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Figure 11 Autoimmunity Upregulation of autoimmune genes As in other chronic disorders, some genes in ME/CFS patients have been found to be associated with autoimmunity, such as the HLA alleles (30)

This can result in: Reduced pain Enhanced joint stability Improved range of motion Quicker return to normal activity Ideal Candidates for Prolotherapy Prolotherapy is most effective in Type I to Type III AC separations , especially when: Pain persists beyond 4-6 weeks of conservative care There is evidence of ligament laxity or instability The patient prefers a non-surgical option The patient is physically active and motivated for recovery The Prolotherapy Treatment Protocol for AC Separation Pre-Treatment Evaluation Prior to treatment, a comprehensive musculoskeletal exam is conducted to assess: Joint instability Tenderness and ligament integrity Shoulder biomechanics Imaging (X-ray or ultrasound) to classify injury severity Injection Technique Patient Positioning: Seated or supine with shoulder exposed Site Preparation: Skin cleaned with antiseptic

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