Hyaluronic acid injections - Benefits and Side Effects
Hyaluronic acid is found in high concentrations in cartilage and synovial fluid, and is an important component of the
extracellular matrixes-exerting joint lubrication and buffering actions thanks to its viscoelastic properties. [9]

Hyaluronic acid injections have been applied to shoulder, knee and joint osteoarthritis, face wrinkles or some other
issues for years, and hyaluronic acid injections have gained reputation in the industry. Many clinical and animal studies
have been conducted to support its applications in such aliments while hyaluronic acid injection side effects have also
been reported. This article highlights the research findings, benefits and unwanted side effects reported in clinical and
animal studies of hyaluronic acid injections.
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Hyaluronic acid injections for Joint Stiffness
Joint stiffness secondary to immobilization was inhibited by intra-articular hyaluronic acid injections in an experimental
joint contracture in rabbits. In 1985, hyaluronic acid was reported that it could reduce the measured stiffness in the
contracture by approximately 50% as compared to the contractures of the untreated rabbits. In addition, hyaluronic acid
also prevented the loss of glycosaminoglycans. [3]

Hyaluronic acid injections for shoulder issues
Ishikawa T at Gunma Prefectural Cardiovascular Center, Japan, states that hyaluronic acid can protect against damage
to articular cartilage and helps to lessen friction between joint surfaces. Hyaluronic acid is effective for pain relief and for
the risk of adhesion, and contractures of joints. The injection of hyaluronic acid is useful for the treatment of frozen
shoulder, osteoarthritis, and rheumatoid arthritis. [2] However, in a study, web-questionnaire was sent to 1000 members
of an international association of surgeons specialized in sports traumatology and knee surgery. 70% of surgeons
considered that, among conservative treatments, hyaluronic acid injections were not an appropriate management for
large tendon tears with 70% fatty infiltration of the infraspinatus tendon and lateral long head of biceps instability. [1]

Hyaluronic acid injections for facial issues
Facial aging, resulting in lower facial ptosis often leads to downward angulation of the oral commissure, which may lead
to troublesome angular chelitis. Treatment involving a combination of hyaluronic acid injections into the marionette lines
and botulinum toxin A to the depressor anguli oris has been successful in a few cases. [7] Hyaluronic acid injection has
also been used to restore the earlobe volume for patients seeking a youthful facial appearance. [6]

Hyaluronic acid has also been used for the correction of facial lines. It was believed that hyaluronic acid injection fillers
were safe and had no occurrence of serious side effects. However, side effects of intermittent swelling and severe
granulomatous allergic reactions that evolved into abscesses have been reported. A clinical case of a 54-year-old
patient is presented. After hyaluronic acid injections in the treatment of nasolabial folds elsewhere, she developed
palpable painful erythematous nodules evolving into abscesses several month after injection. [4]

A 54-year-old woman developed tender nodules in both nasolabial folds that had developed 4 months after the injection
of hyaluronic acid (Restylane) for wrinkles. [5] The temporomandibular connects our jaw to the side of our head, people
have temporomandibular joint dysfunction (TMJD) have difficulties to talk, chew or yawn. Researchers from University of
Barcelona Dental School reviewed various articles and concluded that intraarticular injection of Hyaluronic acid in the
TMJD. [9] In another study, 40 TMJs of 33 patients who have TMD were treated with intraarticular sodium hyaluronate
injections at weekly intervals for 3 weeks. This study shows that intraarticular hyaluronic acid injection for the treatment
of reducing and nonreducing disc displacement of TMJ is effective and safe management. [12]

A new technique was proposed for treating "periorbital hollowing" with hyaluronic gel filling using a unique cannula
designed specifically for periorbital use. In a study, 26 patients with contour abnormalities in the periorbital area (hollow
eye ring, hollow cavities and deflated eyebrow) were treated with a cannula specific for periorbital injections. Treatments
where performed using local anaesthesia using the same protocol as Coleman lipostructure but using hyaluronic acid
gel. The hyaluronic acid gel used in each case was Restylane. After analysis of the patient responses 24 patients (92%)
with a 6 months' follow-up were satisfied or very satisfied of aesthetic result after hyalurostructure of periorbital region.
However, there were 3 cases of bruising (3/52) and 4 cases of lymphatic stasis (4/52). [11]

Hyaluronic acid dermal fillers are commonly used to minimize the appearance of facial lines and wrinkles. After the
injection of hyaluronic acid, there is normally a mild inflammatory reaction. [17] Facial ischemia and herpes simplex virus
reactivation have also been reported. [18, 19]

Hyaluronic acid injections for knee issues
Researchers at Tufts Medical Center reviewed 54 randomized clinical trials of intra-articular hyaluronic acid Vs placebo
on knee osteoarthritis and concluded that intra-articular hyaluronic acid is efficacious by 4 weeks, reaches its peak
effectiveness at 8 weeks and exerts a residual detectable at 24 weeks. [8]

Meniscectomy is a surgical excision of one of the crescent-shaped cartilages of the knee joint. The short-term recovery
period post-arthroscopic meniscectomy is characterized by pain and impaired function most likely related to the
irrigation of synovial fluid from the knee intraoperatively. Consequently, along with removal of harmful debris, the
irrigation fluid dilutes the hyaluronic acid layer covering the joint tissues. Hyaluronic acid contributes to the homeostasis
of the joint environment and is an important component of synovial fluid and cartilage matrix. Theoretically, the
instillation of hyaluronic acid after the procedure may relieve symptoms. In a study, fifty-six patients were injected with
Viscoseal (a 0.5% concentration, isotonic solution of Hyaluronan) or normal saline immediately post-arthroscopy and
divided into the Viscoseal group or control group, respectively. Patients in the control group reported more pain at week
1, with a mean visual analog score (VAS) of 43, than did patients in the Viscoseal group, with a mean VAS of 28. At 4
weeks postoperatively, none of the Viscoseal patients had consumed analgesics, where 9 (of 28) in the control group
reported acetaminophen intake. No significant difference in knee function was found between groups. Intra-articular
injection of Viscoseal after arthroscopic meniscectomy reduced pain in the short-term recovery period. [13]

Although articular hyaline cartilage typically has low potential for regeneration. Microfracture techniques in combination
with intraarticular application of hyaluronic acid were used in rabbit knee articular cartilage defect leading to a thicker
and more organized repair tissue filling the defect. [14]

A total of 100 patients with knee osteoarthritis referred to the clinic received a single course of five injections of
intra-articular hyaluronic acid (Hyalgan). Improvements were seen at five weeks and, to a lesser extent, at 13 weeks. Of
34 treatment withdrawals, most had returned to baseline levels by 13 weeks. The remaining 56 patients maintained
improvements up to 52 weeks, although the pattern of outcome was highly variable between individuals. Withdrawals
and non-responders had higher initial pain severity. [15]

Eighteen patients with carpometacarpal (CMC) osteoarthritis (OA) patient received a single ultrasound- guided injection
of hyaluronic acid into the articular CMC joint. The results were that pain at rest and during activities decreased from 1.8
to 0.5 and from 8.05 to 4.15 respectively. The consumption of pain-killers was also reduced. A single ultrasound guided
injection of hyaluronic acid is a safe and effective procedure in CMC-OA, with a significant improvement in terms of pain.
[16]

Hyaluronic acid injections for hip issues
One study included 21 patients with advanced hip osteoarthritis. All patients received 2.5 ml of hyaluronic acid injection
once a week for 3 weeks by lateral approach under fluoroscopic control. Lequesne index and VAS pain scores
measured 1, 3 and 6 months after treatment were significantly lower compared to baseline scores. No side effect was
observed. [10]

HYaluronic Acid - Compatibility
Hyaluronic acid was injected intradermally in the forearm of a young male volunteer. On high-resolution morphological
MR images the Hyaluronic acid injection is barely visible, but with quantitative MRI the zone of Hyaluronic acid injection is
clearly seen. This is due to Hyaluronic acid having a distinctly different transverse relaxation time, T(2) approximately
600 ms, compared with dermal and hypodermal tissues, 35 and 80 ms, respectively. [6]
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SYNVISC® (hylan G-F 20) is an elastoviscous high molecular weight fluid containing hylan A and hylan B polymers
produced from chicken combs. Hylans are derivatives of hyaluronan (sodium hyaluronate). Hylan G-F 20 is unique in
that the hyaluronan is chemically crosslinked. (Product Insert)
Hyaluronic acid Injection - Side Effects and Benefits
Hyaluronan injection - face, knee, hip, shoulder, eyes, wrinkles   December 10, 2011 zhion@zhion.com    
This website discusses the benefits and side effects of various supplements, herbs and drug products. Different people may experience different
side effects and benefits of a product. You are encouraged to report adverse side effects of hyaluroniac acid injection to FDA, its website is
www.fda.gov., or report the adverse side effects to the manufacturer, you should be able to find the contact information on the label.

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Hyaluronic acid Reviews
Hyaluronic Acid (hyaluronan or hyaluronate) is a polysaccharide composed of alternating molecules of N-acetyl glucosamine and D-glucuronic acid.
It can be found within collagen throughout the body. Hyaluronan can be very large, as its molecular weight may reach millions. As the most
important space filling substance in the human body, Hyaluronan holds water to keep collagen hydrated and "youthful". Hyaluronan forms a viscous
fluid with exceptional lubricating properties necessary for the vital functions of many parts of the human body including the skin, heart valves,
aqueous/ vitreous humor of the eye and synovial fluid (joint lubricant). In articular cartilage, hyaluronan is present as a coat around each
chondrocyte. Aggrecan monomers bind to hyaluronan forming large highly negatively-charged aggregates. These aggregates imbibe water and
are responsible for the resistance of cartilage to compression. The molecular weight (size) of hyaluronan in cartilage decreases with age. The
average 70 kg person has about 15 grams of hyaluronan in the body, and about 1/3 of which is degraded and synthesized daily. Hyaluronan is
synthesized by hyaluronan synthases, these synthases are integral membrane proteins. In inflammation, the wound tissue in the early phase of
wound repair is abundant in hyaluronan, probably a reflection of increased synthesis. Hyaluronan acts as a promoter of early inflammation, but
hyaluronan also can moderate the inflammatory response, which may contribute to the stabilization of granulation tissue matrix. Hyaluronan can
protect against free-radical damage to cells. Hyaluronan has been used to treat osteoarthritis of the knee. In the treatment, a course of injections of
hyaluronan is administrated into the knee joint, and is believed to improve the viscosity of the joint fluid and lubricate the joint, cushions the joint,
and produces an analgesic effect. This treatment is called viscosupplementation. [Wikipedia.org]
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