A Novel Treatment for Combined Adhesive Capsulitis and Glenohumeral Osteoarthritis - Case Study: RELIEF® Treatment.

Adhesive capsulitis (AC) of the shoulder is a prevalent condition often characterized by a prolonged clinical course and significant patient morbidity, leading to a high socioeconomic burden. Despite numerous studies evaluating various treatment modalities, an optimized treatment algorithm remains elusive. Similarly, osteoarthritis (OA) of the shoulder presents a comparable clinical and an even higher socioeconomic impact. Advances in diagnostic imaging and short-term pain management options have not yielded effective long-term disease-modifying therapies. With the decreasing average age of patients suffering from glenohumeral OA, there is a growing interest in regenerative treatments aimed at alleviating symptoms, enhancing quality of life, and potentially postponing invasive surgical interventions. This paper provides an overview of the pathophysiology of both AC and glenohumeral osteoarthritis (GHOA), accompanied by a retrospective pilot case study demonstrating the efficacy of a novel orthobiologic approach known as the RELIEF® treatment. This innovative approach yielded promising short-term outcomes, including significantly improved multi-planar shoulder range of motion (ROM) and functional scores at six months post-treatment. The RELIEF® treatment involves diagnostic dynamic ultrasound to identify scarring or abnormalities in the fascia together with a hydrodissection technique using a combination of cryopreserved micronized human amniotic membrane suspension allograft (hAMA) and Isolyte crystalloid IV fluid. Under direct ultrasound guidance, local anesthetic (2% lidocaine with epinephrine 1:200,000) is utilized to perform multiple injections aimed at lysing fibrotic scar tissue and delivering the allograft to affected areas. Pre- and post-treatment assessments of ROM were conducted by a licensed physical therapist utilizing a goniometer. Measurements were taken at baseline (before treatment) and subsequently at two weeks, two months, four months, and six months post-treatment. Additionally, American Shoulder and Elbow Surgeons (ASES) scores and visual analog scale (VAS) pain ratings were recorded. An MRI of the shoulder (without contrast) was subsequently performed 4 months following the second RELIEF® treatment to evaluate for any radiographically significant changes and to correlate these findings with change in patient-reported symptoms and overall functional status.