Amaç: Hastalarýn rejyonel anesteziden memnuniyetini ve rejyonel anestezi ile ameliyat olan hastalarýn duygu durumlarýný etkileyen faktörleri araþtýrmak.
Gereç ve Yöntem: Çalýþma rejyonel anestezi altýnda ameliyat olan 300 hastayý kapsamaktadýr. Hastalarýn memnuniyeti ve ameliyat sýrasýndaki duygu durumlarý, derlenme odasýnda rejyonel anestezi ile ilgili yapýlan bir anketle deðerlendirilmiþtir.
Bulgular: Tüm hastalar arasýnda rejyonel anesteziden genel memnuniyet 82.3%’tü. Memnuniyet düzeyi 18-25 yaþ grubunda, erkek cinsiyette, geçmiþ rejyonel anestezi deneyimi olanlarda ve preoperatif anestezi deðerlendirmesi sýrasýnda rejyonel anestezi ile ilgili uygun bilgilendirme yapýlan hastalar arasýnda daha yüksekti. Ameliyat sýrasýnda baþarýsýz spinal anesteziye baðlý aðrý duyma ile rejyonel anesteziden memnuniyetsizlik arasýnda anlamlý bir iliþki vardý. Ameliyat öncesi uygun bilgilendirme yapýlan hastalar çoðunlukla “güven” duygusunu ifade etti. Ürolojik ameliyat yapýlan hastalar daha çoðunlukla “rahatlýk” duygusunu ifade etti. Jinekolojik ve obstetrik cerrahi uygulanan hastalar çoðunlukla “heyecan” duygusunu ifade etti. Genel cerrahi ameliyatý yapýlan hastalar ile rejyonel anestezi hakkýnda preoperatif yeterli bilgi alamayan hastalar çoðunlukla “korku” duygusunu ifade etti.
Sonuç: Ameliyat öncesinde rejyonel anestezi hakkýnda yeterli bilgilendirme, memnuniyeti arttýrmakla birlikte hastalarýn ameliyat sýrasýnda güvende hissetmelerini saðlayacaktýr.
Klinik Çalýþma Kayýt No: NCT03476278.

Objectives: This study was designed to evaluate patient satisfaction with a regional anesthesia procedure and factors associated with the mood state of those patients at the time.
Methods: The study was performed with 300 patients who underwent surgery under regional anesthesia. The patients were given a questionnaire while in the recovery room about the experience of undergoing regional anesthesia to determine patient satisfaction and mood state during the procedure.
Results: The overall level of satisfaction with regional anesthesia was 82.3%. The level of satisfaction was higher in the age group of 18-25 years, male gender, in patients who had a previous regional anesthesia experience, and in patients who were well informed about regional anesthesia in a preoperative anesthetic evaluation. There was a relationship between pain due to failed spinal anesthesia during surgery and dissatisfaction with regional anesthesia. Patients who were properly informed preoperatively mostly expressed the feeling of “safe.” Patients who underwent urological interventions most often expressed the feeling of “comfortable”. Patients underwent gynecological and obstetrical surgeries mostly expressed the feeling “excited”. Patients who underwent general surgical procedures and patients who were not informed preoperatively about regional anesthesia most often reported feeling “anxious.”
Conclusion: Providing adequate preoperative information to the patient about regional anesthesia will increase overall satisfaction and will assure the patient feels safe during the perioperative period.
Clinical Trial Registration Number: NCT03476278.

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Amaç: Diz osteoartritinde (OA) kýkýrdak rejenerasyonu saðlamaya yönelik büyüme faktörlerinin salýnýmýný artýran platelet rich plasma (PRP) uygulamalarý ile diz aðrýlarýnda iyileþme saðlanmaya çalýþýlmaktadýr. Biz de bu nedenle diz OA’da PRP’nin kronik aðrý üzerine kýsa dönem etkinliðini ölçmeyi amaçladýk.
Gereç ve Yöntem: Kellgren – Lawrence (K-L) sýnýflamasýna göre grade 2-4 arasý diz OA olan kronik diz aðrýlý 69 hasta çalýþmaya alýndý. 3 hafta aralýklarla uygulanan 3 doz intraartiküler PRP enjeksiyonunu tamamlayan 42 hastanýn 60 diz eklemi ile çalýþma tamamlandý. Hastalarýn aðrýlarý 0. gün, 3., 6., ve 12. haftalarda istirahat ve aktivite visual analog scala (VAS) ile deðerlendirildi.
Bulgular: 37’si kadýn 42 hastanýn ortalama yaþý ve vücut kitle indeksi sýrasýyla (ort±standart sapma (SS)) 60.52±10.41 ve 28.5±9.71 idi. Toplam 18 hasta bilateral diz olup, 60 diz ekleminin 39’u ise K-L grade 3-4 osteoartritti. Hastalarýn 0. gün ve 12. hafta ortalama istirahat ve aktivite VAS skorlarýnda; (sýrasýyla (ort±SS), 5.13±2.70, 7.68±1.83 ve 2.60±2.05, 3.75±2.12, p<0.05) anlamlý iyileþme görüldü. K-L grade 2 hastalarda 0. gün ve 3. hafta istirahat ve aktivite VAS (sýrasýyla (ort±SS), 3.43±1.50, 6.81±1.28 ve 2.57±1.59, 4.10±1.84) skorlarý grade 3-4’e (sýrasýyla (ort±SS), 6.05±2.77, 8.15±1.92 ve 4.49±2.22, 5.74±1.61; p<0.05) göre anlamlý daha iyi olup, 6. ve 12. Hafta istirahat ve aktivite VAS (sýrasýyla (ort±SS), 2.38±1.85, 3.29±1.82; 3.36±1.76, 4.03±1.54 ve 2.14±1.82, 3.19±2.31; 2.85±2.14, 4.05±1.97; p>0.05) skorlarýnda anlamlý bir fark yoktu.
Sonuç: Diz osteoartritinde PRP enjeksiyonlarýnýn 12 haftalýk takip döneminde kronik diz aðrýlarý üzerine anlamlý düzelme saðladýðý görüldü. Ek olarak, erken evre diz OA’lýlarda PRP’ye aðrýda azalma yanýtý daha iyi bulundu.

Objectives: The administration of platelet-rich plasma (PRP), which increases the release of growth factors targeting cartilage regeneration, is used in an effort to relieve pain in knee osteoarthritis (OA). This study measured the short-term efficacy of PRP on chronic pain in patients with OA of the knee.
Methods: Patients with chronic knee pain and grade 2-4 knee OA based on the Kellgren-Lawrence (K-L) classification were enrolled in the study. A total of 60 knee joints of 42 patients who completed 3 doses of intraarticular PRP injections administered at intervals of 3 weeks were analyzed. The patients’ pain was evaluated using a resting and activity visual analog scale (VAS) on day 0, and at week 3, 6, and 12.
Results: Of the 42 patients, 37 were female. The mean age and body mass index was 60.52±10.41 years and 28.5±9.71 kg/m2. A total of 18 patients had bilateral knee involvement, and 39 of the 60 knee joints were classified as K-L grade 3-4 OA. A significant improvement was observed in the mean resting and activity VAS scores at day 0 and week 12 (p<0.05). In K-L grade 2 patients, the day 0 and week 3 resting and activity VAS scores were significantly better than the grade 3-4 scores (p<0.05).
Conclusion: It was observed that PRP injections provided a meaningful improvement in chronic knee pain in patients with knee OA throughout a 12-week period. The pain reduction response to PRP was better in patients with early-stage knee OA.

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Amaç: Bu çalýþmanýn amacý intörn öðrencilerin aðrýya yönelik bilgi düzeylerini deðerlendirmektir.
Gereç ve Yöntem: Kesitsel tipteki bu çalýþma örneklemini Türkiye’nin batýsýnda öðrenim gören 190 hemþirelik fakültesi öðrencisi oluþturmuþtur. Araþtýrma verileri, 2015–2016 yýlý Mart-Haziran aylarý arasýnda, “Öðrenci Tanýtým Formu ve Hemþirenin Aðrý ile Ýlgili Bilgi ve Tutum Anketi (NKASRP)” kullanarak toplanmýþtýr.
Bulgular: Çalýþma örneklemini oluþturan öðrencilerin yaþ ortalamasý 23.06±1.44 olup; %83.7’si kadýn, %96.8’i bekar, %.5.3’ü hemþire olarak çalýþmakta ve öðrencilerin tamamýnýn sosyal güvencesi bulunmaktadýr. Öðrencilerin NKASRP toplam puan ortalamasý %15.85±%3.25 olarak bulunmuþtur. Öðrencilerin bilgi puanlarý karþýlaþtýrýldýðýnda, yalnýzca hemþire olarak görev yapanlarda anlamlý fark olduðu bulunmuþtur. Yaþ ve þimdiye kadar yaþanan en kötü aðrý skoru gibi deðiþkenler ile NKASRP arasýnda anlamlý bir fark bulunmamýþtýr (p>0.05).
Sonuç: Öðrencilerin aðrý bilgi puanlarýnýn düþük olduðu görülmüþtür. Lisans eðitiminde aðrý yönetimine daha fazla yer verilmesinin hastalarýn yaþam kalitesini yükseltmeye yardýmcý olacaðý düþünülmektedir.

Objectives: The purpose of the present study was to examine the knowledge and attitudes of Turkish nursing students about pain management.
Methods: The participants in this cross-sectional study were 190 nursing students who were studying at a nursing faculty in western Turkey. The research data were collected between March and June of the academic year 2015–2016, using a Student Description Form and the Nurses’ Knowledge and Attitudes Survey Regarding Pain (NKASRP).
Results: The mean age of the students in the study sample was 23.06±1.44 years. In all, 83.7% were female, 96.8% were unmarried, 94.7% were working as a nurse, and all had social security. The mean score of the NKASRP was 15.85±3.25%. A comparison of the knowledge scores with student characteristics revealed that only the status of current employment as a nurse demonstrated a significant difference. No significant difference was detected between the NKASRP score and variables such as age and the score of the worst pain ever experienced (p>0.05).
Conclusion: It was determined that the students had a generally poor level of pain knowledge. It will improve the quality of life of patients if pain management is given a greater place in undergraduate education.

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Amaç: Ýnfraklavikular brakial pleksus bloðu el, bilek ve dirsek operasyonlarý için uygun bir rejyonal anestezi tekniði olup, sinir stimülatörü eþliðinde gerçekleþtirilmektedir. Son yýllarda ultrasonografinin periferik sinir bloklarýnda kullanýma girmesiyle birlikte, uygulamalar deðiþmeye baþlamýþtýr. Çalýþmada amacýmýz, infraklavikular brakial pleksus bloðunda, tek baþýna ultrasonografi kullanýmý ile ultrasonografi ile birlikte sinir stimülasyonu kullanýmýný, uygulama süresi, baþarýlý blok oraný, duyusal blok kalitesi açýsýndan karþýlaþtýrmaktýr.
Gereç ve Yöntem: Çalýþma, elektif koþullarda el, bilek ve dirsek operasyonu geçirecek 40 ASA I-II hastada yapýlmýþtýr. Hastalar US (Ultrasonografi) ve USSS (Ultrasonografi + Nörostimulatör) þeklinde iki gruba ayrýlmýþtýr. US ve USSS eþliðinde hastalara, 100 mg bupivakain, 200 mg prilokain 40 ml olacak þekilde SF ile sulandýrýlarak infraklavikular bölgeye uygulanmýþtýr. Uygulama süresi kronometre ile takip edilerek kayýt altýna alýnmýþtýr. Uygulamadan sonra 30 dk süresince 5 dk’da bir elin motor ve duysal bloðu deðerlendirilmiþtir.
Bulgular: Uygulama süresi Grup US’de 6.68±0.75 dk, Grup USSS’de 6.9±1.02 dk olarak bulunmuþtur. Uygulama süresi açýsýndan gruplar arasýnda istatistiksel anlamlý fark bulunmamýþtýr (p>0.05, p=0.62). Grup US’de 20. dk’da 16/20 hastada tam blok ortaya çýkmýþken, Grup USSS’de 20. dk’da 14/20 hastada tam blok ortaya çýkmýþtýr, fark istatistiksel olarak anlamsýzdýr. Grup US’de 2/20 hastada cerrahi iþlem sýrasýnda lokal anestezik infiltrasyonu, Grup USSS’de 1/20 hastada lokal anestezik infiltrasyonu gerekti.
Sonuç: Ýnfraklavikular brakial pleksus blokajýnda ultrasonografi ile birlikte sinir stimülasyonu kullanýmýnýn, sadece ultrasonografi kullanýmý ile karþýlaþtýrýldýðýnda blok baþarýsýna ek bir katkýsý olmadýðý görüldü. Sinir stimülasyonuna baðlý olarak oluþan rahatsýzlýk hissi ve aðrý göz önüne alýndýðýnda, tek baþýna ultrasonografi kullanýmýnýn, sinir stimülasyonuna tercih edilebileceði kanýsýna varýlmýþtýr. Bununla birlikte istatistiksel olarak anlamlý sonuçlar elde etmek ve kesin sonuçlara ulaþabilmek için, bu konuda çok sayýda çalýþmalara ihtiyaç vardýr.

Objectives: Infraclavicular brachial plexus blockade is an anesthetic technique used for operations of the hand, wrist, and elbow. Ultrasound (US)-guidance is a recent addition to the surgical technique. The aim of this study was to compare the use of US alone and US with a nerve stimulator in an infraclavicular brachial plexus blockade in terms of the performance time, successful blockade rate, and the quality of sensory block.
Methods: A total of 40 patients who were scheduled for hand, wrist, or elbow surgery were included in the study. The patients were divided into 2 groups: US and USSS (ultrasonography + neurostimulation). A dose of 40 mL, containing 100 mg bupivacaine and 200 mg prilocaine was administered with the guidance of US or USSS in the infraclavicular regions. Performance time was measured and recorded. Motor and sensory blockade was assessed within 30 minutes after the block.
Results: The mean performance time for Group US and Group USSS was 6.68±0.75 and 6.9±1.02 minutes, respectively, without significant difference between groups (p>0.05, p=0.62, respectively). A complete blockade was seen in 16/20 patients in Group US and in 14/20 patients in Group USSS in 20 minutes, which did not yield a significant difference. During the surgery, local anesthetic infiltration was required in 2/20 patients in Group US and in 1/20 patients in Group USSS.
Conclusion: The results of this study revealed no additional benefit to USSS in block success in comparison with US alone. Considering the feeling of discomfort and pain due to nerve stimulation, it was concluded that use of US alone may be preferred to combination use.

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Amaç: Bu prospektif randomize çalýþmada, midazolama eklenen magnezyumun hemodinami, T-parçasýna geçiþ süresi, mekanik ventilasyon süresi ile BIS monitorizasyonu ve sedasyon ölçekleri kullanýlarak ek sedatif analjezik gereksinimi üzerine etkisini araþtýrmayý amaçladýk.
Gereç ve Yöntem: Yoðun bakým ünitesinde mekanik ventilasyon desteði alan 50 hasta rasgele olarak iki gruba ayrýldý. Grup I, 0.03-0.3 mg/kg bolus yükleme dozu +0.03-02 mg/kg/saat midazolam infüzyonu aldý; Grup II, 30 dakikada. 2 gr bolus, 16 mg/24 saat magnezyum infüzyonu +0.03-02 mg/kg/saat midazolam infüzyonu aldý. BIS seviyeleri ve sedasyon seviyeleri sürekli olarak monitörize edildi.
Bulgular: Grup I’de mekanik ventilasyonun süresi grup II’den daha uzundu (sýrasýyla 31±12 saat; 19±11 saat; p<0.01). T-parçasý ile spontan solunum denemelerine baþlama zamaný, grup I’de grup II’den (27±11 saat; 16±11 saat) daha uzundu (p<0.01). Grup I’in 48 saatlik insülin gereksinimi grup II’den yüksekti (p<0.05).
Sonuç: Yoðun bakým ünitesinde, geleneksel sedasyon protokollerine intravenöz magnezyumun eklenmesi, midazolam ve ek analjezi gereksinimini, mekanik ventilasyon destek süresini herhangi bir yan etkisi olmaksýzýn azaltmýþtýr.

Objectives: The aim of this prospective, randomized study was to investigate the effect of magnesium added to midazolam on the hemodynamics, transition time to a T-piece, mechanical ventilation duration, additional sedative-analgesic requirement using bispectral index (BIS) monitorization and sedation scales.
Methods: Fifty critically ill patients receiving mechanical ventilation support in the intensive care unit were randomly assigned to 2 groups. Group I received a 0.03-0.3 mg/kg bolus loading dose+0.03-02 mg/kg/hour midazolam infusion; Group II received a 2 g bolus at 30 minutes, 16 mg/24-hour magnesium infusion+0.03-02 mg/kg/hour midazolam infusion. BIS levels and sedation levels were continuously monitored.
Results: The duration of mechanical ventilation in Group I was longer than that of Group II (31±12 hours, 19±11 hours, respectively; p<0.01). The length of time to start spontaneous breathing trials with a T-piece was greater in Group I than in Group II (27±11 hours, 16±11 hours, respectively; p<0.01). The 48-hour insulin requirement of Group I was greater than that of Group II (p<0.05).
Conclusion: Adding intravenous magnesium to the traditional sedation protocols in the intensive care unit decreased midazolam use as well as the additional analgesic requirement and mechanical ventilatory support duration without any side effects.

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Amaç: Bel aðrýsý þikayeti ile baþvuran hastalarda uygulanan transforaminal anterior epidural steroid ve lokal anestezik enjeksiyonlarýnýn (TAESE) etkinliðini ve yaþam kalitesindeki deðiþiklikleri retrospektif olarak incelemektir.
Gereç ve Yöntem: Çalýþmaya dahil edilen (191) hasta; lomber disk hernisi (DH), baþarýsýz bel cerrahisi (BBC) ve spinal stenoz (SS) olarak 3 gruba ayrýldý. Hastalarýn aðrýsýnýn deðerlendirilmesinde görsel analog skala (visual analogue scale) (VAS) ve sözel aðrý skalasý (SAS) kullanýldý. Hastalarýn aðrý ölçümleri, tedavi öncesi (VAS 0), uygulamanýn 1. ayýnda (VAS 1), 3. ayýnda (VAS 3) ve 6.ayýnda (VAS 6) yapýldý. Hastalarýn yaþam kalitesi, Týbbi Hastalýklar Sonlaným Çalýþmasý (Medical Outcome Study, MOS) Short Form 36 (SF-36) ile sorgulandý.
Bulgular: Her 3 grupta da hastalarýn aðrý seviyelerinde giriþim öncesine (VAS 0) göre 1, 3 ve 6. aylarda istatistiksel olarak belirgin azalma saptandý (p<0.001). VAS/SAS’daki azalma DH grubunda BBC ve SS gruplarýndaki hastalardan daha fazlaydý. En fazla analjezi, sýrayla DH, BBC ve SS gruplarýndaydý. SF-36 ölçümlerindeki tüm parametreler, SS hastalarýnda DH hastalarýna göre daha düþük saptandý. SS hastalarýnda yaþam kalitesi puanlamalarý en düþükken, SF-36’nýn parametrelerinden fiziksel saðlýk ve sosyal fonksiyon puanlarý BBC grubunda en düþüktü..
Sonuç: TAESE, bel aðrýsýný azaltmada effektiftir ve disk hernisi, baþarýsýz bel cerrahisi ve spinal stenoz’a baðlý bel aðrýsý olan hastalarda güvenli olarak uygulanabilir. Spinal stenozlu hastalarýn yaþam kalitelerinin olumsuz etkilendiði ve bunun da özellikle fiziksel rol güçlüðü parametresi üzerinde olduðu söylenebilir.

Objectives: The aim of this retrospective study was to evaluate the efficacy of transforaminal anterior epidural steroid and local anesthetic injections (TAESE) and the effects on quality of life in patients with low back pain.
Methods: The study patients (n=191) were divided into 3 groups: disc herniation (DH), failed back surgery (FBS), and spinal stenosis (SS). A visual analog scale (VAS) and verbal pain scale (VPS) were used to assess patient pain. Scores were measured before treatment (VAS 0), in the first month of application (VAS 1), 3 months (VAS 3), and 6 months (VAS 6). Patient quality of life was examined using the 36-Item Short Form Health Survey (SF-36).
Results: In all 3 groups, there was a statistically significant reduction in pain compared with the VAS 0 score at 1, 3, and 6 months (p<0.001). The reduction in VAS/VPS was greatest in the DH group, followed by the FBS and SS groups, respectively. All of the parameters of the SF-36 measurement were lower in the SS patients compared with the DH patients. The quality of life score was lowest in the SS patients, though the physical health and social functioning scores were lowest in the FBS group.
Conclusion: TAESE is effective and can be safely performed in patients who have low back pain due to DH, FBS, or SS. The quality of life result was less successful in SS patients, particularly in the parameter of physical role limitations.

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Plastik cerrahi bölümü tarafýndan sol ayak tabanýnda malign melanoma nedeni ile cerrahi eksizyon planlanan 92 yaþýndaki, ASA III, erkek olguda ultrason rehberliðinde uygulanan popliteal blok sonrasý karþýlaþtýðýmýz bölgesel hematom komplikasyonu ile ilgili deneyimimizin paylaþýlmasý amaçlandý.

This report was submitted to share an experience of the development of a local hematoma as a complication following ultrasound-guided popliteal block performance in a 92-year-old, American Society of Anaesthesiologists class III, male patient undergoing surgical excision of a malignant melanoma lesion in the base of the left foot performed by the plastic surgery department.

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Transforaminal epidural steroid enjeksiyonu radiküler aðrý tedavisi için kullanýlan yaygýn bir giriþimdir. Komplikasyonlarý nadir fakat katastrofiktir. En nadir katastrofik komplikasyonlarýndan biri Adamkiewicz arter (AKA) oklüzyonu ile ilgilidir. Bu sunumda transforaminal epidural steroid enjeksiyonu ile iliþkili AKA injurisinden kaçýnmak için uyguladýðýmýz yaklaþýmý sunduk. 71 yaþýnda erkek hasta kliniðimize lomber disk hernisine baðlý radikülopati ile baþvurdu. Hastaya transforaminal steroid enjeksiyonu planlandý. Radyokontrast enjeksiyonu sonrasýnda vasküler dolum görüldü. Bunun üzerine iðneye yeniden pozisyon verilerek epidural alana ulaþmak için inferior giriþ uygulandý. Vasküler yayýlým görülmedi ve dexametazon enjekte edildi. Transforaminal epidural enjeksiyon radiküler aðrý için efektif bir giriþimsel aðrý tedavisidir. Fakat muhtemel katastrofik komplikasyonlar nedeniyle dikkatli olmayý gerektirir. AKA büyük oranda foramenin üst yarýsýnda lokalizedir. Spinal kord iskemisini önlemek için AKA’nýn çok geniþ bir anatomik varyasyona sahip olduðunu akýlda bulundurmak çok önemlidir.

Transforaminal epidural steroid injections are a common intervention in the treatment of radicular pain. Complications are rare, but can be catastrophic. One of the potentially devastating complications is occlusion of the artery of Adamkiewicz (AKA). This report is a description of an approach to avoid the complication of injury to the AKA related to transforaminal epidural injection. A 71-year-old male patient presented at the clinic with radiculopathy secondary to lumbar disc hernia. A transforaminal epidural steroid injection was planned. After a radiocontrast injection, vascular filling was detected. The needle was repositioned and an inferior entrance to the epidural space was used. No vascularity was seen and dexamethasone was administered to the patient. A transforaminal epidural steroid injection is an effective interventional treatment for radicular pain, but it requires careful attention due to the possible complications. The AKA was located in the upper half of the foramen. Keeping the wide variation in the anatomy of the AKA in mind is very important in order to prevent spinal cord ischemia.

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Rotator cuff kalsifik tendiniti çoðunlukla kendiliðinden geçen yaygýn bir omuz rahatsýzlýðýdýr. Ancak bazý hastalarda uzun süreli konservatif tedaviye raðmen aðrýda herhangi bir düzelme görülmez. Bizim bu makaledeki amacýmýz, infraspinatus kalsifik tendiniti olan bir hastada plateletten zengin plazma (PRP) tedavisi sonrasý iyileþmeyi göstermek. PRP tedavisinin bu rahatsýzlýktaki etkinliði kesin olmasa da, dirençli vakalarda etkin bir tedavi seçeneði olabilir.

Rotator cuff calcific tendinitis is a common shoulder disorder that usually subsides spontaneously. Some patients, however, do not show any improvement in the pain after conservative treatment for an extended period of time. The aim of this report was to demonstrate the improvement in a patient with calcific tendinitis of infraspinatus following treatment with platelet-rich plasma (PRP). Although the efficacy of PRP therapy in this condition is uncertain, it can be an effective treatment option in refractory cases.

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