Ultrasound-Guided Intra-articular Prolotherapy Versus Corticosteroid Injection for Sacroiliac Joint Dysfunction: A Prospective Randomized Controlled Trial

Sacroiliac (SI) joint dysfunction is an important cause of chronic low back pain and may be difficult to diagnose and treat. Corticosteroid injection is commonly used for short-term symptom relief, whereas the comparative durability of prolotherapy remains uncertain. This study aimed to compare ultrasound-guided intra-articular prolotherapy with corticosteroid injection in patients with SI joint dysfunction, with pain intensity and functional disability assessed over a 12-week follow-up period.

This prospective randomized controlled trial included 38 patients with SI joint dysfunction. Following a diagnostic intra-articular lignocaine block, patients demonstrating at least 50% pain reduction were randomized in a 1:1 ratio to receive ultrasound-guided intra-articular triamcinolone acetonide (40 mg) or 25% dextrose prolotherapy. All participants received an identical supervised physiotherapy program. Pain intensity and functional disability were assessed using the Numeric Pain Rating Scale (NPRS) and Oswestry Disability Index (ODI), respectively, at baseline, immediately after intervention, and at 4 and 12 weeks.

Nineteen patients were allocated to each group, and all participants completed follow-up. Baseline NPRS scores were comparable between the corticosteroid and prolotherapy groups (8.47 ± 0.77 vs. 8.84 ± 0.38; p=0.1115). Immediately after intervention, NPRS scores decreased substantially in both groups (1.47 ± 0.84 vs. 1.11 ± 0.32; p=0.1044). At 12 weeks, the mean NPRS score was significantly lower in the prolotherapy group than in the corticosteroid group (1.11 ± 0.32 vs. 4.05 ± 1.55; p<0.0001). The mean ODI score at 12 weeks was also significantly lower in the prolotherapy group (8.53 ± 3.19 vs. 21.42 ± 6.82; p<0.0001). No major procedure-related complications or serious adverse events were reported.

Both ultrasound-guided intra-articular prolotherapy and corticosteroid injection improved pain and functional disability in patients with sacroiliac joint dysfunction. Prolotherapy was associated with lower pain and disability scores at 4 and 12 weeks compared with corticosteroid injection.