Local Injection Therapy Research Articles

Eupalinolide A attenuates trauma-induced heterotopic ossification of tendon in mice by promoting YAP degradation through TOLLIP-mediated selective autophagy

BackgroundInhibiting the aberrant osteogenic differentiation of tendon-derived stem cells (TDSCs) is an effective strategy for treating traumatic heterotopic ossification (HO) in tendons. PurposeThis study aimed to investigate whether eupalinolide A (EA) could prevent tendon HO progression by suppressing the osteogenic differentiation of TDSCs. MethodsThe effects of EA on osteogenic differentiation and key signaling pathways in TDSCs were examined in vitro to assess its therapeutic potential and elucidate the underlying molecular mechanisms. Furthermore, the therapeutic efficacy of EA was evaluated in a mouse model of trauma-induced tendon HO via local injection therapy. ResultsEA significantly inhibited the osteogenic differentiation of TDSCs by targeting YAP in vitro. Specifically, EA facilitated the recruitment of E3 ubiquitin ligase HECW1, which mediated K27-linked polyubiquitination of YAP, leading to its degradation via the TOLLIP-mediated selective autophagy pathway. In vivo, EA mitigated trauma-induced tendon HO by inhibiting the YAP pathway. ConclusionsEA could be a potential therapeutic agent for treating traumatic tendon HO. The therapeutic target HECW1 involved in YAP degradation via autophagy presents a new therapeutic avenue to attenuate the progression of traumatic tendon HO.

PH-sensitive adriamycin hydrochloride and oxaliplatin dual-loaded microspheres synergistically enhance local injections effect of hepatocellular carcinoma

Chemotherapy is the primary palliative treatment for advanced hepatocellular carcinoma (HCC). However, the systemic delivery is associated with the drawbacks including a high risk of adverse effects and a low efficacy. Therefore, local injection therapy may be beneficial. Nevertheless, the existing local drug-carrying microspheres(DOBM)have the characteristics of low loading and abrupt release, can not simultaneously load two drugs, and may cause unnecessary toxicity. In this study, we created the dual-loaded bovine serum albumin (BSA) microspheres (also known as DOBM), which were hollow and contained both oxaliplatin (OXA) and Adriamycin hydrochloride (DOX). In addition, this pH-sensitive drug delivery method exhibited a high drug loading capacity and was promising in breaking through biological barriers, making it a viable option for the treatment of HCC through local implantation. Based on physiochemical evaluation of BSA microspheres, they had a porous structure which was close to the surface. Adriamycin and oxaliplatin were successfully added to the surface of BSA microspheres. According to in vitro experimental results, the growth of human HCC (HCC-LM3 and PLC/PRF/5) cell lines was significantly inhibited by DOBM. Furthermore, in the subcutaneous PLC/PRF/5 HCC model, DOBM played an essential role in tumor development and change in the tumor microenvironment.

Comparing the Efficacy of Local Corticosteroid Injection and High-Intensity Laser Therapy in Patients with De Quervain Tenosynovitis

Background and Objective: De Quervain's tenosynovitis is one of the common causes of wrist pain. The present study aimed to compare the effectiveness of high-power laser therapy and local corticosteroid injection in the treatment of De Quervain's tenosynovitis. Materials and Methods: In this clinical trial, 30 patients diagnosed with De tenosynovitis were randomly assigned to two groups of 15, A and B. Group A underwent high-power laser therapy, five sessions for three consecutive weeks, and group B received corticosteroid injections of 1 ml triamcinolone and 1 ml lidocaine 2% in the wrist under ultrasound guidance. Tendon thickness, pain intensity, quality of life, and treatment satisfaction were measured and compared in both groups pre-treatment, month one, and month three post-treatment. Results: In groups A and B, respectively, the mean scores of the thickness of extensor abductor pollicis longus and abductor pollicis brevis muscles before the treatment were 7.57±0.63 and 7.25±0.58 (P=0.120). these value were calculated at 6.55±0.61 and 6.54±0.40 one month later (P=0.955). They were 5.71±0.75 and 5.99±0.45 (P=0.239) mm three months post-treatment. In addition, pain scores before the treatment were 8.60±1.18 and 8.47±1.46 (P=0.785). One month later, they were 2.73±1.66 and 4.27±1.16 (C=0.785), and three months post-treatment, they were 1.73±1.33 and 2.47±1.06 (P=0.007). There was no significant difference between the two groups in terms of quality of life and satisfaction with treatment (P<0.05 for all). Conclusion: Both local corticosteroid injection and high-power laser treatment methods were safe in the treatment of De Quervain's tenosynovitis, leading to a reduction in pain and tendon thickness, as well as an increase in the patient's quality of life

Comparison between the effect of Steroid Injection, Prolotherapy Local Injection and Extracorporal Shock Wave Therapy in Treatment of Symptomatic Calcaneal Spur

Abstract Background Calcaneal spurs are common cause of heel pain occurring anywhere along the calcaneal tuberosity and most frequently found at the insertion of the plantar fascia. They are usually asymptomatic, but when they are painful, the condition is generally the result of inflammation of the insertional fibers of the plantar fascia at the medial tuberosity. Symptomatic calcaneal spurs are often found in association with plantar fasciitis. Like plantar fasciitis, calcaneal spurs can occur alone or may be part of a systemic inflammatory condition such as rheumatoid arthritis or gout. In some patients, the cause seems to be entirely mechanical, and such patients often exhibit an abnormal gait with excessive heel strike. Objective To compare the effectiveness of dextrose prolotherapy injection, corticosteroid injection and extracorporal shockwave in symptomatic calcaneal spur, based on clinical and functional outcome measures. Patients and Methods This study was conducted on forty-five patients diagnosed with symptomatic calcaneal spur (plantar fasciitis) for more than 6 months. The patients were recruited from Physical Medicine, Rheumatology and Rehabilitation department at Ain Shams University Hospitals. Diagnosis was based on detailed history taking, full clinical examination, pain and functional assessments of the foot using visual analogue scale (VAS score) and foot function index (FFI). Results Eight weeks after treatment, the pain score by VAS was significantly improved at ESWT group mostly, less extent at prolotherapy group and least at corticosteroid group. Also the percentage of improvement in ESWT group was found higher than the other groups indicating the long term analgesic effect of ESWT. Eight weeks after treatment, the FFI subscales (pain, disability and activity limitation)and total FFI score significantly improved mostly at ESWT group, less extent at prolotherapy group and least at corticosteroid group indicating the long term beneficial effect of ESWT on the function in patients with chronic PF. Conclusion Although ESWT, dextrose prolotherapy injection, and local corticosteroid injection were all effective in the treatment of symptomatic calcaneal spur during 8weeks of follow-up but, ESWT was superior to all other modalities in its effect on pain intensity and function during daily life activities at long term follow up.

Local injection therapy with hyaluronic acid preparations: in focus of rheumatologists and orthopedic traumatologists

Hyaluronic acid (HA) is an effective and safe medication for local injection therapy (LIT) widely used in the treatment of osteoarthritis (OA) of large joints. The therapeutic effect of HA is determined both by the replacement of the lubricating function of natural hyaluronate (viscosupplementation), which leads to an improvement in the biomechanical parameters of the joint, and by the biological effects that unfold when interacting with cellular receptors (CD44, RHAMM, etc.), resulting in an anti-inflammatory, anti-nociceptive and anabolic effect of HA. HA therapy has a reliable evidence base. According to a number of clinical studies and meta-analyses, LIT with HA – reduces pain intensity by 28–54 % and improves the function of the affected joint by 9–32 % compared to baseline over a 12-24 week observation period. Repeated administration of HA can delay the need for orthopedic surgery. HA extremely rarely causes serious adverse events and can also be prescribed to patients with concomitant diseases. The use of HA for the treatment of OA is included in Russian and several foreign clinical guidelines (in particular OARSI and ESCEO). A new direction in LIT for OA is therapy with combined (hybrid) HA preparations containing high molecular weight (HMW) and low molecular weight (LMW) fractions. A new HA preparation has appeared in our country, which is a stabilized, highly purified hydrogel containing 80 % HMW HA (molecular weight – 30,000 kDa) with transverse "crosslinking" BDDE (innovative ECHATM technology) and 20 % "uncluttered" linear HA (molecular weight – 1500 kDa). This product is characterized by favorable rheological parameters, which guarantee a long-term improvement in the biomechanics of the affected joint and a rapid onset of biological effects, reduction in pain and inflammation and activation of the synthesis of natural hyaluronate.

Efficacy of low molecular weight hyaluronic acid (500–730 kDa) in post-traumatic pathology of periarticular soft tissues at different sites: data from an open-label pilot clinical study

Local injection therapy (LIT) with hyaluronic acid (HA) medications is one of the most promising methods for the treatment of periarticular soft tissue pathology (PASTP) caused by injury or overuse. Objective: to evaluate the efficacy and safety of LIT with HA medication with a molecular weight of 500–730 kDa in patients with various post-traumatic PASTP. Material and methods. The study included 30 patients with rotator cuff syndrome (RCS), lateral epicondylitis (LE) and plantar fasciitis (PF) after trauma. Inclusion criteria were the presence of moderate/severe pain (≥40 mm on a visual analogue scale (VAS)) over a 3-month period and the absence of effect of LIT with glucocorticoids. All patients were administered HA peritendinously three times (7 days apart) under ultrasound guidance. Treatment results were evaluated after 1 and 3 months based on the dynamics of pain intensity (VAS) and functional indicators using the ASES (American Shoulder and Elbow Surgical Evaluation), MES (Mayo Elbow Score) and FFI (Foot Functional Index) questionnaires. Results and discussion. In the general group, there was a statistically significant decrease in pain intensity after 1 and 3 months from a mean of 57.6 ± 14.7 to 37.0 ± 14.8 and 35.0 ± 14.3 mm according to VAS respectively (p < 0.05). In the patient groups with different PASTP, the average assessment of pain intensity and functional impairment at baseline and after 1 and 3 months was: for RCS (n = 11) 59.0 ± 15.1, 39.0 ± 15.7, 36.3 ± 16.2 mm according to VAS and 49.1 ± 14.3, 60.1 ± 13.7, 61.7 ± 3.8 according to ASES, respectively; with LE (n = 10) 54.0 ± 13.4, 35.0 ± 9.7, 34.0 ± 11.7 mm according to VAS and 71.5 ± 11.1, 78.3 ± 9.0, 81.5 ± 8.3 according to MES; with PF (n = 9) 61.0 ± 16.5, 36.6 ± 19.3, 34.4 ± 15.8 mm according to VAS and 47.2 ± 22.8, 39.6 ± 39.7, 39.0 ± 29.9 according to FFI. None of the patients experienced any adverse events during treatment. Conclusion. HA medication with a molecular weight of 500–730 kDa showed good efficacy and safety in LIT of PASTP of the shoulder, elbow joint and foot. Further studies are needed to evaluate the possibility of a broad use of the drug for the treatment of PASTP in real clinical practice.

Differential diagnosis and treatment of enthesopathies

The article provides a review of the literature on the pathology of the periarticular structure of the enthesis - the site of attachment of a tendon or ligament to the bone. The anatomical and functional features of the fibrocartilaginous enthesis are presented in detail from the position of the “enthesis organ”, which includes the enthesis and the adjacent synovial membrane, bursae and adipose tissue. The issues of the occurrence of degenerative changes against the background of mechanical stress and inflammatory rheumatic pathological processes in the above structural and functional anatomical unit are analyzed. The anatomical zones whose entheses are most often affected are given. The terminology of degenerative and inflammatory lesions of the enthesis is considered, including from the standpoint of ICD-10 codes. The advantages and disadvantages of modern terms are discussed, current concepts corresponding to the etiology of the pathological process are proposed: degenerative-dystrophic or traumatic enthesopathy and inflammatory enthesitis. This division of concepts is aimed at adopting the correct diagnostic and treatment tactics for a doctor of any specialization. The differential diagnosis of these nosologies and approaches to conservative treatment are considered. The possibilities of local injection therapy for enthesitis and enthesopathies, the use of anti-inflammatory and reparative techniques are discussed in detail. Based on our own clinical experience, the features of the treatment of various enthesopathies with glucocorticoids, autologous plasma, microinductive collagen, linear hyaluronates and polynucleotides are considered. Issues of priority methods in different clinical situations and the possibility of prolonging the therapeutic effect, as well as a combination of local and non-drug methods, were discussed. The tactics for ineffective local treatment, methods for correcting therapy and the choice of a leading specialist for various pathologies are discussed.

Comparison of local massage, steroid injection, and extracorporeal shock wave therapy efficacy in the treatment of lateral epicondylitis.

This study aimed to compare the clinical outcomes of patients with lateral epicondylitis (LE) treated with local massage, corticosteroid (CS) injection, and extracorporeal shock wave therapy (ESWT). This randomized prospective study included 52 patients. Patients treated with local massage in Group 1 (n=17; 9 males, 8 females; mean age: 46.1±10.9 years; range, 27 to 64 years), CS injection in Group 2 (n=17; 7 males, 10 females; mean age: 46.0±8.8 years; range, 28 to 63 years), and ESWT in Group 3 (n=18; 12 males, 6 females; mean age: 46.7±11.3 years; range, 28 to 68 years) for LE were evaluated between March 2021 and June 2022. Clinical outcomes were assessed using the Visual Analog Scale (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH), and DASH-Work Model (DASH-WM) scoring systems at the initial examination at the beginning of the study and at two-week, three-month, and six-month follow-up controls. Similar results were observed between VAS, DASH, and DASH-WM scores measured during LE diagnosis. In the first two weeks of follow-up, statistically significant decreases were observed in VAS, DASH, and DASH-WM scores in all three groups. Compared to baseline values, Group 1 and 2 had significant difference in VAS and DASH scores at three months. Group 3 had a significant difference in all clinical evaluation scores. At six months, no significant difference was observed in Groups 1 and 2 in any of the scoring systems, while Group 3 showed significant improvements in all scoring systems. Treatment with ESWT was superior to other treatments throughout the study and at the final follow-up. In patients receiving CS injections, the clinical outcomes worsened with time, evidenced by the six-month follow-up. Further studies on combined treatment modalities are needed on this subject.

Backflow reduction in local injection therapy with gelatin formulations

The local injection of therapeutic drugs, including cells, oncolytic viruses and nucleic acids, into different organs is an administrative route used to achieve high drug exposure at the site of action. However, after local injection, material backflow and side effect reactions can occur. Hence, this study was carried out to investigate the effect of gelatin on backflow reduction in local injection. Gelatin particles (GPs) and hydrolyzed gelatin (HG) were injected into tissue models, including versatile training tissue (VTT), versatile training tissue tumor-in type (VTT-T), and broiler chicken muscles (BCM), using needle gauges between 23 G and 33 G. The backflow material fluid was collected with filter paper, and the backflow fluid rate was determined. The backflow rate was significantly reduced with 35 μm GPs (p value < .0001) at different concentrations up to 5% and with 75 μm GPs (p value < .01) up to 2% in the tissue models. The reduction in backflow with HG of different molecular weights showed that lower-molecular-weight HG required a higher-concentration dose (5% to 30%) and that higher-molecular-weight HG required a lower-concentration dose (7% to 8%). The backflow rate was significantly reduced with the gelatin-based formulation, in regard to the injection volumes, which varied from 10 μL to 100 μL with VTT or VTT-T and from 10 μL to 200 μL with BCM. The 35 μm GPs were injectable with needles of small gauges, which included 33 G, and the 75 μm GPs and HG were injectable with 27 G needles. The backflow rate was dependent on an optimal viscosity of the gelatin solutions. An optimal concentration of GPs or HG can prevent material backflow in local injection, and further studies with active drugs are necessary to investigate the applicability in tumor and organ injections.

Osteoarthritis of “atypical” localization: Epidemiology, clinical manifestations, principles of therapy

The problem of osteoarthritis (OA), the most common chronic rheumatic disease, is usually considered in relation to three groups of joints – knee, hip and hands. However, OA can affect any joints of the human body, causing pathological changes characteristic of this nosological form: destruction of joint tissue associated with mechanical stress, chronic inflammation and degenerative processes (neoangiogenesis, fibrosis, heterotopic ossification). This review examines 5 “atypical” OA localizations – shoulder, acromioclavicular, elbow, ankle and foot. The defeat of these joints is observed quite often: shoulder – about 15%, ankle – 3–5%, foot joints – 17% of the inhabitants of the modern population. The main risk factors for this disease are injuries, repeated significant stress, instability and deformities of the joints. The clinic is typical for OA and is manifested by “mechanical” and “starting” pains, stiffness, increasing dysfunction, crunching and deformation. In some cases, persistent synovitis is noted, accompanied by pain at rest and at night. Generally recognized criteria for OA of “atypical” localization have not yet been developed, therefore, its diagnosis is based on the presence of characteristic complaints, typical radiological changes (narrowing of the articular gap, subchondral sclerosis, osteophytes) and the exclusion of other pathology that can cause joint damage. Treatment of this pathology should be complex and include the combined use of non-drug methods (orthosis, physical therapy, physiotherapy) and pharmacological agents, such as nonsteroidal anti-inflammatory drugs, slow-acting symptomatic agents and local injection therapy (intra-articular administration of glucocorticoids, hyaluronic acid, platelet-enriched plasma). When conservative therapy is ineffective, a wide range of surgical interventions is used, from arthroscopic chondroplasty to total endoprosthetics.

Опыт лечения энтезопатий методикой локальной инъекционной терапии

Введение. Особенность энтезопатий, или периартропатий, заключается в том, что, являясь участком постоянного биомеханического напряжения и оказывая влияние на соседние твердые и мягкие ткани, энтезис формирует воспалительный импульс, приводящий к развитию воспаления в синовиальной оболочке, прилегающей к энтезису. Одним из патогенетически обоснованных шагов в лечении энтезопатий является метод периартикулярного введения хондропротектора. Этот метод позволяет воздействовать на различные звенья воспалительного процесса, влиять на клеточное дыхание. Цель работы. Изучить влияние локальной инъекционной терапии метаболическим специфичным стимулятором репарации соединительной ткани на течение периартропатий. Материалы и методы. 10 пациентам (6 женщин и 4 мужчины в возрасте 54,3 ± 0,4 года) проведено лечение явлений энтезопатий инъекционным методом с использованием метаболического специфичного стимулятора репарации соединительной ткани. 8 пациентам был выставлен и инструментально подтвержден диагноз «трохантерит односторонний», двум пациентам – «двусторонний эпикондилит». Инъекции проводились периартикулярно по 2 мл каждые 3 дня, всего выполнено 5 уколов. Для оценки результатов использовали шкалу оценки интенсивности боли ВАШ, а также сравнивали объем движений в тазобедренном и локтевом суставах до и после лечения. Всего было три контрольных точки – до начала лечения, в момент окончания лечения и через 14 дней после последнего введения препарата. Заключение. Показано, что при локальном введении препарата начинает преобладать репаративная стадия и исход воспаления в сухожильной части мышц. Клинически это наблюдается в виде улучшения функции и ликвидации боли. Background. The peculiarity of enthesopathies, or periarthropathies, is that, being an area of constant biomechanical stress and influencing adjacent hard and soft tissues, the enthesis forms an inflammatory impulse, leading to the development of inflammation in the synovial membrane adjacent to the enthesis. One of the pathogenetically substantiated steps in the treatment of enthesopathies is the method of periarticular administration of a chondroprotector. This method allows you to influence various parts of the inflammatory process and influence cellular respiration. Objective. To study the effect of local injection therapy with a metabolic specific stimulator of connective tissue repair on the course of periarthropathies. Materials and methods. 10 patients (6 women and 4 men aged 54.3 ± 0.4 years) were treated for enthesopathies by injection using a metabolically specific stimulator of connective tissue repair. Eight patients were diagnosed with "unilateral trochanteritis" and instrumentally confirmed, and two patients were diagnosed with "bilateral epicondylitis." Injections were performed periarticularly, 2 ml every 3 days, for a total of 5 injections. To evaluate the results, we used the VAS pain intensity scale, and also compared the range of motion in the hip and elbow joint before and after treatment. There were three control points in total before the start of treatment, at the end of treatment and 14 days after the last administration of the drug. Conclusion. It has been shown that when the drug is administered locally, the reparative stage and the outcome of inflammation in the tendon part of the muscles begin to predominate. Clinically, this is observed in the form of improved function and elimination of pain.

Historical and contemporary management of infantile hemangiomas: a single-center experience.

Objective: This study explores the 22-year evolution of Infantile Hemangiomas (IHs) treatment strategies at a single-center hospital, aiming to establish an individualized IHs management protocol. Methods: Retrospective review of IHs infants 2000-2022 at the Department of Plastic Surgery, Jiangxi Provincial Children's Hospital. Results: In our study of 27,513 IHs cases, 72.2% were female, with the median age at first hospital visit being 25 days. The majority of cases had localized and superficial lesions primarily on the head, face, and neck (67.5%). Ulceration rates fell from 21.1% to 12.6% with the introduction of propranolol. Management strategies have shifted over time, with the proportion of cases undergoing expectant management dropping from 32.9% to 12.4%. Since 2008, 26.1% of patients were treated with oral propranolol, largely replacing corticosteroids. Topical β-blockers have been used in 12.1% of cases, leading to a reduction in local injection therapy from 20.8% to 13.2%. Laser therapy, introduced in 2016, has been used in 13.8% of cases, while surgical excision has dropped from 25.0% to 8.5% due to alternative treatment options. Combination therapy was used in 8.8% of cases post-2015, indicating a rising trend. Drawing from the evolution of IHs management strategies, an individualized protocol for the management of IHs was successfully established. Conclusion: Treatment for IHs has evolved over recent decades, with less invasive medical interventions increasingly replacing more invasive methods. Furthermore, a personalized treatment protocol established in this study could boost the cure rate of IHs while minimizing potential side effects and complications.

Diagnosis and treatment of dorsalgia in outpatient practice

Dorsalgia − nonspecific back pain is the leader in the number of requests for medical help. Nonspecific musculoskeletal pain accounts for up to 80–90% of all pain syndromes. Back pain can be provoked by professional static-dynamic overloads, violations of the statics of the musculoskeletal system, exposure to cold and/or vibration, overweight, hereditary factors, etc. In outpatient practice, doctors often have to deal with various forms and clinical manifestations of dorsalgia. The leading role in the diagnosis is given to the physical examination of the patient. With the active collection of complaints and anamnesis, the doctor has the opportunity to identify the leading problem that prompted the patient to seek medical help, clarify the localization of the process, the time of occurrence and the sequence of symptoms, which allows you to fully imagine the picture of the disease and differentiate between simultaneously occurring nosologies. The identification of the affected structure, which is the root cause of musculoskeletal pain, does not affect the appointment of basic drug therapy, but it is absolutely necessary when conducting local injection therapy, as well as a number of non-drug treatment methods. Among the pharmacological drugs used to treat musculoskeletal pain, the priority remains for NSAIDs, the choice of which, first of all, is dictated by its safety. The favorable safety profile of Nimesil® (nimesulide) has been confirmed by numerous domestic and foreign studies. Nimesulide is registered in 50 countries for the treatment of pain syndromes, and is also used as an antipyretic and anti-inflammatory drug. According to the results of a study in the Russian Federation, Nimesil® (nimesulide) turned out to be the most frequently prescribed drug, which is due to its high effectiveness and ability to accumulate in therapeutic concentration in the focus of inflammation. In addition to pharmacotherapy, the treatment regimen for musculoskeletal pain should include, on a parity basis, non-drug treatment methods that allow correction of pathobiomechanical changes. If ignored, in many cases, drug anesthesia does not lead to the desired effect, which can contribute to the chronization of pain. The described clinical case illustrates the simultaneous course of two variants of dorsalgia in the patient, different in localization, clinical manifestations, severity and duration of the course.

Main clinical characteristics of pain in patients with lumbosacral transitional vertebrae

Based on an analysis of modern medical literature, to study the main clinical characteristics of pain in patients with transitional lumbosacral vertebrae. A search was made for articles in the scientific electronic libraries CYBERLENINKA, eLIBRARY, Google Scholar, and the electronic database of biomedical publications PubMed. Sixty-eight scientific publications corresponded to the stated goal. The review of literature shows that the localization of pain in patients with transitional vertebrae corresponds to the zone of pseudarthrosis between the enlarged transverse process of the LV vertebra and the wing of the sacrum. In most patients, the pain is deep, not superficial. Pain intensity ranges from 3.0 to 8.4, reaching an average of 6.0 on the visual analog scale. Pain can radiate to one of the buttocks and the lower limb. The intensity of pain in the leg at the same time, on average, reaches 5.4 points. The pain syndrome can last for months, the course of the disease acquires a sluggish, undulating character with periodic exacerbations. The causes of exacerbations of pain may be excessive loads on the spine, concomitant vertebrogenic diseases and spinal injuries, excess weight, and in women, a history of pregnancy. Pain management can be either conservative or surgical. The scope of conservative treatment consists of using acupuncture and taking non-steroidal anti-inflammatory drugs. The greatest therapeutic effect is achieved with local injection therapy of analgesics and glucocorticoids at the neoarticulation point. The effectiveness of the course of therapeutic blockades reaches a period from several months to a year. The arsenal of surgical techniques includes pseudoartrectomy, radiofrequency denervation, minimally invasive endoscopic surgery, and transpedicular fusion. In most patients, after surgical treatment, complete relief of pain is noted. The review provides information on the predominant localization of pain in patients with transitional vertebrae, its nature, intensity, irradiation, duration, causes of exacerbation, as well as the effectiveness of the methods of conservative and surgical treatment.

Реконструктивная локальная инъекционная терапия

The article discusses the treatment of osteoarthritis (OA) as the most common joint disease. The recommendations from professional associations for the patient management in OA using hyaluronic acid (HA) preparations differ somewhat depending on the affected joint, although they generally indicate positive effects of their use. Studies have shown the HA participation in the phagocytosis reduction, as well as in lowering the levels of prostaglandins, fibronectin, cAMP and a number of other anti-inflammatory effects. There is also a hypothesis that HA can prevent the release of arachidonic acid, block nociceptors and reduce the bradykinin formation, as well as it has chondroprotective properties. At the same time, total joint replacement is considered optimal (which has proven itself to be an effective and safe type of surgery) during the OA progression, the preservation of severe pain and loss of joint function, and the inefficacy of conservative treatment. The authors draw attention to the most common complication that occurs during total joint replacement — contralateral limb pain, and explain the mechanisms of its progression. They also present their case follow-ups of patients after total joint replacement with the development of synovitis in the contralateral hip joint and synovitis in combination with ligamentitis in the contralateral knee joint. Besides, the article highlights the clinical picture patterns and the methods of reconstructive local injection therapy with HA. KEYWORDS: osteoarthritis, knee joint, hip joint, hyaluronic acid, total joint replacement, contralateral limb pain, intra-articular injection, periarticular injection. FOR CITATION: Filatova Yu.S., Solovyov I.N., Solovyov E.I. Reconstructive local injection therapy. Russian Medical Inquiry. 2024;8(4):208– 214 (in Russ.). DOI: 10.32364/2587-6821-2024-8-4-4.

On the use of type I tropocollagen for local injection therapy of spine, upper and lower extremity disorders

A meeting of Interdisciplinary Expert Panel with leading specialists in the field of orthopedics/traumatology, surgery, rheumatology, and neurology was held in Moscow on February 10, 2023. The purpose of the meeting was to discuss the current status of local injection therapy (LIT) in Russia and the rationale behind the use of collagen-based products for various musculoskeletal disorders. The experts considered the following issues: (1) General contraindications to the use of medical products based on tropocollagen as well as an algorithm for actions in case of adverse events; (2) Guidelines regarding LIT in general and LIT using tropocollagen in particular, including in combination with other LIT products; (3) Particular indications and approaches to the treatment of patients with abnormal changes in appendicular joints and spine with damage to both intra-articular structures and periarticular soft tissue.

Comparing the Efficacy of Local Corticosteroid Injection, Platelet-Rich Plasma, and Extracorporeal Shockwave Therapy in the Treatment of Pes Anserine Bursitis: A Prospective, Randomized, Comparative Study.

Pes anserine bursitis (PAB) is one of the most common causes of painful knee syndromes. This study aimed at examining the efficacy of local corticosteroid injection, platelet-rich plasma (PRP) injection, and extracorporeal shock wave therapy (ESWT) as different modalities to alleviate pain and enhance function in patients with pes anserine bursitis (PAB). A prospective, randomized, comparative study was conducted on 180 patients diagnosed with chronic PAB. They were equally divided into three groups as follows: Group I received a local corticosteroid injection of 40 mg of methylprednisolone acetate/1 ml; Group II received a PRP injection; and in Group III, ESWT was used. Outcome measures included the visual analog scale (VAS), Western Ontario and McMaster Universities (WOMAC) pain score, WOMAC physical function score, and Ritchie articular index (RAI) for tenderness, which were recorded at the baseline, after 1 week, and after 8 weeks. Before the application of procedures, there was a statistically significant increase in the WOMAC pain score in the local corticosteroid group compared to the PRP group and the ESWT group (P < 0.001). After the application of procedures, there was a statistically significant improvement in the 1-week and 8-week WOMAC pain score, WOMAC physical function score, and VAS in the local corticosteroid group in comparison to the PRP group and the ESWT group. (P < 0.001). Moreover, RAI for tenderness shows statistically significant improvement at 8 weeks in the local corticosteroid groups compared to the PRP groups (P < 0.001) and ESWT groups (P < 0.001). Similarly, a statistically significant difference was found between the PRP and ESWT groups (P=0.023). Our data suggest that in patients with PAB, local corticosteroid injection is more efficient than PRP injection and ESWT for reducing pain and enhancing function.

Pain Management Interventions in Lumbar Spinal Stenosis: A Literature Review.

Lumbar spinal stenosis (LSS) occurs due to the narrowing of the space within the vertebral canal and or intervertebral foramina. This results in the compression of the spinal cord and possibly the roots of the spinal nerves.Lower back pain and neurogenic claudication (NC) are major symptoms of spinal stenosis. This is a literature review that summarizes the important findings pertaining to pain management of spinal stenosis. Twenty-four original articles were assessed. Pain can be treated through non-invasive or surgical methods. Conservative techniques include physical exercises, epidural corticosteroid injection, local anesthetic injection therapy, and oral analgesics. Surgical intervention deals with the decompression of the affected spinal region, with or without vertebral fusion surgery. Other novel surgical techniques include implantation of specific equipment, known as interspinous spacer devices and minimally invasive lumbar decompression (MILD). Most studies offering a comparative analysis have demonstrated that surgical intervention is more efficacious than non-surgical interventions to manage pain associated with spinal stenosis.

Local injection therapy in the complex treatment of musculoskeletal disorders: principles of application, evidence base, safety

Local injection therapy (LIT) is an important component of the complex treatment of musculoskeletal disorders (MSD), which is widely used in real clinical practice. Glucocorticoids, hyaluronic acid drugs (HA), autologous cell drugs, botulinum toxin type A, radioactive isotopes, etc. are used for LIT. LIT makes it possible to achieve a pronounced symptomatic effect, while in some cases, for example, repeated HA treatments in patients with osteoarthritis, the possibility of slowing the progression of the disease and reducing the need for surgical treatment is discussed.The performance of LIT requires special skills and abilities of the physician, careful compliance with the rules of asepsis and antisepsis, and instrumental visualization. LIT can be associated with serious complications and therefore must be performed according to strict indications.The Expert Council was devoted to defining the basic principles of LIT. The indications for the use of certain types of this therapies, the evidence base for its efficacy and safety, the order of application of different drugs, and the need to combine LIT with other drug and non-drug treatments of MSD were reviewed.

Therapeutic Effectiveness of Needle Injection Versus Needle-Free Jet Injector System for Botulinum Toxin Type a in Palmar Hyperhidrosis.

The most important problem with local injections of botulinum toxin type A (BTX-A) in palmar hyperhidrosis is pain during the injections. We evaluated therapeutic effectiveness and pain of local injections of BTX-A using needle-free direct administration system. We performed BTX-A local injection therapy using a conventional injection needle in the left hand and a needle-free direct administration system in the right hand. A reduction in the quantity of perspiration was observed 4 weeks after administration of both Needle and Needle-free BTX-A, and reduction was maintained throughout 28 weeks observation period. Both hyperhidrosis Disease Severity Scale scores and Dermatology Life Quality Index for hands treated with Needle BTX-A and hands treated with Needle-free BTX-A had decreased significantly by 4 weeks after treatment. Pain visual analog scale scores and the degree of pain were significantly lower in hands treated with Needle-free BTX-A than in hands treated with Needle BTX-A. When the trigger of the pressurized needle-free injector device is activated, the gas powered driving pressure propels BTX-A through an orifice (0.13 mm) about four times narrower than a 30 G needle at very high speed. As most pain occurs during the needle prick itself, the advantage of a small orifice coupled with high-speed penetration of BTX-A through the pressurized device results in reduced pain during administration. The needle-free direct administration system administers the injectate under the skin without a visible needle.