Role of combined biological treatment with platelet rich plasma, bone marrow concentrate with hyaluronic acid in mild to moderate osteoarthritis, tendinosis with impingement of shoulder joint

Background: Osteoarthritis of the shoulder joint with tendinosis and impingement is one of the most common causes of the painful stiff shoulder. Subacromial corticosteroid injection with physiotherapy has been the main treatment option for this problem but recurrence is a problem with this treatment. The index study evaluated the role of combined biological treatment to address this difficult problem. Patients & Method: A prospective study was conducted to see the effects of combined biological treatment in 8 patients with MRI evidence of mild to moderate osteoarthritis of the gelanohumeral/AC joint, tendinosis (Supraspinatus, Biceps, Subscapularis), impingement and stiffness of the shoulder. All the patients received weekly ultrasound-guided first injection of Hyaluronic acid injection (20 mg) in the glenohumeral /AC joint and 12.5 % Dextrose in to the tendons and subacromial space; second injection of bone marrow concentrate (BMAC) in the gelanohumeral (3 ml) /AC joint (1 ml) and Platelet Lysate in the tendons and subacromial space; and received 3rd & 4th injection of Platelet Lysate in the Gelanohumeral/AC joint (with hyaluronic acid 20 mg), tendon & subacromial space. Results: All the patients showed improved Oxford Shoulder Score and VAS pain score at 3 months and 6 months follow up, but it was statistically significant at 6 months only. All the patients had mild pain and stiffness for the first two days, which improved paracetamol only; no NSAIDs were given during treatment. Conclusion: Combined biological treatment with PRP, BMAC, Hyaluronic acid injections improves pain, range of motions, quality of life and maybe a good alternative treatment option for patients having mild to moderate osteoarthritis, tendinosis, and impingement syndrome.