Hyaluronic acid is a natural component of synovial fluid and contributes to its lubricating properties. During treatment, a hyaluronic acid preparation is injected directly into the shoulder joint with a fine needle.

The treatment is one of the various forms of hyaluronic acid therapy. Before an injection, it must be determined precisely whether the symptoms actually originate from the shoulder joint or from another structure.

A hyaluronic acid injection in the shoulder can be considered for selected degenerative complaints of the shoulder joint, particularly for:

• Shoulder osteoarthritis, also known as omarthrosis;
• load-dependent pain in the shoulder joint;
• increasing restriction of movement;
• recurrent complaints despite conservative treatment;
• intolerance or insufficient effect of other measures.

Not all shoulder pain originates in the actual shoulder joint. Tendons, bursae, the acromioclavicular joint, the rotator cuff, or the cervical spine can also cause complaints. Therefore, a thorough orthopedic examination is necessary. The existing page on shoulder infiltration also distinguishes several possible target structures.

Further information on the condition can be found on our page on shoulder osteoarthritis.

The scientific evaluation of hyaluronic acid therapy for osteoarthritis of the true shoulder joint is cautious. The guideline of the American Academy of Orthopaedic Surgeons concludes that hyaluronic acid offers no proven benefit in glenohumeral osteoarthritis and issues a strong recommendation against it.

A hyaluronic acid injection in the shoulder should therefore not be presented as a routine standard treatment. A specific effect or duration of effect cannot be guaranteed. Other conservative and surgical treatment options should also be considered during the medical consultation.

Medical examination

First, the location, duration, and possible triggers of the symptoms are discussed. The doctor examines the mobility, strength, and stability of the shoulder. Existing X-ray, ultrasound or MRI findings can be included in the assessment.

Determination of the target structure

Before the injection, it is determined whether the shoulder joint is indeed the likely source of pain. A hyaluronic acid injection into the joint is not automatically appropriate if, for example, the symptoms originate from a tendon or a bursa.

Preparation and injection

The shoulder area is carefully disinfected. The hyaluronic acid preparation is then introduced into the intended joint using a fine needle.

Depending on the anatomical situation, the position of the needle can be monitored using ultrasound. Ultrasound enables visualization of joints, tendons, bursae, and other structures in the shoulder area.

Follow-up

After the injection, the immediate reaction is monitored. You will then receive individual recommendations regarding loading of the shoulder and the further treatment plan.

An ultrasound-guided procedure can help visualize the target structure and monitor the position of the needle during treatment. Whether ultrasound guidance is necessary depends on the intended target region and the physician’s assessment.

Further information can be found on the page about ultrasound-guided pain therapy. 

The number and intervals of applications depend on the product used and the individual treatment plan. Depending on the product, a single application or a series of multiple injections may be planned.

Whether another injection is advisable is determined based on the effect to date, tolerability, and the medical findings.

Inform the treating physician in particular about:

• acute infections or fever;
• skin changes at the injection site;
• allergies to components of the preparation;
• blood clotting disorders;
• blood-thinning medications;
• a planned or recently performed shoulder surgery;
• pregnancy;
• medications taken regularly.

Medications must not be discontinued or changed before the treatment without consulting a doctor.

After the treatment, it may be advisable to temporarily rest the shoulder. Strenuous sports activities, heavy lifting, and repeated overhead movements should initially be avoided in accordance with the doctor's recommendation.

Temporary pain or a sensation of pressure at the injection site may occur. In case of worsening pain, significant swelling, severe redness, increased warmth, or fever, the practice should be contacted.

A hyaluronic acid injection does not automatically eliminate the cause of the symptoms. Depending on the diagnosis, other or additional measures may be appropriate:

• Physiotherapy and therapeutic exercises;
• Improvement of mobility;
• Strengthening of the rotator cuff and shoulder blade muscles;
• Adjustment of strain-inducing movement patterns;
• Medication-based treatment;
• other forms of Infiltration of the shoulder;
• surgical evaluation for advanced joint damage.

You can find an overview of various treatment options for joint osteoarthritis on the page on Osteoarthritis therapy.