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

Abstract

Objective To systematically review and evaluate the efficacy and complication profile of prolotherapy using hyperosmolar dextrose solution injection for rotator cuff tendinopathy. Literature Survey MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials (from inception to 1 July, 2019). Methodology A comprehensive search was completed to identify randomized controlled trials addressing prolotherapy using hyperosmolar dextrose solution for rotator cuff tendinopathy. Two reviewers independently screened the titles, abstracts, and full texts, and then extracted data from eligible studies. All reported outcome measures and complications were analyzed descriptively. Synthesis Five studies satisfied inclusion criteria. Included studies analyzed a total of 272 participants with a final follow‐up ranging from 6 weeks to 12 months. Prolotherapy differed greatly among studies. Two studies used a multisite enthesis injection protocol while the other three used ultrasound‐guided protocols. Two of the studies used an intrasubstance supraspinatus injection and three used a supraspinatus enthesis injection. Control groups consisted of nonoperative rehabilitation including physical therapy and medical management in three studies, supraspinatus saline enthesis injection in one study, and corticosteroid injection in one study. There was statistically significant improvement in pain intensity with multisite injection protocols compared to physical therapy and medical management in both studies. Ultrasound‐guided supraspinatus injection trials did not find any statistically significant difference in pain intensity, range of motion, strength, function, or ultrasound characteristics compared to controls of enthesis saline injection or corticosteroid. The complication rate was low, with only 6/272 participants experiencing adverse events consisting of transient increase in pain for 1 to 2 days postintervention. Conclusions Prolotherapy with hyperosmolar dextrose solution is a potentially effective adjuvant intervention to physical therapy for patients with rotator cuff tendinopathy ranging from tendinosis to partial‐thickness and small full‐thickness tears. Further studies are necessary to determine effects in subpopulations as well as optimal technique including dextrose concentration, volume, and location.

Dextrose Prolotherapy for Muscle, Tendon and Ligament Injury or Pathology: A Systematic Review

“…showed that injection of dextrose prolotherapy for the supraspinatus tendon can reduce pain and improve functional outcome over a 6-month period. There was no adverse effects on tendon structure and, in fact, prolotherapy groups showed significant improvements in ultrasound characteristics of the supraspinatus tendon, decreasing pain, with increased range of motion and strength of muscle [32].…”

Comparison of Clinical and Ultrasound Imaging Outcomes Between Corticosteroid and Hypertonic Dextrose Injections for Chronic Supraspinatus Tendinopathy

“…In recent years, prolotherapy has been widely used and proposed as an alternative treatment to steroid injection. 4 Studies have compared the effects of prolotherapy with those of steroid. 7 Nasiri et al 23 reported that in terms of VAS and SPADI scores, prolotherapy was not inferior to corticosteroid injection in patients with rotator cuff–related shoulder pain, with the effect lasting up to 12 weeks after the intervention.…”

“… 3 In recent years, prolotherapy has been considered an alternative treatment for patients with chronic rotator cuff tendinopathy. 4 Prolotherapy is an injection-based therapy that exerts a regenerative effect on patients with chronic musculoskeletal pain. 25 Hypertonic dextrose is one of the most commonly used prolotherapy agents and is considered to induce cell proliferation, thus strengthening and healing the tendon.…”

Dextrose Prolotherapy for Supraspinatus Partial Tear: A Case Report

“…Non-adverse events were not reported with dextrose prolotherapy in this case as in many preceding cases. [23] CONCLUSION RC tears present with severe shoulder pain, weakness of shoulder flexion, abduction or external rotation, that can significantly impact activities of daily life. Prolotherapy is the injection of growth factors or growth factor production stimulants to promote regeneration of normal cells and tissue.…”