STRESZCZENIEWstęp. Ce lem ba da nia by ło okre śle nie przy dat no ści te ra pii z za sto so wa niem wła snej su ro wi cy u pa cjen tów z obja wa mi uci sko wy mi ko rze nia w prze bie gu dys ko pa tii od cin ka lę dźwio we go. Za sto so wa no te ra pię opar tą na Au to logicz nej Kon dy cjo no wa nej Su ro wi cy (Au to lo gic Con di tio ned Se rum, ACS, Or tho ki ne).Ma te riał i me to dy. U 15 pa cjen tów z jed no po zio mo wą prze pu kli ną ją dra mia żdży ste go po twier dzo ną ob ra zem MRI, z ob ja wa mi uci sko wy mi ko rze nia ner wo we go bez nie do wła du w ba da niu kli nicz nym, za sto so wa no 6 da wek ACS, po da wa nych przez te go sa me go le ka rza pod kon tro lą USG, sto su jąc doj ście tyl no -bocz ne w oko li cę otwo ru mię dzy krę -go we go. Kon tro lę sta nu kli nicz ne go prze pro wa dza no po 1 mie sią cu i po 3 mie sią cach od ostat niej daw ki. Do oce ny inten syw no ści bó lu za sto so wa no ska lę punk to wą i VAS, do oce ny stop nia obrzę ku ko rze nia ner wo we go za sto so wa no testy kli nicz ne -ob cią że nia w po zy cji sto ją cej na jed nej no dze (One Leg Stan ce, OLS test) i test bier nej ele wa cji koń czyny (Stra ight Leg Ra ise, SLR test), zaś do okre śle nia stop nia nie peł no spraw no ści kwe stio na riusz Oswe stry.Wy ni ki. Z gru py 15 pa cjen tów 2 oso by mu sia ły być ope ro wa ne z po wo du na ra sta ją cych do le gli wo ści bó lo wych. U po zo sta łych pa cjen tów wy ka za no sta ty stycz nie zna mien ną re duk cję bó lu, zmniej sze nie kli nicz nych ob ja wów ucisku ko rze nio we go i po pra wę wy ni ków w ska li Oswe stry. Nie od no to wa no po wa żnych po wi kłań te ra pii ani uszkodzeń ko rze nia po in iek cjach.Wnio ski. 1. Te ra pia Or tho ki ne wy ko ny wa na pod kon tro lą USG mo że być in te re su ją cą opcją w te ra pii ze spo łów uci sko wych ko rze ni w prze bie gu kon flik tu ko rze nio wo -dys ko we go. 2. Ni niej sze do nie sie nie wstęp ne sta no wi podsta wę do ba da nia na licz niej szej gru pie pa cjen tów, w dłu ższej per spek ty wie cza so wej i z gru pą kon tro l ną.Słowa kluczowe: ból krzyża, choroba dyskowa, iniekcja okołokręgosłupowa, surowica własna SUMMARY Background. The aim of the study was to determine the usefulness of autologous serum in the treatment of patients with signs of radicular compression in the course of lumbar discopathy. The treatment was based on the use of autologous conditioned serum (ACS, Orthokine).Material and methods. A total of 15 patients with MRI-confirmed single-level nucleus pulposus herniation with signs of radicular compression without paresis in a clinical examination received 6 doses of ACS administered by the same doctor under ultrasound guidance from a posterolateral approach to the area of an intervertebral foramen. The clinical condition of the patients was reassessed at 1 month and 3 months after the administration of the last dose. Pain intensity was assessed with a scoring system and a VAS scale, and radicular oedema was assessed with the following clinical tests: one-leg stance (OLS test) and stra...

Background Partial-thickness rotator cuff injuries (PTRCI) are the sum of degenerative, overload, and microtrauma processes. An external supply of collagen and platelet-rich plasma (PRP) could potentially counteract the deterioration of degenerative tendinopathy. This study aimed to compare the effectiveness of collagen with PRP, PRP alone, and collagen alone in the treatment of PTRCI. Methods Ninety patients with PTRCI were randomised and treated with ultrasound-guided injections into the shoulder bursa every consecutive week: Group A – collagen with PRP (n = 30), Group B – collagen alone (n = 30), and Group C – PRP alone (n = 30). Primary outcomes were pain intensity measured in control points on a numeric rating scale (NRS), QuickDash, and EQ-5D-5L questionnaires at the initial assessment (IA) and control assessments after 6 (T1), 12 (T2), and 24 (T3) weeks, respectively. Results No statistical differences were found between groups in primary outcomes, although there was a trend towards improvement in Groups A and C (opposite to Group B) between T2 and T3. The following parameters were also observed: rotator cuff discontinuity (n = 3, one case in each group) and rotator cuff regeneration (n = 22 in Group A, n = 20 in Group B, and n = 23 in Group C). Conclusions Combined therapy of collagen and PRP in PTRCI presents similar effectiveness to monotherapies with collagen or PRP. Trial registration The study was prospectively registered on the NCT Trial Center (identification number: NCT04492748) on 30.07.2020.

Due to the rapid development of transport and a significant increase in the number of road users, whiplash injuries are a global health problem and a significant financial burden for both health care systems and insurance systems. The rich symptomatology of whiplash injuries with their impact on the somatic and emotional-behavioral sphere prompts us to define a new disease entity, namely Whiplash Associated Disorders (WAD). The mechanism of whiplash injury is still under debate and theories explaining the pathogenesis of WAD are very diverse, ranging from purely biomechanical and hydrostatic to neurophysiological, emphasizing sensitization and dysfunctional neuromodulation of pain after whiplash injuries. WAD syndrome should be understood more broadly than just cervical trauma, as problems specific to local legal cultures often determine both epidemiological indicators, the course of treatment and prognosis of the disease. There is a need for further research on the issue of whiplash considering inconsistent literature data about optimal rehabilitation after such injuries.

Background. The PRP method is widely used to support healing and regeneration in musculoskeletal and aesthetic medicine. The current literature, however, brings contradictory reports as to its effectiveness, which, at least in part, should be attributed to the diversity of methods for producing the concentrate, including the use of various volumes of whole blood, single vs double centrifugation vs filtration, use of thrombin vs calcium chloride to activate the process, and, finally, the use of an anticoagulant. The aim of the study was to retrospectively evaluate the effectiveness of high-volume PRP therapy with the Angel® system (Arthrex) in our patients. Material and methods. A total of 400 therapies were performed on 299 patients. The most frequently represented indications were knee osteoarthritis (OA), n = 164, including mild (n = 30), moderate (n = 38), and advanced (n = 96) stage; lumbar degenerative disc disease (LDDD), n = 54; rotator cuff injuries (RCI), n = 52; lumbar spinal stenosis (LSS), n = 37; cervical degenerative disc disease (CDDD), n = 17; and shoulder OA, n = 12. Therapies for LDDD and LSS patients were additionally divided with respect to the route of administration (periradicular vs epidural). The assessment tool was the modified Macnab scale. Follow-up examinations were performed at two and six months after PRP administration. Indicators of treatment success were defined as the percentage of satisfactory results and the percentage ratio of satisfactory results to non-satisfactory results after 2 and 6 months of follow-up (S/NS2 and S/NS6). For the advanced stage of knee OA, the results were compared in three age groups (under 66, 67-73 and over 74). Results. For the entire treatment group, the mean S/NS2 ratio was 1.56; in the group of the most frequently represented indications, the highest satisfaction ratio was obtained in LDDD (2.84), and the lowest in the group of RCI (0.96). The mean value of the S/ NS6 ratio was 2.24, being the highest in mild knee OA (4.79) and CDDD (4.67), and the lowest in shoulder OA (0.72). In the age group over 74 years, the frequency of non-satisfactory results shows an increase in patients with advanced knee OA. Conclusions. 1. High-volume PRP therapy can be used as a local regenerative and anti-inflammatory treatment, demonstrating the highest efficacy in early knee OA and CDDD. 2. High PRP therapy demonstrates a high safety profile. 3. The final effects of the therapy develop over a period of several months of follow-up and depend on the severity of the degenerative process and the patient's age.

A -opracowanie koncepcji i założeń (preparing concepts) B -opracowanie metod (formulating methods) C -przeprowadzenie badań (conducting research) D -opracowanie wyników (processing results) E -interpretacja i wnioski (interpretation and conclusions) F -redakcja ostatecznej wersji (editing the final version) StreszczenieZespół Górnego Otworu Klatki Piersiowej (Thoracic Outlet Syndrom, TOS) jest jednym z najbardziej kontrowersyjnych mieszanych zespołów uciskowych (naczyniowo--nerwowych) zarówno ze względu na trudności diagnostyczne jak i brak ogólnie przyjętych standardowych algorytmów postępowania. Ocenia się, iż ta jednostka chorobowa występuje u 10 na 100 000 osób, a w obrazie klinicznym odnotowuje się przewagę objawów naczyniowych nad neurogennymi. W pracy przedstawiono patogenezę funkcjonalnej odmiany zespołu uwzględniając współczesne doniesienia związane z efektami obecnie podejmowanych kierunków postępowania leczenia zachowawczego. Przytoczono argumentację dotyczącą znaczenia poprawnej diagnostyki i wynikającej z niej możliwości zindywidualizowania terapii zgodnej z aktualnie preferowanymi kierunkami postępowania rehabilitacyjnego funkcjonującymi w dostępnej literaturze, jak również wynikającej z własnych wieloletnich doświadczeń. zespół uciskowy naczyniowo-nerwowy, TOS, klatka piersiowa, rehabilitacja, leczenie zachowawcze, powięź AbstractThoracic Outlet Syndrome (TOS) is one of the most controversial compression (vascular and neurogenic) syndromes both due to the fact it is difficult to diagnose and because of the lack of generally accepted standard procedures. It is estimated that this condition occurs in 10 out of 100 000 people, while clinical examinations reveal that arterial symptoms are more common than neurogenic ones. This work presents a pathogenesis of the functional type of the syndrome with regard to contemporary studies analysing the effects of currently applied forms of conservative treatment. The study presents arguments concerning the significance of proper diagnosis which makes it possible to individualise the therapy according to current trends in rehabilitation mentioned in the available literature and resulting from the authors' own experience.arterial-neurogenic compression syndrome, TOS, thorax, rehabilitation, conservative treatment, fascia email: piotrgodek.smc@gmail.com Słowa kluczowe: