Intra-articular injection of high versus low molecular weight hyaluronic acid in adhesive capsulitis - randomized trial

Q: What was the main purpose of comparing HMW-HA and LMW-HA?

To evaluate the comparative clinical effectiveness and safety of intra-articular injections of high molecular weight versus low molecular weight hyaluronic acid in patients with idiopathic adhesive capsulitis over 24 weeks.

Q: What outcomes were measured during the trial?

Visual analogue scale (VAS) pain scores, Oxford shoulder score (OSS), active range of motion, and patient satisfaction were assessed at 4, 12, and 24 weeks.

Q: Which treatment showed better pain and functional results?

HMW-HA was associated with greater pain reduction and functional improvement compared with LMW-HA, with between-group differences favoring HMW-HA at later endpoints.

Sep 28, 2026

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Adhesive capsulitis (AC) is a chronic inflammatory shoulder condition causing limited glenohumeral range of motion, where management prioritizes pain reduction and restoring joint function. This randomized, triple-blinded trial compared intra-articular injections of low molecular weight (LMW) versus high molecular weight (HMW) hyaluronic acid (HA) in AC patients. Fifty-six participants receiving standard physical therapy were followed at 4, 12, and 24 weeks using VAS, Oxford Shoulder Score, active ROM, and satisfaction as outcomes.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages13

Reading Time33 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusion

Article Highlights

Objectives

Methods

Key findings

Clinical relevance

Article History

References

Future Science OA 2026, VOL. 12, nO. 1, 2581460 [https://doi.org/10.1080/20565623.2025.2581460](https://doi.org/10.1080/20565623.2025.2581460) ReseaRch aRticle Intra-articular injection of high versus low molecular weight hyaluronic acid in adhesive capsulitis; randomized trial Mahshad Mira, Rezvaneh Mohebbia, Ghader Mohammadnezhada, seyed ahmad Raeissadatb, alireza Parhizgarc and hadi esmailya aStudent research committee, Department of clinical Pharmacy, School of Pharmacy, Shahid Beheshti university of Medical Sciences, tehran, iran; bclinical research Development center, Shahid Modarres Hospital, Physical Medicine and rehabilitation research center and Department, School of Medicine, Shahid Beheshti university of Medical Sciences, tehran, iran; cMD Anderson cancer center, the university of texas, Houston, tX, uSA ABSTRACT Background: adhesive capsulitis (ac) is a chronic inflammatory condition with limited range of motion (ROM) in the glenohumeral joint. the main goals in managing ac are pain reduction and returning joint function. intra-articular hyaluronic acid (ha) has been considered a safe modality in ac. this study compared the effectiveness of intra-articular injection of low molecular weight (lMW) with high molecular weight (hMW) ha in patients with ac. Methods: Fifty-six patients with ac were randomized in this triple-blinded clinical trial. all underwent standard physical therapy. the outcomes were visual analog scale (Vas), Oxford shoulder score (Oss), active ROM, and patient satisfaction at 4, 12, and 24 weeks. Results: No significant differences were detected in between-group variables at baseline. Both groups showed marked improvement in Vas, Oss, and ROM over [time. at](time. at) four weeks lMW-ha group had lower pain (P = 0.049). conversely, the trend of Vas at 12-week and 24-weekendpoints favors hMW-ha (Baseline to endpoint: −5.48 ± 1.68 and −3.91 ± 1.31 reduction in Vas as the primary outcome, P < 0.001). satisfaction had significantly improved in both groups. Conclusion: hMW-ha was associated with greater pain reduction and functional improvement compared with lMW-ha Trial Registration: the trial protocol was registered at the iranian Registry of clinical trials (iRct), a WhO Primary Register setup (registration No: iRct20170608034390N4; First registration date: 01/01/2020). ARTICLE HIGHLIGHTS Background: • adhesive capsulitis (frozen shoulder) is a common cause of shoulder pain and stiffness with prolonged recovery. • intra-articular hyaluronic acid (ha) is increasingly used, but the comparative effectiveness of high molecular weight (hMW) versus low molecular weight (lMW) ha remains unclear. Objectives: • to compare the clinical effectiveness and safety of intra-articular hMW-ha versus lMW-hain patients with idiopathic adhesive capsulitis. • to evaluate pain relief, functional improvement, range of motion (ROM), and patient satisfaction over 24 weeks. Methods: • a randomized, superiority clinical trial with 51 patients (25 in hMW-ha, 26 in lMW-ha). • Patients received ultrasound-guided intra-articular injections followed by a standardized home exercise program. • Primary endpoint: Visual analogue scale (Vas) pain score at 24 weeks. • secondary outcomes: Oxford shoulder score (Oss), range of motion (ROM), and patient satisfaction. Key findings: • Both groups improved significantly in pain and function over time. • at 24 weeks, the hMW-ha group demonstrated significantly greater reduction in Vas pain and improvement in Oss compared with lMW-ha. • improvements in sPaDi and ROM were observed in both groups, but between-group differences were modest. • Patient satisfaction increased in both groups, without significant between-group differences. • No serious adverse events were reported in either group. ARTICLE HISTORY Received 29 august 2025 accepted 24 October 2025 KEYWORDS adhesive capsulitis; hyaluronic acid; physical therapy; ultrasoundgui

FAQs

What was the main purpose of comparing HMW-HA and LMW-HA?

To evaluate the comparative clinical effectiveness and safety of intra-articular injections of high molecular weight versus low molecular weight hyaluronic acid in patients with idiopathic adhesive capsulitis over 24 weeks.

What outcomes were measured during the trial?

Visual analogue scale (VAS) pain scores, Oxford shoulder score (OSS), active range of motion, and patient satisfaction were assessed at 4, 12, and 24 weeks.

Which treatment showed better pain and functional results?

HMW-HA was associated with greater pain reduction and functional improvement compared with LMW-HA, with between-group differences favoring HMW-HA at later endpoints.

Sep 28, 2026

Uploaded by Muffet