Dextrose Prolotherapy Versus Control Injections in Painful Rotator Cuff Tendinopathy

Area of Science:

• Orthopedics and Sports Medicine
• Regenerative Medicine
• Pain Management

Background:

• Rotator cuff tendinopathy is a common cause of shoulder pain, often leading to chronic disability.
• Current treatments for rotator cuff tendinopathy include physical therapy, medications, and injections, with varying success rates.
• Prolotherapy, using dextrose injections, is explored as a potential treatment for musculoskeletal pain, including tendinopathies.

Purpose of the Study:

• To compare the efficacy of dextrose prolotherapy versus saline injections in managing pain and degenerative changes in rotator cuff tendinopathy.
• To evaluate dextrose prolotherapy's effect on pain levels, patient satisfaction, and ultrasound-confirmed degenerative changes.
• To assess dextrose prolotherapy's effectiveness against two distinct saline injection control groups.

Main Methods:

• A randomized controlled trial involving 73 participants with chronic shoulder pain and ultrasound-confirmed rotator cuff tendinopathy.
• Participants received three monthly injections: dextrose into entheses, saline into entheses, or saline superficially.
• All participants underwent concurrent programmed physical therapy; outcomes included pain improvement (visual analog scale) and Ultrasound Shoulder Pathology Rating Scale (USPRS) scores at 9 months.

Main Results:

• At 9-month follow-up, 59% of dextrose-injected participants achieved significant pain improvement, compared to 37% with enthesis-saline and 27% with superficial-saline.
• Patient satisfaction scores were higher in the dextrose group (6.7) versus enthesis-saline (4.7) and superficial-saline (3.9).
• No significant differences were observed in USPRS findings between the groups, suggesting pain relief may not be due to tissue regeneration.

Conclusions:

• Injection of hypertonic dextrose onto painful entheses, combined with physical therapy, yielded superior long-term pain reduction and patient satisfaction for rotator cuff tendinopathy.
• The observed benefits of dextrose prolotherapy were not attributable to regenerative effects on the rotator cuff tendons.
• Dextrose prolotherapy represents a potentially effective treatment option for select patients with painful rotator cuff tendinopathy, augmenting standard care.