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.
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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.