Archives of Physical Medicine and Rehabilitation
VOLUME 103, ISSUE 2, P237-244, FEBRUARY 01, 2022
Che-Li Lin, MD, PhD
Published: October 02, 2021 DOI:https://doi.org/10.1016/j.apmr.2021.07.812
Abstract
Objectives
To investigate the effect of hypertonic dextrose injection (my note: prolotherapy) on pain and disability in patients with chronic supraspinatus tendinosis. The secondary aim was to evaluate its effect on the tendon range of motion (ROM) and morphology.
Design
Randomized double-blind placebo-controlled trial.
Setting
Outpatient clinic.
Participants
Individuals (N=57) with symptomatic chronic supraspinatus tendinosis.
Interventions
Participants were randomly administered ultrasound-guided injections of 20% hypertonic dextrose (study group, n=29) or 5% normal saline (control group, n=28).
Main Outcome Measures
The primary outcome measure was visual analog scale (VAS) scores for pain and Shoulder Pain and Disability Index (SPADI) scores. Secondary outcomes included the ROM and ultrasound examination findings of the supraspinatus tendon at baseline and at 2, 6, and 12 weeks postintervention.
Results
The study group exhibited significant improvements in the VAS (mean difference [MD], −2.1; 95% confidence interval [CI], −2.7 to −1.4; P<.001) and SPADI (MD, −11.6; 95% CI, −16.5 to −6.7; P<.001) scores compared with baseline scores at week 2. However, the effect was not sustained to week 6. Flexion ROM increased at weeks 2 (MD, 14.1; 95% CI, 5.7-22.5; P<.001) and 6 (MD, 8.9; 95% CI, 2.4-15.4; P=.003) compared with baseline. The thickness of the supraspinatus tendon improved at weeks 6 (MD, .50; 95% CI, .26-.74; P<.001) and 12 (MD, .61; 95% CI, .37-.84; P<.001) compared with baseline. The ratio of histograms also improved at weeks 6 (MD, .19; 95% CI, .06-.32; P=.002) and 12 (MD, .26; 95% CI, .10-.41; P<.001) compared with baseline.
Conclusion
Hypertonic dextrose injection could provide short-term pain and disability relief in patients with chronic supraspinatus tendinosis. Ultrasound imaging at week 6 revealed changed tendon morphology.
Notes:
Hypertonic dextrose prolotherapy (DPT) is an injection therapy used to treat chronic painful musculoskeletal conditions (14,15). The mechanism of action is not well understood; the historical understanding posits that DPT facilitates healing and subsequent pain control through initiation of a temporary inflammatory reaction with related tissue proliferation (16,17,18,19). [From: Efficacy of hypertonic dextrose injection (prolotherapy) in temporomandibular joint dysfunction: a systematic review and meta-analysis]
14. Rabago, D. & Nourani, B. Prolotherapy for osteoarthritis and tendinopathy: A descriptive review. Curr. Rheumatol. Rep. 19, 34. https://doi.org/10.1007/s11926-017-0659-3 (2017).
15. Hauser, R. A., Lackner, J. B., Steilen-Matias, D. & Harris, D. K. A systematic review of dextrose prolotherapy for chronic musculoskeletal pain. Clin. Med. Insights Arthritis Musculoskelet. Disord. 9, 139–159. https://doi.org/10.4137/CMAMD.S39160 (2016).
16. Jensen, K. T., Rabago, D. P., Best, T. M., Patterson, J. J. & Vanderby, R. Jr. Early inflammatory response of knee ligaments to prolotherapy in a rat model. J. Orthop. Res. 26, 816–823. https://doi.org/10.1002/jor.20600 (2008).
17. Jensen, K. T., Rabago, D. P., Best, T. M., Patterson, J. J. & Vanderby, R. Jr. Response of knee ligaments to prolotherapy in a rat injury model. Am. J. Sports Med. 36, 1347–1357. https://doi.org/10.1177/0363546508314431 (2008).
18. Yoshii, Y. et al. The effects of hypertonic dextrose injection on connective tissue and nerve conduction through the rabbit carpal tunnel. Arch. Phys. Med. Rehabil. 90, 333–339. https://doi.org/10.1016/j.apmr.2008.07.028 (2009).
19. Yoshii, Y. Effects of multiple injections of hypertonic dextrose in the rabbit carpal tunnel: A potential model of carpal tunnel syndrome development. Handbook 9, 52–57. https://doi.org/10.1007/s11552-013-9599-1 (2014).