Comparative Effectiveness of Ultrasound-Guided Intratendinous Prolotherapy Injection with Conventional Treatment to Treat Focal Supraspinatus Tendinosis

Abstract

Objective To evaluate the efficacy of dextrose prolotherapy injection for focal supraspinatus rotator cuff tendinosis via outcomes such as functional score, range of movement, and real-time ultrasound parameters. Materials and Methods 12 adult patients with focal supraspinatus tendinosis recruited after they had less than 30% improvement in functional (DASH) scores after one month of physiotherapy following initial presentation. Seven patients had 0.5–1.0 ml of prolotherapy injection (12.5% dextrose, 0.5% lignocaine) injected into the area of focal tendinosis under ultrasound guidance. Meanwhile, five patients continued standard physiotherapy with no intervention performed. Regional area of echogenicity in decibels, DASH, range of movements of the shoulder, pain, and sleep scores were measured at baseline and at 12 weeks. Results The prolotherapy group showed significant improvement in shoulder abduction (p=0.030) and an improvement in sleep score (p=0.027). The echogenicity of area of tendinosis significantly increases at the end of treatment (p=0.009). However, there was a nonsignificant reduction in pain score in the injection group (43.5%) and in the control group (25%) at 12 weeks (p > 0.005). Conclusion Ultrasound-guided intratendinous prolotherapy injection significantly improves patient's range of abduction and improves sleep within 12 weeks of treatment compared to conventional physiotherapy management. Trial Registration This study was registered under Current Controlled Trials (UK) and given International Standard Randomised Controlled Trial Number (ISRCTN) of 43520960.

Effectiveness of Dextrose Prolotherapy for Rotator Cuff Tendinopathy: A Systematic Review

“…Following the title screen, 74 studies were included in abstract screening, of which 24 progressed to full‐text review. A total of 20 studies were removed by the full‐text review, leaving four papers to be included for analysis (Figure ) . One additional article was retrieved through manual reference search of included studies.…”

“…George et al conducted an open‐label randomized controlled trial of a one‐time ultrasound‐guided single‐site injection of 0.5‐10 mL of 12.5% dextrose and 0.5% lidocaine into a focal area of tendinosis in the supraspinatus tendon plus physiotherapy compared to conventional physiotherapy in patients with focal supraspinatus tendinosis including tendinosis, calcific tendinitis, and partial‐thickness tears. Patients with dynamic impingement on ultrasound and full‐thickness tears were excluded.…”

“…The risk of bias summary and graph is presented in Figures and . All studies, except Seven et al and George et al, were rated as a low risk of bias in terms of incomplete outcome data due to low loss to follow‐up. Seven et al and George et al were rated as high‐risk of incomplete outcome data bias due to high loss to follow‐up rate among the control group (>20%), which was more than 10% larger lost to follow‐up rate than the intervention group in both studies.…”

“…A total of 20 studies were removed by the full-text review, leaving four papers to be included for analysis ( Figure 1). [18][19][20][21][22] One additional article was retrieved through manual reference search of included studies. Authors were in high agreement throughout all stages of screening, with an unweighted kappa of 0.962 for title screening, 0.760 for abstract screening, and 1.00 for full-text screening.…”

Non-operative orthobiologic use for rotator cuff disorders and glenohumeral osteoarthritis: A systematic review

“…George et al compared 7 patients treated with a sin-243 gle ultrasound-guided injection of prolotherapy to 5 pa-244 tients treated with standard exercise therapy [34]. The 245 Disabilities of the Arm, Shoulder, and Hand (DASH) 246 score was used to evaluate functional outcomes.…”