Hyaluronic Acid Intra-Articular Injections in Patients Affected by Moderate to Severe Glenohumeral Osteoarthritis: A Prospective Randomized Study

Glenohumeral osteoarthritis (OA) is characterized by the appearance of typical degenerative changes in the cartilage, synovialmembrane, synovialfluid, and subchondral bone.1OA is one of the main reasons of persistent shoulder pain and reduced range of motion (ROM)2,3 and can compromise the activitiesofworkanddaily living leading to thedevelopmentof depressive syndromes.1,4 The treatment of this pathology can be conservative in patients affected by grade I–III OA or grade IV OA with contraindications to surgical treatment. The conservative approach generally includes intra-articular injections with corticosteroids, hyaluronic acid (HA), physical therapy, or the use of oral analgesics.5–11 However, analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) are often associatedwith essential side effects.12–14 Viscosupplementation with HA intra-articular injections is a nonsurgical treatment that can improve pain relief and lead to a partial recovery