HYALURONIC ACID “OSTENIL TENDON” IN PARTIAL THICKNESS TEARS 0F THE SUPRASPINATUS TENDON-CLINICAL AND SONOGRAPHIC ASSESSMENT R. Nestorova Centre of Rheumatology, Sofia, Bulgaria R. Rashkov, t Petranova, I. Sheytanov, S. Monov, R. Stollev, Z. Kolarov Medical University. Sofia Z Stefanov Sports Acoderniy Sofia Statistical analysis For VAS and SFA assessment Repeated measures analysis was used. For assessment of Bursitis X analysis was used. Results Pain during active rnovement was significantly reduced after the first injection and it was 6 fold reduced on Hie third visit. (Fig.1) The index of SFA had a statistically significant improve ment 0f ail SFA cnteria which correlated with increasing 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 with the 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 US demonstrated.(Fig. 5) We present sonographic images in transverse scan 0f SSP tendon showing PTT as hypoechoic zone before treatment(Visit 1) and recovered tissue of the tendon after the treatment with Ostenil Tendon(Visit 3).(Image 1&2) Conclusions HA Ostenil Tendon led to a relatively rapid and sustained relief of pain and increased functional activity of the shoulder. Thanks to its tendoprotection, Ostenil Tendon increased patient quality 0f life which was proved by resuits 0f SFA scale and high level 0f patient and physician assessment. US proved healing process of tendon structure in the places of partial thickness lesions and enhance the SSP gliding as a result 0f lubricating and viscoelastic properties 0f the HA. No adverse events were observed. Injections under US control were accepted favourably by the patients. tndudlng criteda 4. Pain by VAS nver 25mm ABSTRACT Objective: 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 Supraspinaiun tendon )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) und Questionnaires 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 m won 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 9000 assessrneni 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 cd Iubncabng and viscnelastrc propertios cf the HA. No adverse avents mare observed. Injections onder us coniro) were accepied favorable by ihe patients. Objective To determine the efficacy 0f Hyaluronic acid (HA) injections Ostenil Tendon concerning pain, functional activity 0f the shoulder and tendon recovery in patients with 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 ligamentous ultrastructure. Lubricating the tendon results in the relief 0f pain, improvement of the tendon function and reduction 0f the potential for adhesions. The accuracy of Ultrasonography (US) for evaluation of the RC, benefit 0f performance of US-guided procedures and monitoring cf therapy have been proved. US imaging can be 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 Methods 23 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 exclude other pathologies at the discretion 0f the study physician (i.e. to exciude fracture). Shoulder Function 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 MS sonographers with at least 5 years experience in MSU scanned together each patient and reached consensus on the US findings. Ostenil Tendon 4Omg/2.0 ml was injected around the affected tendon for a total of two injections at weekly intervals. Teble I 1. A~e 18-80 yeatn 2!cl(tsrdlo~ieo(~ Shnuider1 per)arihrliis 3. Durabnn 0f ihe sympioms op io 7 days Excludlng cnltenta 1. JOint inlIammatoryand’tttaùiîtàtid~uto. immune disease. infections 2~0~)iti)i’S’rfh~ilfbthy. traumas, surgery inshoo)der, Fui thic%.nesstearsoffheRc 3~Ph~’niotherap~Tand iOpCaldtiOficO$iero(ds appIi~5tion wlthin a monthibeforo and divin9 the monitoring ‘4other diseases — diébetes melitus, neutc)ogical diseaseslincf. brachial picOtin penphere) neuropathyl 5. Neoplasms, chemotherapy, radioiharapy 5. Sonographic proved PTT 0f lite RC PAIN NASI 1v en Figurai SFA no su 20 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 I. Pe0’eia RJ. CuyliannA. Deoa,ra J, Ofohamed N Lev R Manaliernent 0f tencin efbnw IonS radium vyalumoare penaiticxlaropecnuns Sports A4e,hcma Artjv’oscopy Raliab:uoanon. Tlierapy 11 Tenhvolocjy 20f 2:111 2. Pac’elia MJ, CogllanoA, Pet,eiia RJ, caiglnalrenea,nli long taon afncacy and saraty o! pe,cair;cxlar liyaloroo,c acidi,r acxla ank!a spcaxl Foyn SyO,nsored 2000 37 0470 3. PathOs et al. li(aoegemen: cf Tennis Elbow muS ooNem hyalxrovota pe,iartic’xlar i,tiaolionss,noli, Margmioe, Image I Image 2 Arthmnvopy RoSabulitalio,r, Tirerapy L Tox500togy 2050, 2:4 4. M Vlyvlioo, Z. Dad,ena. A. Foliadoo. M. Papavagiu(ox, IV. Feexxlidis, K Me6zooSymplomaùoParfi& Rotalor Colt’ Tears: Diagnostic Perfunnaoce n! Ulirosoundenduegnetio Renunance Imaging cdlv Surgical Cto,naiatiov,- Muocxioslieleia( Rad,oiogy 2500, Vuc 50. No. 1. P 101.505 5. Naredo E, Agxado P 0e M,gue E. viol. Paa,fotnhoxlde,.con,pavonn 0f phyoical eusmi,retjes anti cihaaocog~uphic 000ings Mir Rheum 0,02002 61 f 32-6. li. Iagvoccn. A, Rfpouoo E, Moenagh G. 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