment, weighing the risks and benefits, I believe it is sometime to consider and to try.

As it is not yet proven for the shoulder (remember that is not saying it does not work, just the study has not shown it yet), it is not covered by insurance companies, and typically requires a cash payment.

In my office, we frequently use hyaluronic acid in the shoulder when requested. I have seen many patients notice improvement in pain and function. If you have worsening arthritis of the shoulder, and would like to avoid surgery, I think trying a series of hyaluronic acid injections is reasonable. I would suggest you discuss this with me or your surgeon and make the best decision for you.

One response to “Hyaluronic Acid Injections for the Shoulder”

Antnio Calderon

April 24, 2018

Thank you , Dr. Hacker, for your insightful response to my question. Your answer was detailed and helpful.

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Brian K.

September 16, 2019

Dr. Hacker, thank you for this note. I have bilateral shoulder OA that has been managed with steroid injections, physical therapy, and oral analgesics. Pain has become intolerable and I’m too young for a shoulder replacement(s.) I am on my second Synvisc injection, of a series of three, dosed one week apart in each shoulder. Thus far, there has been a very substantial reduction in pain. The primary challenge is obtaining the Synvisc. Insurers will not cover the cost for shoulder injections, even after repeated petitions for a prior approval. Thus, I obtained and paid cash in Mexico for the drug. (It is also available in this manner via Canada.) Both choices are at least half price of what would be paid in the US. Either way, I’ll be happy to check back in to comment on the duration of pain relief. My orthopedist employed anterior injections without the assistance of a fluoroscope. Fingers crossed!

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Scott Hacker MD

September 22, 2019

You are welcome. Please let me know if you need more information. I truly believe your question is one that many have and hope this reaches others with similar trouble. All the best !

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Scott Hacker MD

September 22, 2019

Dear Brian
I’m so glad to hear that the synvisc injections are helping. Perhaps someday the insurers will think differently. In fact, they have pulled back from the use of viscosupplementation in knees as well, despite multiple clinical trials that proved its benefit. I give a lot of these injections for knees and shoulders these days but the patients, like you, have to pay for it. My office in San Diego tries to make this affordable for everyone. It is certainly an easier way to go than having surgery. Using image guidance may not make much of a difference in placement of the injection. Please let me know if you have more questions. All the best,
Scott Hacker MD

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Charlie Willey

August 21, 2020

I’ve just had a HA injection in my right shoulder. It has already had a significant reduction in pain. In just 24 hours.. I will probably have to pay for this myself but did not have to immediately. I’m a 67 year old male that has already had 2 shoulder surgeries. Shoulder replacement surgery has been suggested and I frankly do not want to go through this again. I live to far from Mexico or Canada to go there. Wish me Luck,

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Perry Silverman

August 31, 2020

Dear Dr. Hacker,

What is the cost of the viscosupplementation injections at your office when used for the shoulder?

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Scott Hacker MD

December 5, 2020

Viscosupplementation injections for the shoulder are common – unfortunately, there is not enough research data to claim that it works or not. While considered off-label usage, we perform shoulder viscosupplementation injections in my office. Please contact my office to get cost information. Thanks for asking. Hope to see you soon.

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Walter Novey

February 23, 2021

Hello Dr. Hacker,

Do you know about any clinical stuidies that are currently being done to validate the efficacy of synvisc injections for shoulder arthritis. Given the amount of shoulder arthritis in this country, it would seem like a clinical trial would make sense as a path for FDA approval (leading to eventual insurance coverage).
Thanks,
Walt Novey, MD

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Matthew Israelson

May 17, 2022

Thanks Dr Hacker –
This is the 1st , actually, informative, piece I’ve
found on the possibility of hyaluronic injections for
the shoulder.
I did see some articles noting the presence of
HA in tumor growth . Just wondering your thoughts
on that? Also, it appears you do use this from time to
time in shoulders – – are the results generally favorable? I’m at a point that sleep is no longer
possible unless I’m in a chair . My goal now is to avoid this constant discomfort . I’m told that the joint
is lready for complete replacement, but prefer not to go that route yet.
Thanks
Matt

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James Nuehring

June 10, 2022

What if your Kaiser Sports Medicine Dr. states, Syncvisc is a mixed bag and only used on knees.

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Scott Hacker MD

October 25, 2022

Hi Walt
Agree it does make sense to do the definitive studies but I am not aware of anything currently in the pipeline for this. I know it has been discussed with several companies, but nothing so far. I suppose we will have to wait at this point. All the best

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Scott Hacker MD

October 25, 2022

Everyone is entitled to their opinion. One must consider the risks vs benefits. So far there seems to be little known risk in the shoulder and a potential benefit. I have personally seen patients improve with it and return for it every 6 months.

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Scott Hacker MD

January 28, 2023

Thanks Matt – I use a lot of HA in the shoulder for patients that request it as it is not approved for this use by insurance. Despite that i have a few patients that keep coming back for it and love it. Not sure about eh tumor growth. Nothing I’ve seen mentions that. The replacement of course if a gold standard treatment for severe shoulder arthritis, but it may be worth discussing the HA injections with your ortho doc and see if he/she is willing to try. All the best.

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Richard Silvano

February 2, 2023

Dr. Hacker, I can’t say enough about HA use in reducing shoulder pain. I had needed a total shoulder replacement for some time but because of family responsibilities I kept putting it off. My ortho doctor had given me a cortisone injection that lasted less than 2 weeks. Then he said he had some samples of HA and would I like to try it in my shoulder. I’d try anything at that point and he gave me a series of 3 injections 1 week apart. HA lasted me a year and a half. At that point I ended up having the surgery. HA was a godsend.

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Kathleen Gardner

September 10, 2023

Dr. Hacker, I live in NJ. Do you have any colleagues in NJ who provide HA treatment for shoulder pain? Also: are there any clinical trials yet?

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Scott Hacker MD

October 14, 2024

Please write to me separately from this post and I can give you a few doctors I know in the New York / New Jersey area. No trials are currently in progress on shoulder HA, but Pacira is working on a longer acting steroid treatment for shoulders. All the best.

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