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Adhesive capsulitis (frozen shoulder) is a painful condition marked by shoulder stiffness, decreased range of motion (ROM), and functional impairment.
Intra-articular hyaluronic acid + ketorolac improves shoulder mobility in adhesive capsulitis, with modest gains in external rotation and adduction compared with ketorolac alone.
Adhesive capsulitis (frozen shoulder) is a painful condition marked by shoulder stiffness, decreased range of motion (ROM), and functional impairment. This randomized controlled trial explored the effectiveness of moderate-molecular-weight hyaluronic acid (HA) combined with ketorolac (non-steroidal anti-inflammatory drug; NSAID) versus ketorolac alone in improving shoulder pain, functional outcomes, and joint ROM.
In total, 56 patients diagnosed with adhesive capsulitis were randomly assigned to receive either combined HA plus ketorolac injection (n = 28) or ketorolac injection alone (n = 28). Each patient received a single intra-articular shoulder injection, followed by a standardized rehabilitation and physiotherapy program. Clinical outcomes were determined using the Thai shoulder pain and disability index (Thai SPADI), visual analog scale (VAS) for pain, passive shoulder ROM, and analgesic medication usage. Assessments were executed at baseline and at 2, 6, 12, and 24 weeks after treatment.
Both groups illustrated remarkable improvement in shoulder pain and disability scores over time. However, there were no statistically significant differences between the groups in overall SPADI or VAS scores at any follow-up visit, as depicted in Table 1:
Notably, HA + ketorolac showed a higher improvement in specific shoulder ROM parameters, including better external rotation at 24 weeks (mean difference 9°) and more improvement in adduction at both 2 weeks (mean difference 5°) and 24 weeks (mean difference 8°). Analgesic consumption remained similar between groups, and no severe adverse events or safety concerns were noted.
Both intra-articular HA + ketorolac injection and ketorolac injection alone considerably improved shoulder pain, functional outcomes, and disability in adhesive capsulitis. While overall pain and functional improvements were comparable, the combination therapy demonstrated modest but pronounced advantages in restoring external rotation and shoulder adduction. Thus, HA + ketorolac injection appears to be a valuable non-steroid option, particularly for those who cannot receive corticosteroid injections for frozen shoulder.
Journal of Shoulder and Elbow Surgery
Efficacy of combined intra-articular hyaluronic acid and ketorolac versus ketorolac alone in the treatment of adhesive capsulitis: a randomized controlled trial
Sorawut Thamyongkit et al.
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