{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T20:38:32Z","timestamp":1763584712597,"version":"build-2065373602"},"reference-count":11,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2021,9,22]]},"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Avascular necrosis (AVN) can impact up to 50% of patients with sickle cell disease (SCD) and can result in significant pain, decline in physical function and decreased quality of life. While hyaluronic acid (HA) has been used in the adult population for shoulder osteoarthritic pain, we present the first published pediatric case of HA injections in the glenohumeral joint, used to improve function and pain control.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case presentation<\/jats:title>\n                  <jats:p>The patient is a 12-year-old woman with SCD, who suffered from chronic pain due to AVN of the humeral and femoral head. Despite engaging in a multidisciplinary pain management plan, she continued to have severe decline in physical functioning and became a wheelchair user. As a result, she was scheduled for a right total hip arthroplasty, which necessitated aggressive postoperative therapies using the glenohumeral joint. To improve this pain and to facilitate postoperative recovery, the patient underwent 4\u2009weekly HA injections into the glenohumeral joint. Over a 2-month period, the patient was able to improve physical functioning, decrease opiate use and participate in all postoperative therapies.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Conservative options to improve functioning and pain are especially important in pediatric patients where it may be desirable to delay surgical interventions until skeletal maturity. Our case report demonstrates the benefits of intra-articular HA as part of a multidisciplinary pain management plan to improve function and decrease pain related to AVN of the humeral head. Future studies should assess the long-term benefits of HA injections for AVN in the setting of SCD.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rapm-2021-102842","type":"journal-article","created":{"date-parts":[[2021,10,12]],"date-time":"2021-10-12T17:29:58Z","timestamp":1634059798000},"page":"136-138","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Hyaluronic acid injections for treatment of pediatric sickle cell avascular necrosis of the humeral head"],"prefix":"10.1136","volume":"47","author":[{"given":"Jocelyn Ying-Ah","family":"Wong","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Los Angeles, Los Angeles, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sang","family":"Le","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Los Angeles, Los Angeles, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carl","family":"Lo","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Los Angeles, Los Angeles, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Costandi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Los Angeles, Los Angeles, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vasili","family":"Chernishof","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Los Angeles, Los Angeles, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2243-0031","authenticated-orcid":false,"given":"Eugene","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Los Angeles, Los Angeles, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,10,12]]},"reference":[{"key":"2025101112184062000_47.2.136.1","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1097\/AJP.0000000000000289","article-title":"Psychosocial and functional outcomes in youth with chronic sickle cell pain","volume":"32","author":"Sil","year":"2016","journal-title":"Clin J Pain"},{"key":"2025101112184062000_47.2.136.2","article-title":"Treatment for avascular necrosis of bone in people with sickle cell disease","author":"Mart\u00ed-Carvajal","year":"2016","journal-title":"Cochrane Database Syst 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randomized study","volume":"5","author":"Di Giacomo","year":"2017","journal-title":"Joints"},{"key":"2025101112184062000_47.2.136.7","doi-asserted-by":"crossref","first-page":"227","DOI":"10.2147\/MDER.S189522","article-title":"NASHA hyaluronic acid for the treatment of shoulder osteoarthritis: a prospective, single-arm clinical trial","volume":"12","author":"McKee","year":"2019","journal-title":"Med Devices"},{"key":"2025101112184062000_47.2.136.8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.24966\/ORP-2052\/100029","article-title":"Single us guided HA injection reduced hip pain and improved function for 20 months: a case of osteonecrosis","volume":"3","author":"Ali Moustafa","year":"2017","journal-title":"ORP"},{"key":"2025101112184062000_47.2.136.9","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-015-0775-z"},{"key":"2025101112184062000_47.2.136.10","article-title":"Hyaluronic acid injections for knee osteoarthritis. systematic review of the literature","volume":"50","author":"Aggarwal","year":"2004","journal-title":"Can Fam Physician"},{"key":"2025101112184062000_47.2.136.11","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1016\/j.jse.2018.09.011","article-title":"Outcomes of hyaluronic acid injections for glenohumeral osteoarthritis: a systematic review and meta-analysis","volume":"28","author":"Zhang","year":"2019","journal-title":"J Shoulder Elbow Surg"}],"container-title":["Regional Anesthesia &amp; Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rapm-2021-102842","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T19:18:53Z","timestamp":1760210333000},"score":1,"resource":{"primary":{"URL":"https:\/\/rapm.bmj.com\/lookup\/doi\/10.1136\/rapm-2021-102842"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,12]]},"references-count":11,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,12,17]]},"published-print":{"date-parts":[[2022,2]]}},"alternative-id":["10.1136\/rapm-2021-102842"],"URL":"https:\/\/doi.org\/10.1136\/rapm-2021-102842","relation":{},"ISSN":["1098-7339","1532-8651"],"issn-type":[{"type":"print","value":"1098-7339"},{"type":"electronic","value":"1532-8651"}],"subject":[],"published":{"date-parts":[[2021,10,12]]}}}