HYALURONIC ACID “OSTENIL TENDON” IN PARTIAL THICKNESS TEARS

0F THE SUPRASPINATUS TENDON-CLINICAL

AND SONOGRAPHIC ASSESSMENT

R. NestorovaCentre of Rheumatology, Sofia, Bulgaria

R. Rashkov, t Petranova, I. Sheytanov, S. Monov, R. Stollev, Z. KolarovMedical University. Sofia

Z StefanovSports Acoderniy Sofia

Statistical analysisFor VAS and SFA assessment Repeated measures analysis was used. For assessment of BursitisX analysis was used.

ResultsPain during active rnovement was significantly reduced after the first injection and it was 6 foldreduced on Hie third visit. (Fig.1)The index of SFA had a statistically significant improve ment 0f ail SFA cnteria which correlated withincreasing of the point number with 33 points, reaching 64 points. (Fig.2)74% (n1 7) 0f patients gave a very good and good assessment 0f the efficacy, which coincided withthe opinion of the physician. (Fig.3&4)No adverse events were reported. No subjects withdrew from the study during the treatment phase.78% (n=18) 0f patients had a complete recovery or improved structure 0f the SSP which was USdemonstrated.(Fig. 5)We present sonographic images in transverse scan 0f SSP tendonshowing PTT as hypoechoic zone before treatment(Visit 1) andrecovered tissue of the tendon after the treatment with OstenilTendon(Visit 3).(Image 1&2)

ConclusionsHA Ostenil Tendon led to a relatively rapid and sustained relief ofpain and increased functional activity of the shoulder. Thanks to itstendoprotection, Ostenil Tendon increased patient quality 0f lifewhich was proved by resuits 0f SFA scale and high level 0f patientand physician assessment. US proved healing process of tendonstructure in the places of partial thickness lesions and enhance theSSP gliding as a result 0f lubricating and viscoelastic properties 0fthe HA. No adverse events were observed. Injections under UScontrol were accepted favourably by the patients.

tndudlng criteda

4. Pain by VAS nver 25mm

ABSTRACTObjective: To deterrrrine the eihcacy 0f Hyaiuronic oc O (HA) Iniections Ostend Tendon concerning pain, ionciional acuiviiy 0f the shouider and tendon reeoeery in patients wiih partiai thickness teats )PTT1 0f ihe Supraspinaiuntendon )SSP). The accuracy 0f Ulirasonography (US) for diagnosis 0f PTT 0f the Rotator 00ff )Rc), beneifi cf performance o) US-guided procedures anti monitoring 0f liierapy have benn proveti.Meterlal and Methode: 23 patienis wrih painiul shoulder anti sonographic prooed PTT 0)111e SSP mare inc)uded. A Pa ri Diary witir a ien point clouai ana)ogue scaie. Shoulder Function Assessment tSFA) scate (O-70) undQuestionnaires 0f the eftlcacy according to the patient and the physician were eoaiuated. US examination won provided by Mindray M5 scanner wlth muiti-frequency linear transducer (7.5-10 MHz). Osteni) Tendon 40mg12.0 mwon in~ecied around ihe affecied tendon once a week fora iota) of 1mo injections. Ai appficaiions were parformed undar us conirof.R.euits: Pain won signifcanhiy reduced after the first intention and ihis affect was mointaioed uni) the end 0f the observations) period. SFA index won signiflcantiy improued. 74% cf patientn gave e oery gond and 9000assessrneni o) ihe efflcacy, whicb coincided milS lite opinion o) lire physician. 78% cf patienis had o complete recooery or improved structure of iSa S5P whiçh was US demonsiratati.ConclusIons: HA Osieni) Tendon ied ix o reiaiively rapid anti susiained relief 0f pain and incroased funciinnai activiiy 0f lite shoulder. US prnved repair process 0f the tendon stniciure and giiding 0f ihe SSP as u resufi cdIubncabng and viscnelastrc propertios cf the HA. No adverse avents mare observed. Injections onder us coniro) were accepied favorable by ihe patients.

ObjectiveTo determine the efficacy 0f Hyaluronic acid (HA) injections Ostenil Tendon concerning pain, functional activity 0f the shoulder and tendon recovery in patientswith partial thickness tears (PTT) 0f the Supraspinatus tendon (SSP).HA is a naturally occurring biological substance, representing an unbranched, high-molecular weight polysaccharide as a major component 0f ligamentousultrastructure. Lubricating the tendon results in the relief 0f pain, improvement of the tendon function and reduction 0f the potential for adhesions. The accuracyof Ultrasonography (US) for evaluation of the RC, benefit 0f performance of US-guided procedures and monitoring cf therapy have been proved. US imaging canbe considered almost equally effective in detecting partial tears cf the rotator cuif compared to MRI, particularly located in the area of the SSR

Materlal and Methods23 patients with shoulder periarthritis and sonographic proved PTT cf the SSP were included. Including and excluding critena are shown in Table 1.No NSAID. corticosteroids or topical analgesics were allowed during the study, as well as 48 hours prior to assessments. Ail patients had radiograph to excludeother pathologies at the discretion 0f the study physician (i.e. to exciude fracture). ShoulderFunction Assessment (SFA) scale (0-70) was evaluated at aIl visits - on the baseline(first injection),on the second week(second injection) and two months after the baseline. Questionnaires cf the _________________ ___________________________efficacy according to the patient and the physician were assessed on the third visit.US examination was provided by Mindray M5 scanner with multi-frequency linear transducer (7.5-10 MHz) on the first and third visit. To objectify the MSU evaluation, two trained and experienced MSsonographers with at least 5 years experience in MSU scanned together each patient and reachedconsensus on the US findings.Ostenil Tendon 4Omg/2.0 ml was injected around the affected tendon for a total of two injections atweekly intervals.

Teble I

1. A~e 18-80 yeatn

2!cl(tsrdlo~ieo(~Shnuider1 per)arihrliis

3. Durabnn 0f ihe sympiomsop io 7 days

Excludlng cnltenta1. JOint inlIammatoryand’tttaùiîtàtid~uto.

immune disease. infections2~0~)iti)i’S’rfh~ilfbthy. traumas, surgery

inshoo)der, Fui thic%.nesstearsoffheRc3~Ph~’niotherap~Tand iOpCaldtiOficO$iero(ds

appIi~5tion wlthin a monthibeforo and divin9the monitoring

‘4other diseases — diébetes melitus,neutc)ogical diseaseslincf. brachial picOtinpenphere) neuropathyl

5. Neoplasms, chemotherapy, radioiharapy5. Sonographic proved PTT

0f lite RC

PAIN NASI

1ven

Figurai

SFA

no

su20

10

PATIENT AS5ESSNENT PHYSICIAN ASSESSMENT

65%V..~ w~J

FIgure 3

VISIT I

FIgure 2

MSU EVAL.UATION

.~

FIgure 5

VISIT 3

FIgure 4

VISIT 3 VISIT I

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