Abstract
Background. Intra-articular injections of autologous platelet-rich plasma (PRP), which is a natural biological stimulant and affects various parts of the regenerative process, are often used in the treatment of adhesive capsulitis. Another line of using the reparative potential of biopolymers is the application of polynucleotides (PN), which, due to their effect on fibroblasts, are able to stimulate regeneration processes during adhesive capsulitis.
Aim of study. To evaluate the clinical efficacy of intra-articular injections of autologous platelet-rich plasma and a polynucleotide-based drug in the complex therapy of shoulder adhesive capsulitis, depending on the stage of the disease.
Methods. Performed prospective cohort study included 42 patients aged 47 to 60 years with the diagnosis of adhesive capsulitis. The duration of the disease varied from 3 months to 5 years. The patients were divided into 2 groups depending on the stage of the disease at the time of the treatment: 24 patients with the first stage of the disease (group AC1) and 18 patients with the second stage (AC2). Each group was divided into 2 subgroups of patients. In subgroups either PRP or PN were administered. The results were assessed 1 week, 1 month, 3 months after the start of the treatment. Evaluation of pain management efficacy was carried out using the visual-analog scale (VAS). The change in the quality of life of patients and the function of the shoulder joint were defined using the DASH questionnaire for assessing the function of the upper limb and the Simple Shoulder Test (SST).
Results. The use of PRP made it possible to achieve pain relief regardless of the stage of the disease. Patients of the AC1 group had a progressive pain syndrome attenuation from 80 to 45 points according to the VAS scale during the first 7 days after the start of the treatment. On the contrary, patients of the AC2 group had a slight pain increase by the end of the 1st week, that was associated with growing physical activity of patients. In the group of patients treated with PN, all experienced pain regression after the first injection. 20% of patients had pain relief within 24-36 hours after the start of the treatment., Increased joint pain was registered in 2 (10%) patients, which passed spontaneously during the first day. Pain syndrome intensity decreased in patients with both stages of the disease. According to the VAS, it decreased from 90-80 to 65 points after the first injection within 4 days in the AC1 group. Patients of the AC2 group did not notice significant effect after the first injection. The second injection reduced the pain to 65-70 points.
Conclusion. The effectiveness of PN-based drugs had no statistically significant difference from that of PRP, but their effect was achieved faster.