However, adverse effects after local injections of steroids were reported, including paler skin, tissue atrophy, tendon rupture, and even cartilage damage.[20,34–36] HA may play an antiinflammatory role by inhibiting proinflammatory cytokines and cyclooxygenase-2/prostaglandin E2 production in rotator cuff injury.[18,37] We considered HA could decrease inflammation leading to pain reduction, and HA did not do further harm at the soft tissues and bony structures of hemiplegic shoulders in stroke patients with high risk of rotator cuff injury. The gene discussed is PTGS2; the disease is stroke disorder.