Abstract
INTRODUCTION: There is growing evidence that hyaluronic acid (HA) injections can significantly improve pain and function in rotator cuff tendinopathy. However, there is no consensus regarding the optimal parameters for HA injections. This narrative review explores the procedural considerations for HA injections in rotator cuff tendinopathy. METHODS: A literature search using Pubmed and Cochrane was conducted to assess procedural considerations for HA injections in rotator cuff tendinopathy including the type of HA (linear vs. cross-linked), the molecular weight (low, moderate, and high), the combination of HA with other products, the number and frequency of injections, the injection guidance, and the adverse effects. RESULTS: Nine randomized-controlled trials and two prospective non-randomized studies assessed the efficacy of HA injections for rotator cuff tendinopathy, and their characteristics were thoroughly analyzed. Two studies compared the efficacy of different molecular weight HA. One study assessed the efficacy of HA combined with extracorporeal shockwave therapy. CONCLUSION: Highlights of the findings include the clinical benefits of HA injections for rotator cuff tendinopathy, the better tolerability of low molecular weight HA compared to high molecular weight, the safer adverse effect profile of HA compared to glucocorticoid injections, and the synergistic effect of HA and extracorporeal shockwave therapy.