This document outlines a study examining the role of platelet rich plasma (PRP) injections in treating rotator cuff tendinopathy and tears. The study aims to evaluate the response of patients receiving dual PRP injections and estimate the efficacy of this treatment. It describes collecting blood from 100 patients to prepare two doses of PRP for injection into the supraspinatus tendon and joint space. Outcomes will be evaluated at 6, 12, and 18 months post-treatment using pain and disability scales. The study aims to determine if PRP injections provide significantly improved pain and function compared to pre-treatment levels.
Early Outcome of Discectomy with Interspinous Process Distraction Device a Re...CrimsonPublishersOPROJ
Early Outcome of Discectomy with Interspinous Process Distraction Device a Retrospective Cross-Sectional Study by Gunaseelan Ponnusamy* in Crimson Publishers: Orthopedic Research and Reviews Journal
Avascular necrosis of Hip - treatment modalities and current concepts.pptxVivek Jadawala
Slide 1 - Treatment modalities of Avascular Necrosis of Hip
JOURNAL CLUB PRESENTATION
Dr. Vivek Jadawala
PGY-3, Dept. of Orthopaedics,
JNMC, DMIHER
Slide 2 - image
slide 3 - image
slide 4 - Osteonecrosis of Hip - Osteonecrosis is death of living elements of involved bone (cells including marrow) with progressive destruction and alteration of bone architecture as a result of compromised vascularity.
Usually aseptic but may be incited by loss of vascularity from infection.
Slide 5 - Epidemiology - Male > Female
Average age group – 35 to 50 years
Bilateral Hip joints – 80 % of the cases
Most common site – Antero-lateral aspect of femoral head
Slide 6 - Blood supply of femoral head
Slide 7 - Classification of AVN: Ficat and Arlet -STAGE 0 :
X-ray : normal
MRI: normal
clinical symptoms: nil
STAGE I :
X-ray : normal or minor osteopenia
MRI: edema
bone scan: increased uptake
clinical symptoms: pain typically in the groin
Slide 8 - Stage I
Slide 9 - Stage II -
X-ray: mixed osteopenia and/or sclerosis and/or subchondral cysts, without any subchondral lucency (crescent sign)
MRI: geographic defect
Bone scan: increased uptake
clinical symptoms: pain and stiffness
Slide 10 - Stage III - X-ray: Crescent sign and eventual cortical collapse
MRI: same as plain radiograph
clinical symptoms: pain and stiffness +/- radiation to knee and limp
Slide 11 - Stage IV - X-ray: end-stage with evidence of secondary degenerative change
MRI: same as plain radiograph
clinical symptoms: pain and limp
Slide 12 - Stage IV
Slide 13 - image
Slide 14 - Steinberg staging of AVN
Slide 15 - Steinberg staging - STAGE 0:
- normal or non-diagnostic radiographs, MRI and bone scan of at risk hip (often contralateral hip involved, or patient has risk factors and hip pain)
STAGE I:
normal radiograph, abnormal bone scan and/or MRI
STAGE II:
- cystic and sclerotic radiographic changes
STAGE I AND II
A, mild: <15% head involvement as seen on radiograph or MRI
B, moderate: 15% to 30%
C, severe: >30%
Slide 16 - STAGE III:
- subchondral lucency or crescent sign
A, mild: subchondral collapse (crescent) beneath <15% of articular surface
B, moderate: crescent beneath 15% to 30%
C, severe: crescent beneath >30%
STAGE IV:
flattening of femoral head, with depression graded into
A, mild: <15% of surface has collapsed and depression is <2 mm
B, moderate: 15% to 30% collapsed or 2-4 mm depression
C, severe: >30% collapsed or >4 mm depression
Slide 17 - STAGE V:
- joint space narrowing with or without acetabular involvement
STAGE VI:
- advanced degenerative changes
Slide 18 - Association Research Circulation Osseous classification
Slide 19 - image
Slide 20 - Kerboul angle - Original classification was proposed on radiographs where he divided the necrotic region into small, medium and large regions:
Small - less than or equal to 160°
Medium - 161 to 199°
Large - 200 or more degrees.
Slide 21 - Modified Kerboul angle - based on MRI has much higher values as the MRI overestimates the necrotic region
Early Outcome of Discectomy with Interspinous Process Distraction Device a Re...CrimsonPublishersOPROJ
Early Outcome of Discectomy with Interspinous Process Distraction Device a Retrospective Cross-Sectional Study by Gunaseelan Ponnusamy* in Crimson Publishers: Orthopedic Research and Reviews Journal
Avascular necrosis of Hip - treatment modalities and current concepts.pptxVivek Jadawala
Slide 1 - Treatment modalities of Avascular Necrosis of Hip
JOURNAL CLUB PRESENTATION
Dr. Vivek Jadawala
PGY-3, Dept. of Orthopaedics,
JNMC, DMIHER
Slide 2 - image
slide 3 - image
slide 4 - Osteonecrosis of Hip - Osteonecrosis is death of living elements of involved bone (cells including marrow) with progressive destruction and alteration of bone architecture as a result of compromised vascularity.
Usually aseptic but may be incited by loss of vascularity from infection.
Slide 5 - Epidemiology - Male > Female
Average age group – 35 to 50 years
Bilateral Hip joints – 80 % of the cases
Most common site – Antero-lateral aspect of femoral head
Slide 6 - Blood supply of femoral head
Slide 7 - Classification of AVN: Ficat and Arlet -STAGE 0 :
X-ray : normal
MRI: normal
clinical symptoms: nil
STAGE I :
X-ray : normal or minor osteopenia
MRI: edema
bone scan: increased uptake
clinical symptoms: pain typically in the groin
Slide 8 - Stage I
Slide 9 - Stage II -
X-ray: mixed osteopenia and/or sclerosis and/or subchondral cysts, without any subchondral lucency (crescent sign)
MRI: geographic defect
Bone scan: increased uptake
clinical symptoms: pain and stiffness
Slide 10 - Stage III - X-ray: Crescent sign and eventual cortical collapse
MRI: same as plain radiograph
clinical symptoms: pain and stiffness +/- radiation to knee and limp
Slide 11 - Stage IV - X-ray: end-stage with evidence of secondary degenerative change
MRI: same as plain radiograph
clinical symptoms: pain and limp
Slide 12 - Stage IV
Slide 13 - image
Slide 14 - Steinberg staging of AVN
Slide 15 - Steinberg staging - STAGE 0:
- normal or non-diagnostic radiographs, MRI and bone scan of at risk hip (often contralateral hip involved, or patient has risk factors and hip pain)
STAGE I:
normal radiograph, abnormal bone scan and/or MRI
STAGE II:
- cystic and sclerotic radiographic changes
STAGE I AND II
A, mild: <15% head involvement as seen on radiograph or MRI
B, moderate: 15% to 30%
C, severe: >30%
Slide 16 - STAGE III:
- subchondral lucency or crescent sign
A, mild: subchondral collapse (crescent) beneath <15% of articular surface
B, moderate: crescent beneath 15% to 30%
C, severe: crescent beneath >30%
STAGE IV:
flattening of femoral head, with depression graded into
A, mild: <15% of surface has collapsed and depression is <2 mm
B, moderate: 15% to 30% collapsed or 2-4 mm depression
C, severe: >30% collapsed or >4 mm depression
Slide 17 - STAGE V:
- joint space narrowing with or without acetabular involvement
STAGE VI:
- advanced degenerative changes
Slide 18 - Association Research Circulation Osseous classification
Slide 19 - image
Slide 20 - Kerboul angle - Original classification was proposed on radiographs where he divided the necrotic region into small, medium and large regions:
Small - less than or equal to 160°
Medium - 161 to 199°
Large - 200 or more degrees.
Slide 21 - Modified Kerboul angle - based on MRI has much higher values as the MRI overestimates the necrotic region
Study of current pattern of Cervical Spondylotic Myelopathy and to evaluate t...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Open debridement and radiocapitellar replacement in primary and post-traumati...Alberto Mantovani
Background: Postmortem and clinical studies have shown an early and prevalent involvement of the radiohumeral
joint in primary and secondary arthritis of the elbow. The lateral resurfacing elbow (LRE) prosthesis
has recently been developed for the treatment of lateral elbow arthritis. However, few data have been
published on LRE results.
Materials and methods: A prospective multicenter study was designed to assess LRE preliminary results.
There were 20 patients (average age, 55 years). Preoperative diagnosis were primary osteoarthritis in 11
and post-traumatic osteoarthritis in 9. All patients underwent open debridement and LRE prosthesis.
Patients were evaluated preoperatively and postoperatively with the Mayo Elbow Performance Score
(MEPS), modified American Shoulder Elbow Surgeons (m-ASES) elbow assessment, and the Quick
Disabilities of the Arm, Shoulder and Hand (Quick-DASH). Mean follow-up was 22.6 months.
Results: At the last follow-up, the mean improvement of MEPS and m-ASES was 35 (P ¼ .001) and 34
(P ¼ .001) respectively; the average Quick DASH decreased by 29 (P ¼ .001). Average range of motion
was improved by 35 (P ¼.001). MEPI results were excellent in 12 patients, good in 2, and fair and poor in
3 each. Mild overstuffing was observed in 5 patients, and an implant malpositioning in 3. The implant
survival rate was 100%.
Conclusion: LRE showed promising results in this prospective investigation. Most patients had an
uneventful postoperative course and have shown a painless elbow joint, with satisfactory functional
recovery at short-term follow-up. Further studies with longer follow-up are warranted.
Short Term Analysis of Clinical, Functional Radiological Outcome of Total Kne...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Benefits of Mechanical Manipulation of the Sacroiliac Joint: A Transient Syno...CrimsonPublishersOPROJ
Benefits of Mechanical Manipulation of the Sacroiliac Joint: A Transient Synovitis Case Study by Brady Hauser* in Crimson Publishers: Orthopedic Research and Reviews Journal
Arthroscopic Anterior Capsular Release for Idiopathic Frozen ShoulderApollo Hospitals
Frozen shoulder (Adhesive capsulitis) has been defined as a condition characterized by both active
and passive loss of motion. Zuckerman et al further classified Frozen shoulder into primary and secondary groups. Primary or idiopathic frozen shoulder has by definition no clear cause. The initial treatment consists of conservative
management with NSAID, Physiotherapy, intra-articular steroids or saline and in some instances manipulation under
anaesthesia. Once in a while there are cases which are refractory to conservative treatment and manipulation under anaesthesia has its risks like fractures and rotator cuff tears. Arthroscopic capsular release of stiff shoulders has been done providing excellent functional outcome and reproducible results.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Study of current pattern of Cervical Spondylotic Myelopathy and to evaluate t...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Open debridement and radiocapitellar replacement in primary and post-traumati...Alberto Mantovani
Background: Postmortem and clinical studies have shown an early and prevalent involvement of the radiohumeral
joint in primary and secondary arthritis of the elbow. The lateral resurfacing elbow (LRE) prosthesis
has recently been developed for the treatment of lateral elbow arthritis. However, few data have been
published on LRE results.
Materials and methods: A prospective multicenter study was designed to assess LRE preliminary results.
There were 20 patients (average age, 55 years). Preoperative diagnosis were primary osteoarthritis in 11
and post-traumatic osteoarthritis in 9. All patients underwent open debridement and LRE prosthesis.
Patients were evaluated preoperatively and postoperatively with the Mayo Elbow Performance Score
(MEPS), modified American Shoulder Elbow Surgeons (m-ASES) elbow assessment, and the Quick
Disabilities of the Arm, Shoulder and Hand (Quick-DASH). Mean follow-up was 22.6 months.
Results: At the last follow-up, the mean improvement of MEPS and m-ASES was 35 (P ¼ .001) and 34
(P ¼ .001) respectively; the average Quick DASH decreased by 29 (P ¼ .001). Average range of motion
was improved by 35 (P ¼.001). MEPI results were excellent in 12 patients, good in 2, and fair and poor in
3 each. Mild overstuffing was observed in 5 patients, and an implant malpositioning in 3. The implant
survival rate was 100%.
Conclusion: LRE showed promising results in this prospective investigation. Most patients had an
uneventful postoperative course and have shown a painless elbow joint, with satisfactory functional
recovery at short-term follow-up. Further studies with longer follow-up are warranted.
Short Term Analysis of Clinical, Functional Radiological Outcome of Total Kne...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Benefits of Mechanical Manipulation of the Sacroiliac Joint: A Transient Syno...CrimsonPublishersOPROJ
Benefits of Mechanical Manipulation of the Sacroiliac Joint: A Transient Synovitis Case Study by Brady Hauser* in Crimson Publishers: Orthopedic Research and Reviews Journal
Arthroscopic Anterior Capsular Release for Idiopathic Frozen ShoulderApollo Hospitals
Frozen shoulder (Adhesive capsulitis) has been defined as a condition characterized by both active
and passive loss of motion. Zuckerman et al further classified Frozen shoulder into primary and secondary groups. Primary or idiopathic frozen shoulder has by definition no clear cause. The initial treatment consists of conservative
management with NSAID, Physiotherapy, intra-articular steroids or saline and in some instances manipulation under
anaesthesia. Once in a while there are cases which are refractory to conservative treatment and manipulation under anaesthesia has its risks like fractures and rotator cuff tears. Arthroscopic capsular release of stiff shoulders has been done providing excellent functional outcome and reproducible results.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
1. THE ROLE OF PLATELET RICH PLASMA IN ROTATOR CUFF
TENDINOPATHY AND TEARS
NAME:- DR.T.VAISHNAVI
FIRSTYEARRESIDENT
DEPARTMENT OFORTHOPAEDICS
GUIDE:- DR.HARANADH
PROFESSOR
DEPARTMENT OFORTHOPAEDICS
COGUIDE:- DR.VENKATKISHAN
PROFESSOR
DEPARTMENTOFRADIOLOGY
2. AIM
• To study the role of platelet rich plasma in the management of rotator cuff
tendinopathy and tears
OBJECTIVES
• To evaluate the response of the patients to dual injection PRP[platlet rich plasma] as a treatment
modality in rotator cuff tendinopathy and tears.
• To estimate the efficacy of dual injection PRP[platlet rich plasma] for the treatment of patients with
rotator cuff tendinopathy and tears.
3. INTRODUCTION
• Shoulder pain affects up to 67% of the population at some point in
one’s lifespan 1.
• Common diagnoses implicated in the etiology of shoulder pain include impingement
syndromes (e.g-subacromial and subcoracoid),osteoarthrosis, labral tears, and soft
tissue pathologies of the rotator cuff such as tendinopathy of the various diagnosis
attributed to shoulder pain1.
• It has been estimated that approximately 65% of individuals present with some form
of rotator cuff pathology (e.g-tendinopathy and tear), with the supraspinatus and
infraspinatus most often affected 2.
4. • Tendinopathy is a collective term used to describe pathology within, and pain arising from,
the tendon itself. In the shoulder, PRP has been used for treatment of rotator cuff tendinitis
or partial thickness rotator cuff (PTRC) tears in a number of studies and has shown
improvement in symptoms compared to steroids, physical therapy, hyaluronic acid and
placebo controls3,4,5,6,7,8,9,10 .
5. METHODOLOGY
• PLACE OF STUDY: DEPARTMENT OF ORTHOPAEDICS KAMINENI INSTITUTE OF MEDICAL
SCIENCES,NARKETPALLY
• TYPE OF STUDY: Prospective study
• SAMPLE SIZE: 100 patients.
• STUDY DURATION :April 2023 to MARCH 2025
• The study will be conducted after approval by the Ethics Committee of Kamineni Institute Of Medical
Sciences , Narketpally.
• All patients satisfying the inclusion criteria will be enrolled in the study.
• A written informed consent will be taken from the patients prior to start of the study.
6. • Dual PRP injection is offered to all patients who have rotator cuff tendinopathy and tears.
• Rotator cuff tendinopathy and tears are evaluated by clinical and radiological examination in each
case.
• The clinical examinations and rotator cuff tendinopathy and tears are diagnosed based on shoulder
pain, a positive NEER and Hawkins sign, and increased pain with elevation of the arm.
INVESTIGATIONS
• Xray Shoulder- Anteroposterior view , axillary view Grashey(True AP) and Y view
• Ultrasonography(USG) of Shoulder
7. Based on the USG results, patients are divided into 4 groups:
• NORMAL TENDON: The tendon has a normal homogenous appearance throughout, and where it
inserts onto the greater tuberosity there is no abnormal reaction-taking place on the bone side.
• ABNORMAL TENDON: The tendon may appear abnormal with loss of the homogenous appearance
or appear abnormally thin. There is an abnormal tendon enthesis, which is clearly visualized as a
ragged greater tuberosity. Fluid may be present in the bursa.
• PARTIAL-THICKNESS TEAR:A lucent patch is visualized in the tendon either on the articular or
bursal surface, but there are continuous tendon fibers inserting into the greater tuberosity. In all cases
an abnormal tendon enthesis was observed (even in those with bursal sided tears). Fluid is often seen
in the bursa.
8. • FULL-THICKNESS TEAR: A lucent patch is visualized running through the full-thickness of
the tendon. The width of this in the sagittal plane is the tear size. This is associated with a
concavity in the bursal surface, which is either directly visualized or becomes apparent
with pressure from the probe. The tendon enthesis is abnormal and there is fluid in the
bursa. In larger tears no tendon is often visible. The surface of the greater tuberosity is
abnormal and a heterogenous substance fills the space left by the tendon. In smaller
tears a tendon edge may be visible in the longitudinal plane and this measurement is the
degree of retraction.
9. Table 1 Patient Demographics
DERMOGRAPHICS All patients Normal Abnormal
tendon
Partial
thickness
tear
Full
Thickness
tear
Total
Male
Female
Mean age
10. Prior to injection Quick Disabilities of the Arm, Shoulder, and Hand (QDASH)
assessment and Pain Visual Analog Scale (VAS) scores were obtained on all
patients.
11.
12. PLATELET RICH PLASMA PREPARATION
• 20ML of blood was drawn from each Patient and processed
through a double Spin technique to create 2 doses 5 ML of PRP.
• PRP is injected in 2 separate locations at the time of treatment.
• The first injection is injected into the bursal surface of supraspinatus tendon.
• The second injection is injected with the patient in prone position into the glenohumeral
intra-articular space under the supraspinatus tendon just proximal to the superior equator
of the humeral head
13.
14. The first injection is into the supraspinatus tendon
insertion critical zone and bursal area with the
patient seated.
The second injection is into glenohumeral intra
articular space under the supraspinatous
tendon at or just proximal to the superior
equator o the head with patient in prone
position
15. After treatment, patients are advised to limit activity for one week, and to use topical ice
and acetaminophen as needed. After one week, patients were counselled to resume
normal activities and has to follow these:
1. Avoidance of non-steroidal anti-inflammatory medication (NSAIDs) since there is
evidence that NSAIDs, both Cox 1 and 2, interfere with rotator cuff healing [14, 15].
2. Avoidance of corticosteroid injection into the shoulder, because corticosteroids can
cause tendon damage [16–18].
3. Avoidance of all activities that cause pain for one week, followed by gradual increase in
activity.
4. Avoidance of other analgesics including topical liniments, ice, kinesiotape, and oral
analgesics, which can accelerate damage by masking pain and allowing greater use.
16. Clinical outcome and pain are to be evaluated using patient completed Q-DASH
assessment and VAS at 6 months, 12 months and 18 months after treatment.
A global assessment of combined pain and functional improvement will be performed by
asking patients the percent improvement from before treatment to the follow up point.
Patients who described at least a 30 % improvement will be considered to have a
significantly improved outcome.
Statistical analysis will be performed using comparison of means between the pre-
treatment VAS and QDASH scores and scores at 6 months,12 months and 18 months.
Similar analysis will be performed for scores in each of the subgroups and for the change in
global scores between subgroups.
17. INCLUSION CRITERIA:
1. USG report showing Tendinopathy and Tears.
2. USG report showing Partial thickness tear.
3. Patients who have given consent for PRP injection.
4. Patient age > 40 years
18. EXCLUSION CRITERIA
• Patients who had surgery or other treatment in the six months prior to the
PRP injection
• Patients with significant shoulder tendinopathy and tears, such as severe
arthritis.
19. PROFORMA
AGE:
SEX:
CHIEF COMPLAINT:
HISTORY O PRESENT ILLNESS:
PAST HISTORY:
PERSONAL HISTORY:
FAMILY HISTORY:
GENERAL EXAMINATION:
LOCAL EXAMINATION: Inspection-abnormal swelling and deformity,attitude,overlying skin
Palpation-local rise of temperature,tenderness,crepitus,
Range of movements-
Neck examination-
Distal neurovascular deficiency
SYSTEMIC EXAMINATION:
20. I/We, the relative of the patient have read and understood the information
provided in the “patient information sheet” and have been informed and
explained the purpose and nature of the evaluation in the language I
understand.
I am aware of the fact that I may not derive any benefit from the evaluation
and that I reserve the right to opt out of the study at any point of time.
I am willingly agree to participate in this study
Patient’s sign/thumb impression witness’s sign/thumb
impression
Name: Name:
Date: Date:
CONSENT
21.
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