Hyaluronidase in Intra-articular Steroid Injection Treating the Adhesive Capsulitis for Shoulder

NCT ID: NCT04347733

Last Updated: 2020-04-15

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

30 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-05-02

Study Completion Date

2019-07-16

Brief Summary

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Adhesive capsulitis (AC) is painful and disabling condition that is associated with a gradual loss of shoulder motion. Intra-articular steroid injection is a common treatment in the initial painful stage of AC, and its use in combination with hyaluronidase may offer increased therapeutic efficacy owing to synergistic effects. We determined the therapeutic efficiency of the co-administration of hyaluronidase in early AC by evaluating symptomatic, anthropometric, and imaging changes.

Detailed Description

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We enrolled eligible patients with primary adhesive capsulitis in the initial stage.The subjects were randomly assigned into 3 groups to receive ultrasound-guided intra-articular injections with 20 mg (group A) and 40 mg triamcinolone acetonide (group B) and 20 mg acetonide combined with hyaluronidase (group C). The outcome measures included the visual analogue scale (VAS), the shoulder disability questionnaire (SDQ), abduction and external rotation range of motion, and intra-sheath fluid (ISF) before treatment and at 2, 4, 8, and 16 weeks after treatment.

Conditions

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Adhesive Capsulitis of Shoulder

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SEQUENTIAL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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Group A

Intra-articular injection, 20 mg (0.5 mL) of triamcinolone acetonide mixed with 2 mL of 2% lidocaine and 7.5 mL of normal saline

Group Type EXPERIMENTAL

Triamcinolone Acetonide 40mg/mL

Intervention Type DRUG

We aimed to examine the therapeutic efficacy of the combination of hyaluronidase and steroid injection for adhesive capsulitis and to determine whether such a combination therapy might enable the total amount of steroids to be reduced.

Group B

40 mg (1 mL) of triamcinolone acetonide mixed with 2 mL of 2% lidocaine and 7.0 mL of normal saline

Group Type EXPERIMENTAL

Triamcinolone Acetonide 40mg/mL

Intervention Type DRUG

We aimed to examine the therapeutic efficacy of the combination of hyaluronidase and steroid injection for adhesive capsulitis and to determine whether such a combination therapy might enable the total amount of steroids to be reduced.

Group C

20 mg (0.5 mL) of triamcinolone acetonide and 1 mL of hyaluronidase mixed with 2 mL of 2% lidocaine and 6.5 mL of normal saline

Group Type ACTIVE_COMPARATOR

Triamcinolone Acetonide 40mg/mL

Intervention Type DRUG

We aimed to examine the therapeutic efficacy of the combination of hyaluronidase and steroid injection for adhesive capsulitis and to determine whether such a combination therapy might enable the total amount of steroids to be reduced.

Hyaluronidase Injection

Intervention Type DRUG

We aimed to examine the therapeutic efficacy of the combination of hyaluronidase and steroid injection for adhesive capsulitis and to determine whether such a combination therapy might enable the total amount of steroids to be reduced.

Interventions

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Triamcinolone Acetonide 40mg/mL

We aimed to examine the therapeutic efficacy of the combination of hyaluronidase and steroid injection for adhesive capsulitis and to determine whether such a combination therapy might enable the total amount of steroids to be reduced.

Intervention Type DRUG

Hyaluronidase Injection

We aimed to examine the therapeutic efficacy of the combination of hyaluronidase and steroid injection for adhesive capsulitis and to determine whether such a combination therapy might enable the total amount of steroids to be reduced.

Intervention Type DRUG

Other Intervention Names

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Hirax Inj® BMI KOREA Pharmaceutical, South Korea

Eligibility Criteria

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Inclusion Criteria

* Normal findings on simple x-rays of the shoulder but limitations in passive range of motion on physical examination
* Increased intra-sheath fluid (ISF) sufficient to encircle the long head of the biceps tendon within the upper portion of the bicipital groove of the humerus.

Exclusion Criteria

* Ultrasonographic diagnosis of other concomitant fundamental abnormalities causing shoulder pain such as rotator cuff tear, bicipital tendon rupture, calcific tendinopathy, and subacromial-subdeltoid bursitis
* A history of shoulder injury
* A history of more than 1 year of conservative treatment for chronic shoulder pain
* Corticosteroid or hyaluronidase injections within the prior 6 months
* Hemiplegic shoulder
* Self-reported history consistent with scapula fracture or disarticulation
* Ipsilaterally cervical herniated intervertebral disc or brachial plexus injury
* Diabetes mellitus refractory to insulin therapy or glycated hemoglobin greater than 6.5
* Refusal to participate in this study
Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Veterans Health Service Medical Center, Seoul, Korea

OTHER

Sponsor Role lead

Responsible Party

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Wonjae Lee, MD PhD

Director for the department of physical medicine and rehabilitation

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Wonjae Lee, MD, Ph D

Role: STUDY_DIRECTOR

Veterans Health Service Medical Center, Seoul, Korea

Locations

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Veterans Health Service Medical Center

Seoul, , South Korea

Site Status

Countries

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South Korea

References

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Fields BKK, Skalski MR, Patel DB, White EA, Tomasian A, Gross JS, Matcuk GR Jr. Adhesive capsulitis: review of imaging findings, pathophysiology, clinical presentation, and treatment options. Skeletal Radiol. 2019 Aug;48(8):1171-1184. doi: 10.1007/s00256-018-3139-6. Epub 2019 Jan 3.

Reference Type BACKGROUND
PMID: 30607455 (View on PubMed)

Ahn JH, Lee DH, Kang H, Lee MY, Kang DR, Yoon SH. Early Intra-articular Corticosteroid Injection Improves Pain and Function in Adhesive Capsulitis of the Shoulder: 1-Year Retrospective Longitudinal Study. PM R. 2018 Jan;10(1):19-27. doi: 10.1016/j.pmrj.2017.06.004. Epub 2017 Jun 12.

Reference Type BACKGROUND
PMID: 28619380 (View on PubMed)

Tandon A, Dewan S, Bhatt S, Jain AK, Kumari R. Sonography in diagnosis of adhesive capsulitis of the shoulder: a case-control study. J Ultrasound. 2017 Aug 21;20(3):227-236. doi: 10.1007/s40477-017-0262-5. eCollection 2017 Sep.

Reference Type BACKGROUND
PMID: 28900523 (View on PubMed)

Byun SD, Park DH, Hong YH, Lee ZI. The additive effects of hyaluronidase in subacromial bursa injections administered to patients with peri-articular shoulder disorder. Ann Rehabil Med. 2012 Feb;36(1):105-11. doi: 10.5535/arm.2012.36.1.105. Epub 2012 Feb 29.

Reference Type BACKGROUND
PMID: 22506242 (View on PubMed)

Buhren BA, Schrumpf H, Hoff NP, Bolke E, Hilton S, Gerber PA. Hyaluronidase: from clinical applications to molecular and cellular mechanisms. Eur J Med Res. 2016 Feb 13;21:5. doi: 10.1186/s40001-016-0201-5.

Reference Type RESULT
PMID: 26873038 (View on PubMed)

Cho CH, Song KS, Kim BS, Kim DH, Lho YM. Biological Aspect of Pathophysiology for Frozen Shoulder. Biomed Res Int. 2018 May 24;2018:7274517. doi: 10.1155/2018/7274517. eCollection 2018.

Reference Type RESULT
PMID: 29992159 (View on PubMed)

Other Identifiers

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2017-03-011-001

Identifier Type: -

Identifier Source: org_study_id

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