Intra-articular injections for shoulder arthritis in adults : a systematic review

Abstract

Background

The management of glenohumeral osteoarthritis (GHOA) is challenging, particularly in patients who are not eligible for surgery. In recent years, several injectable therapies, including hyaluronic acid (HA), corticosteroids (CCs), platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and mesenchymal stem cells (MSCs), have emerged as potential options for managing pain and improving joint function. This systematic review aims to summarise the current evidence on infiltrative strategies to manage GHOA in adults. Methods

This review followed the PRISMA 2020 guidelines. PubMed, Web of Science, and Embase were systematically searched in May 2025. All clinical studies investigating infiltrative strategies to manage shoulder arthritis in adults were considered for inclusion. Only studies with a minimum follow-up of six months were included. The methodological quality of the included studies was assessed using the Cochrane RoB2 tool for randomised controlled trials (RCTs) and the ROBINS-I tool for non-randomised studies. Results

Data from 1125 patients (1126 shoulders) were analysed. The mean age of the patients was 63.4 ± 5.8 years, and 34.1% (384 of 1125 patients) were women. The most commonly studied intra-articular treatments included HA and CCs. The rate of surgery for persistent symptoms or functional impairment was 3.2% (35 of 1079 reported procedures). The overall rate of complications was 7.2% (56 of 780 reported procedures). Conclusion

Infiltrative management can provide symptomatic relief in adults with GHOA. Current evidence supports the potential role of different injectable therapies, with hyaluronic acid demonstrating consistent, though modest, benefits. In contrast, the evidence for orthobiologics remains limited, mainly because of heterogeneity in study design, outcome measures, and patient characteristics. High-quality comparative trials with long-term follow-up are required to establish optimal treatment strategies and to identify patient subgroups most likely to benefit from specific interventions.