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Quality Improvement (Original Research)

Outcomes of Hyaluronic Acid Injections Targeting the Subacromial Space: A Quality Improvement Study

Thursday, October 23, 2025
3:45 PM - 5:00 PM MT
Location: Session Room - 250 DEF

    Poster Presenter(s)

  • Richard C. Allred, DO (he/him/his)

    Resident
    UCLA David Geffen SOM/ UCLA Medical Center/VA Greater Los Angeles Health
    Santa Monica, California

    • Co-Author(s)

  • Samuel Olson, MD

    Medical Resident
    UCLA David Geffen SOM/ UCLA Medical Center/VA Greater Los Angeles Health
    Santa Monica, California

  • Jennifer Tram, MD

    Medical resident
    UCLA David Geffen SOM/ UCLA Medical Center/VA Greater Los Angeles Health
    Los Angeles, California

  • EB

    Elite Ben-Ozer, MD

    Health Sciences Clinical Professor
    UCLA-VA PM&R
    Encino, California

  • AN

    Anne Nastasi, MD

    Assistant Professor of Medicine DGSOM, retired
    GLA VA
    Northridge, California

Disclosure(s):
Richard C. Allred, DO: No financial relationships to disclose
Samuel Olson, MD: No financial relationships to disclose
Anne Nastasi, MD: No financial relationships to disclose
Background and/or Objectives: To evaluate the impact of subacromial hyaluronic acid injections on shoulder pain within our clinic population, as part of an ongoing quality improvement initiative.

Design: Retrospective review conducted under a QI framework.

Setting : A single outpatient rehabilitation and pain management Veterans Affairs clinic.

Participants : Fifteen patients who presented for treatment of shoulder pain received a series of subacromial hyaluronic acid injections between July 1, 2022, and March 1, 2024.

Interventions: A series of three 1% sodium hyaluronate (2 mL total per injection) were administered into the subacromial space as part of standard care for shoulder pain.

Main Outcome Measures: Pain was assessed using the Numeric Pain Rating Scale (NPRS) prior to the first injection and after the third injection, approximately two weeks later. Additionally, medical documentation was reviewed for the presence or absence of key elements identified as important for future research-oriented data collection.

Results: All participants were male; average age was 65.56 ± 10.2 years. Mean NPRS scores decreased from 5.10 ± 2.0 pre-treatment to 2.93 ± 2.7 post-treatment (p=.021). There were no statistically significant differences in pain score changes when groups were separated by shoulder exam findings (Neer’s, Hawkins, Yocum) or by MRI findings (all p > 0.05).

Conclusions: As part of this QI study, patients demonstrated a statistically significant reduction in shoulder pain following a subacromial hyaluronic acid injection series. There were no demonstrated differences in pain score changes based on shoulder exam findings or the number of tendons involved on MRI. While encouraging, these results are intended to inform local clinical practice and are not generalizable beyond this setting. As a result of this project, resident documentation templates were also revised to include a patient functional survey and more detailed procedure elements. Research with longer follow-up and larger sample sizes is needed to further validate these findings.