Highlights of the Study • Existing literature does not explain the mechanism of extracorporeal shock wave therapy (ESWT) in reducing coccydynia. • This study shows that ESWT is a convenient, cost-effective method with low complication rates. • ESWT provides effective pain control for chronic coccydynia.

Departmental sources Background: Osteoarthritis secondary to developmental dysplasia of the hip (DDH) is one of the major causes of hip pain and disability. The aim of the study was to compare the effectiveness of prolotherapy (PrT) injections versus exercise protocol for the treatment of DDH. Material/Methods: There were 46 hips of 41 patients who had osteoarthritis secondary to DDH included in this study. Patients were divided into 2 groups: treated with PrT (PrT group; n=20) and exercise (control group; n=21). Clinical outcomes were evaluated with visual analog scale for pain (VAS) and Harris hip score (HHS) at baseline, 3 weeks, 3 months, 6 months, and a minimum of 1-year follow-up. In PrT group clinical results were also compared in Crowe type I-IV hips. Results: Between group analysis revealed no significant between group differences at baseline. Dextrose injection recipients out performed exercise controls for VAS pain change score at 6 months (-4.6±2.6 versus-2.8±2.5; P=0.016), and 12 months (-4.5±2.4 versus-2.9±2.5; P=0.017) and for HHS at 6 months (24.2±14.0 versus 14.8±12.4; P=0.007) and 12 months (24.3±13.4 versus 16.5±11.3; P=0.018). Conclusions: To our best knowledge, this study is the first regarding the effects of an injection method in the treatment of osteoarthritis secondary to DDH. According to our study, PrT is superior to exercises. PrT could provide significant improvement for clinical outcomes in DDH and might delay surgery.

Purpose Patients with chronic low back pain, who do not respond to conservative treatment methods, generally undergo surgical revision operations, and sometimes an undesirable condition called failed back surgery syndrome (FBSS) may be inevitable. Hereby, dextrose is one of the regenerative methods that has gained popularity in the treatment of many musculoskeletal problems, and we aimed to present and evaluate the outcomes of 5% dextrose for the treatment of FBSS. Methods It has been designed as a consecutive case series. A total of 79 patients with FBSS, who had minimum 6 months of symptoms and did not respond to 3 months of conservative methods between May 2014 and March 2016, participated in the study. Prolotherapy injections were applied in posterior and lateral approaches. Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) were used for the pre-and post-treatment evaluations. Patient satisfaction was assessed with using a 5-point Likert scale by phone contacting. Results There was statistically significant difference between repeated VAS and ODI measurements. Conclusions These results may be the first step giving a lead to an undiscovered field. This treatment method should be kept in mind for FBSS patients before giving a decision of revision surgery.

Dextrose solutions (in 1%, 5%, 10%, 15%, 20% and 25% concentrations) were applied on adult human fibroblasts in vitro culture condition. Cell proliferation assay was used for finding the cell deaths in cell culture. Up to 80% fibroblast cells died in high dextrose concentrations (15%, 20% and 25%). The deaths of cells were visualized on inverted microscope. In low dextrose concentrations (1%, 5% and 10%), viable cell ratio was above 80%. The gene expression analysis were performed on selected genes which have roles on angiogenesis and apopitosis [VEGFA (Vascular Endothelial Growth Factor A-OMIM ABSTRACTObjectives: Hypertonic dextrose injection in prolotherapy is an injection-based treatment used in chronic musculoskeletal conditions. Dextrose prolotherapy raises growth factor levels and enhances tissue repair, reduces musculoskeletal pain. Despite of uses for many years, the effect of dextrose solution on cellular and molecular base is not fully clear. Here, the roles of dextrose solutions was tried to find out in different concentrations on human fibroblasts in vitro. Gene expression alterations were analyzed in uses of dextrose solutions on growth and apoptotic factors. Methods:The effects of dextrose solution (1%, 5%, 10%-low doses, 15%, 20% and 25%-high doses) were evaluated in vitro by using human fibroblast culture. In each condition total RNA extraction and cDNA synthesis were performed. The gene expression levels of angiogenic and apoptotic factors were analyzed by using real-time polymerase chain reaction. The gene expression results of growth and apoptotic factors were correlated with control results. Results:Results;Dextrose solutions were affected the viability of fibroblast cells in culture flask in high concentrations. In high doses dextrose concentrations, up to 80% of fibroblasts were died because of toxic conditions. Viable fibroblast cell ratios were decreased proportionally due to the dextrose concentration. Low dextrose concentrations increased gene expressions in angiogenic (VEGFA, PDGFA, PDGFB, IGF1) and in apopitotic factors (CASP3 and CASP8) in fibroblasts. Conclusions: Conclusion; Dextrose solution in high concentrations, decreases viable cell ratios on adult fibroblast cell line. Dextrose solutions in proper concentrations increase the gene expressions of angiagenic and apopitotic factors on viable cells in adult fibroblast cell culture.

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Patellofemoral pain syndrome (PFPS) is the most common problem in musculoskeletal system. Platelet-rich plasma (PRP) has been suggested to be beneficial in the treatment of sports injuries. The purpose of this study is to compare single and triple PRP injections in the treatment of PFPS and to show whether or not triple application of PRP injection may be more effective. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : This is a randomized controlled clinical trial. A total of 30 patients with PFPS for more than 3 months, with age of 20 to 35 years, were included in this study. The patients were divided into three groups as single injection application group (n=20) or triple injection application group (n=10) and the unaffected opposite knees were used as controls (n=30). 2 mL of PRP injected into the knee joints. In triple injection group the injections were done a month apart. All patients received a six-week standard exercise program. The outcome measures proprioception, isokinetic test and Kujala patellofemoral score were assessed at baseline and 4 months after baseline. R Re es su ul lt ts s: : Among the patients with PFPS treated with an exercise program, a triple PRP injection compared with a single PRP injection did not result in greater improvement in knee functions, balance and proprioception, isokinetic muscle strength and endurance during a 4-month follow-up (p<0.05). C Co on nc cl lu us si io on n: : The triple PRP injection was found to be no more effective than single PRP injection. K Ke ey y W Wo or rd ds s: : Patellofemoral pain syndrome; platelet-rich plasma Ö ÖZ ZE ET T A Am ma aç ç: : Patellofemoral ağrı sendromu (PFAS), en yaygın kas-iskelet sistemi problemidir. Trombositten zengin plazma (PRP) spor yaralanmaları tedavisinde önerilmektedir. Bu çalışmada, PFAS tedavisinde tek ve üçlü PRP uygulaması karşılaştırılarak, üç kez uygulanan PRP enjeksiyonunun daha etkin olup olmadığının gösterilmesi amaçlanmıştır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Randomize kontrollü bu çalışmaya, üç aydan uzun süredir PFAS olan, yaşları 20-35 yıl arasındaki 30 hasta dâhil edildi. Hastalar tek enjeksiyon uygulama grubu (Grup 1, n=20) ve üçlü enjeksiyon uygulama grubu (Grup 2, n=10) olmak üzere ikiye ayrıldı, sağlam olan diğer dizler ise kontrol grubu (Grup 3, n=30) olarak değerlendirildi. Eklem içine 2 mL PRP enjeksiyonu yapıldı. Üçlü enjeksiyon uygulama grubuna bir ay arayla PRP enjekte edildi. Tüm olgulara altı haftalık standart egzersiz programı uygulandı. Katılımcılar başlangıçta ve başlangıçtan dört ay sonra izokinetik test, balans testi ve Kujala patellofemoral skorlama sistemi ile değerlendirildi. B Bu ul lg gu ul la ar r: : PFAS tedavisinde egzersiz ile birlikte tekli ve üçlü PRP enjeksiyonunun dört aylık takibi sonucunda diz fonksiyonu, denge ve koordinasyon, izokinetik kuvvet ve dayanıklılık açısından istatistiksel olaral anlamlı bir fark saptanmadı (p<0,05). S So on nu uç ç: : Üçlü PRP enjeksiyon grubu, tekli PRP enjeksiyon grubundan daha etkin bulunmadı. A An na ah h t ta ar...

Aims:Prolotherapy is a regenerative treatment that induces the local inflammation response and has been used clinically for many musculoskeletal system disorders. Dextrose is the most common solution that is used for prolotherapy. Dextrose prolotherapy can be used as a complementary treatment for various musculoskeletal system disorders including low back pain. The aim of our trial is to assess the potential effectiveness of 5% dextrose injection for radicular low back pain resulting from lumbar disc herniation. Methods:We evaluated a total of 40 patients treated with 5% dextrose prolotherapy for radicular low back pain for one year. Of these patients, 20 patients were treated with only prolotherapy. The other 20 patients were treated with prolotheraphy and physical therapy. 5% dextrose solution is used for the treatment and the solution being injected to iliolumbar and transverse ligament insertion levels and at the facet level. We used Visual Analog Scale (VAS) 10 cm, Oswestry Disability Index (ODI) and Short Form-36 (SF-36) for the evaluation of pain, mobility, quality of life and functional status of the patients. Results:A significant reduction in pain was reported in all patients in both groups. The pain and disability scores significantly improved both in two groups at the 3, 12 and 52-week follow-up with no significant difference between the groups. Conclusions:Patients with radicular low back pain resulting from disc herniation can be treated effectively by using 5% dextrose prolotheraphy.

Pain is a symptom caused by a disease process and/or tissue injury. With the prolongation of life expectancy in humans, the incidence of degenerative joint diseases and as a result pain has increased. Unfortunately, a method of treatment that stops or reverses progression by affecting the pathogenesis in these diseases has not been developed. Physical therapeutics such as medicine and physical rehabilitation often are prescribed for patients suffering with pain. Recently, in addition to these routine therapies used in pain treatment, many regenerative injection-based therapies, including prolotherapy (PrT) or platelet-rich plasma (PRP) have been widely used. PrT is using for damaged or degenerated connective tissue healing, such as ligaments, tendons, and cartilage. The combination of local inflammatory effect, stimulation of local growth factor release, and down regulation of neuropathic inflammation can be defined as the mechanism. As a result of these, joint instability and ligament laxity reduce and pain decrease. PRP is the cellular component of the plasma. Although PRP is used for the same reasons as PrT, it can be used in acute cases unlike PrT. This chapter is intended to understand the use of regenerative injection therapies (PrT and PRP) better in the treatment of pain.