Efficacy of combined intra-articular hyaluronic acid and ketorolac versus ketorolac alone in the treatment of adhesive capsulitis: a randomized controlled trial
Issued Date
2026-01-01
Resource Type
ISSN
10582746
eISSN
15326500
Scopus ID
2-s2.0-105030562123
Pubmed ID
41548592
Journal Title
Journal of Shoulder and Elbow Surgery
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SCOPUS
Bibliographic Citation
Journal of Shoulder and Elbow Surgery (2026)
Suggested Citation
Thamyongkit S., Charoenchaipong P., Fuangfa P., Taweesakulvashra R., Saengpetch N. Efficacy of combined intra-articular hyaluronic acid and ketorolac versus ketorolac alone in the treatment of adhesive capsulitis: a randomized controlled trial. Journal of Shoulder and Elbow Surgery (2026). doi:10.1016/j.jse.2025.12.007 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/115442
Title
Efficacy of combined intra-articular hyaluronic acid and ketorolac versus ketorolac alone in the treatment of adhesive capsulitis: a randomized controlled trial
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Corresponding Author(s)
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Abstract
Background: Intra-articular corticosteroids are widely used for adhesive capsulitis, but alternatives are needed for patients with contraindications. Hyaluronic acid (HA) and ketorolac have demonstrated individual benefits; however, evidence regarding their combined use remains limited. This study aimed to evaluate and compare the clinical outcomes of intra-articular injection of combined moderate -molecular-weight HA and ketorolac versus ketorolac alone in patients with adhesive capsulitis, focusing on shoulder function, pain reduction, and improvement in range of motion (ROM). We hypothesized that the HA + ketorolac combination would provide superior improvement in function, pain, and ROM compared with ketorolac alone. Methods: In this randomized, double-blind controlled trial, 56 patients were allocated to HA + ketorolac (n = 28) or ketorolac alone (n = 28). Each received a single intra-articular injection followed by standardized rehabilitation. Outcomes included the Thai Shoulder Pain and Disability Index (Thai SPADI), visual analog scale (VAS), passive ROM, and analgesic use, assessed at baseline and at 2, 6, 12, and 24 weeks. Results: Both groups improved significantly in SPADI and VAS over time, with no between-group differences at any visit (24-week SPADI: 9.8 ± 12.5 vs 12.1 ± 17.8; P = .932; VAS: 0.8 ± 1.1 vs 1.4 ± 2.2; P = .501). The HA + ketorolac group demonstrated greater recovery in specific ROM planes, including significantly better external rotation at 24 weeks (mean difference 9°, 95% confidence interval [CI] 0 -18; P = .039) and greater improvement in adduction at both 2 weeks (mean difference 5°, 95% CI 0 -10; P = .039) and 24 weeks (mean difference 8°, 95% CI 2 -14; P = .012). Analgesic consumption was comparable between groups, and no serious adverse events were reported. Conclusion: Both HA + ketorolac and ketorolac alone significantly improved pain and function in adhesive capsulitis. Combination therapy provided small but statistically significant advantages in recovery of external rotation and adduction. Both treatments represent reasonable options, particularly for patients in whom corticosteroids are contraindicated.