Effectiveness of Prolotherapy Combined with Physical Therapy Versus Physical Therapy Only for Frozen Shoulder: A Case Report

Abstract

Case series Patients: Male, 66-year-old • Male, 65-year-old Final Diagnosis: Frozen shoulder Symptoms: Limited range of motion of shoulder • pain radiating into the neck and elbows • shoulder pain Medication: — Clinical Procedure: Injection of prolotherapy • physical therapy Specialty: Rehabilitation Objective: Unknown etiology Background: Frozen shoulder (FS) is a common conditions that causes significant morbidity. It is characterized by restriction of both active and passive shoulder motion (ROM) of the glenohumeral joint. The etiology, pathology, and most efficacious treatments are unclear. The purpose of FS treatment is complete elimination of pain and recovery of shoulder joint function. Prolotherapy injects certain compounds into articular spaces, ligaments, and/or ten-dons to relieve pain and disability around joint spaces and to stimulate a proliferation cascade to enhance tissue repair and strength. This case report aims to describe functional outcome changes in 2 patients with FS, comparing prolotherapy combined with physical therapy vs physical therapy only. Case Reports: We report the cases of 2 patients with confirmed FS. Patient A was 66-year-old man with chief concern of right shoulder pain and limited ROM in the past 3 months, which disrupted daily life, with a visual analog scale (VAS) of 6 out of 10. Patient B was 65-year-old man with chief concern of right shoulder pain and limited ROM in the past 2 months. The symptoms affected his general quality of life, with a VAS of 5 out of 10. Patient A underwent prolotherapy combined with physical therapy and had significantly improved ROM after 2 weeks, with relieved pain and improved shoulder function. Patient B underwent physical therapy only and showed similar ROM and no significant pain improvement. Conclusions: Initial treatment with prolotherapy combined with physical therapy for patients with frozen shoulder achieved fast improvement of active and passive ROM, significantly decreased pain, and improved quality of life compared to physical therapy intervention only.

Combined Prolotherapy and Physical Therapy in a 60-Year-Old Man with Left Shoulder Pain and Limited Range of Motion (Frozen Shoulder) Following a Hemiplegic Stroke: A Case Report

“…Prolotherapy injections were used by Bertrand et al [24] for rotator cuff tendinopathy in a randomized controlled trial. Prolotherapy in patients with frozen shoulder has proven to be a good adjunctive approach, showing promising benefits in reducing pain, enhancing range of motion, and improving shoulder functionality [25,26]. The results showed a significant improvement in pain and functional scores.…”

The level of ratio between matrix metalloproteinase-1 (MMP-1) and tissue inhibitor matrix metalloproteinase-1 (TIMP-1) after prolotherapy intervention and the functional outcome in patient with frozen shoulder: A randomized controlled trial

“…[5–7] Previous case reports have demonstrated the effectiveness of prolotherapy combined with physical therapy significantly reducing the disability of the arm, shoulder, and hand (DASH) score relative to over 6 weeks after injection. [8]…”

“…[5][6][7] Previous case reports have demonstrated the effectiveness of prolotherapy combined with physical therapy significantly reducing the disability of the arm, shoulder, and hand (DASH) score relative to over 6 weeks after injection. [8] The ratio between matrix metalloproteinase-1 (MMP-1) and tissue inhibitor matrix metalloproteinase-1 (TIMP-1) are specific biomarkers used to diagnose and evaluate fibrosis breakdown in the glenohumeral joint capsule of FS. [9,10] Standard extracellular matrix (ECM) remodeling depends on the balance between MMP-1 and TIMP1; it is a ratio of MMP-1/TIMP-1, and derangement in this balance that favors TIMPs can result in fibroproliferative diseases.…”