Periarticular Neurofascial Dextrose Prolotherapy Versus Physiotherapy for the Treatment of Chronic Rotator Cuff Tendinopathy

Mofrad, Morteza Kazempour; Rezasoltani, Zahra; Dadarkhah, Afsaneh; Mofrad, Reza Kazempour; Abdorrazaghi, Fateme; Azizi, Sirous

doi:10.1097/rhu.0000000000001218

Cited by 8 publications

(7 citation statements)

References 21 publications

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“…8,11,12 In addition, prolotherapy, botulinum toxin, and platelet-rich plasma have been reported to yield better outcomes in patients with shoulder pain. [13][14][15][16] Recently published systematic reviews and guidelines indicated that surgery does not provide notable improvements in pain, function, or quality of life (QOL) compared with PT. 17,18 Hyaluronic acid (HA) is a major glycosaminoglycan of the extracellular matrix.…”

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confidence: 99%

Low Molecular-weight Hyaluronic Acid Versus Physiotherapy for the Treatment of Supraspinatus Tendinopathy: A Randomized Comparative Clinical Trial

Rezasoltani

Esmaily

Dadarkhah

et al. 2021

J Am Acad Orthop Surg

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Introduction: The tendons of the rotator cuff are major sources of shoulder pain. This study aimed to compare the effects of low molecular-weight hyaluronic acid with physiotherapy (PT) in patients with supraspinatus tendinopathy (ST). Methods: We carried out a parallel two-group randomized comparative clinical trial in an outpatient clinic of physical medicine and rehabilitation at a teaching hospital. In total, 51 patients (31 women) aged 20 to 55 years with ST were randomly allocated to subacromial hyaluronate injection (n = 28) and PT (n = 23) groups. For the hyaluronate group, we administered a single injection of 2 mL (20 mg) hyaluronate 1% (500 to 700 kDa). For PT, we prescribed three sessions of treatment per week for 12 weeks, totaling 36 sessions including rotator cuff activation exercises. The primary outcome was shoulder pain in the visual analog scale. The secondary outcomes included the range of movement and the disability score of the shoulder, and a World Health Organization questionnaire on quality of life. We did the measurements at the baseline and at one, four, and 12 weeks after intervention. Results: The results showed that both interventions were beneficial in the management of ST. However, hyaluronate was more effective in reducing shoulder pain at rest and during activities (both P < 0.001, effect size = 0.52 and 0.68, respectively). The two interventions similarly decreased patients' disability (P = 0.196). Hyaluronate improved shoulder motion and the quality of life better than PT. Conclusion: In the treatment of ST, low molecular-weight hyaluronate is more effective than PT, at least for three months. Particularly, hyaluronate is more successful in alleviating pain.

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confidence: 99%

Low Molecular-weight Hyaluronic Acid Versus Physiotherapy for the Treatment of Supraspinatus Tendinopathy: A Randomized Comparative Clinical Trial

Rezasoltani

Esmaily

Dadarkhah

et al. 2021

J Am Acad Orthop Surg

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“…The majority of included studies were from Europe (21.40.38%) and the remaining from Asia, (18, 34.6%), South America (5 (9.62%), North America (4,7.69%), and Australia (4 (7.69%). 22 out 52 studies had published protocols available [ 32 , 33 , 36 , 37 , 40 , 43 , 44 , 47 , 53 , 58 , 61 , 65 , 68 , 69 , 71 , 72 , 74 – 76 , 78 , 80 , 82 ].…”

Section: Resultsmentioning

confidence: 99%

“…ER ROM had 12 studies with high risk [ 34 , 38 , 39 , 41 , 48 , 57 , 59 , 62 , 70 , 75 , 81 , 84 ] and 5 with some concerns [ 35 , 40 , 56 , 63 , 77 ]. SPADI consisted of 8 studies at high risk [ 32 , 38 , 43 , 59 , 75 , 76 , 83 , 84 ], 13 with some concerns [ 35 , 42 , 51 , 52 , 60 , 61 , 65 , 67 , 72 , 80 , 82 , 85 , 86 ] and 3 with low risk of bias [ 69 , 73 , 74 ]. Finally, DASH had 8 studies at high risk [ 32 , 34 , 47 , 50 , 66 , 70 , 79 , 81 ], 7 with some concerns [ 33 , 36 , 37 , 44 ,…”

Section: Resultsmentioning

confidence: 99%

Shoulder specific exercise therapy is effective in reducing chronic shoulder pain: A network meta-analysis

Silveira,

Lima,

Beaupre

et al. 2024

PLoS ONE

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Background Exercise therapy (ET) is frequently an early treatment of choice when managing shoulder pain, yet evidence on its efficacy to expedite recovery is inconsistent. Moreover, the value of adding adjunct therapies (i.e. injections, manual therapy, electrotherapy) to ET is currently unclear. This study combined both direct and indirect evidence across studies on the effectiveness of ET with/without adjunct therapies compared to usual medical care for adults with chronic shoulder pain. Methods and findings Using a network meta-analysis, randomized control trials comparing ET along with adjunct therapies were identified in MEDLINE, Embase, CINAHL, Sportdiscus, CENTRAL, Conference Proceedings Citation Index-Science, clinicaltrials.gov, and association websites. Outcomes included pain, range of motion (ROM), and health-related quality of life (HRQL) measures in adult patients with chronic shoulder pain. Data analysis used a Frequentist hierarchical model. CINeMA tool assessed the confidence in the results and Cochrane Risk of Bias tool assessed quality of studies. 54 studies primarily from Europe (40.38%) included 3,893 participants who were followed up to 52 weeks. Shoulder-specific ET (Mean difference (MD) = -2.1; 95% confidence interval (CI) = -3.5 to -0.7) or in combination with electro-physical agents (MD = -2.5; 95% CI = -4.2 to -0.7), injections (MD = -2.4; 95% CI = -3.9 to—1.04) or manual therapy (MD = -2.3; 95% CI = -3.7 to -0.8) decreased pain compared to usual medical care. Trends with ROM and HRQL scores were seen; however, only Manual Therapy (MD = -12.7 and 95% CI = -24.4 to -1.0) achieved meaningfully important changes. Sensitivity analysis excluding studies with high risk of bias showed similar results, with exception of injections that did not reach significance (MD = -1.3; 95% CI = -4.3 to 1.7). Conclusion(s) Shoulder-specific ET provided pain relief up to 52 weeks. Adjunct therapies to shoulder-specific ET added little value in reducing pain. The quality of evidence varied between moderate and very low.

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“…7,8 Some medications, including corticosteroids, nonsteroidal anti-inflammatory drugs, hyaluronic acid (HA), botulinum toxin, platelet-rich plasma, and dextrose, have been used for injection therapy of rotator cuff tendinopathy. 2,3,9 However, few studies have been carried out to compare the efficacy and toxicity of these medications. 2 Therefore, choosing among different injection substances in rotator cuff tendinopathy is still an open subject of research.…”

Section: Introductionmentioning

confidence: 99%

High- Versus Low-Molecular-Weight Hyaluronic Acid for the Treatment of Rotator Cuff Tendinopathy: A Triple-Blind Randomized Comparative Trial

et al. 2021

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Background Shoulder pain most commonly originates from the tendon structures of the rotator cuff. Objective We compared the clinical effects of high- versus low-molecular-weight (LMW) hyaluronic acid for the management of rotator cuff tendinopathy. Methods We carried out a parallel, triple-blind, randomized comparative trial at a teaching hospital. In total, 56 patients aged 16 to 70 years with rotator cuff tendinopathy were randomly allocated to 2 groups. We administered a single shoulder injection of either 1 mL of 1% high- (>2000 kDa) or 1 mL of 1% LMW hyaluronate (500-700 kDa) to the corresponding groups. The primary outcome was the intensity of shoulder pain. The secondary outcomes were range of motion and disability of the shoulder, and quality of life. We performed the measurements at baseline and at 1, 4, and 12 weeks postintervention. The pain measurements were repeated at the sixth month postintervention. Results Comparisons of baseline versus 3 months showed that both interventions were beneficial in the management of the tendinopathy (all P values <0.05). However, between-group analyses did not indicate any clinically significant difference between the 2 medications. The pain, induration ( P = 0.007), and inflammation at the site of the injection were less prominent for LMW hyaluronate. Conclusion and Relevance Both medications are effective for the treatment of tendinopathy. The benefits last at least for 3 months, and pain alleviation lasts partially for 6 months. The shoulder injection of LMW hyaluronate is more tolerable to the patient. Therefore, we recommend LMW hyaluronate as the first choice for the management of rotator cuff tendinopathy.

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Periarticular Neurofascial Dextrose Prolotherapy Versus Physiotherapy for the Treatment of Chronic Rotator Cuff Tendinopathy

Cited by 8 publications

References 21 publications

Low Molecular-weight Hyaluronic Acid Versus Physiotherapy for the Treatment of Supraspinatus Tendinopathy: A Randomized Comparative Clinical Trial

Low Molecular-weight Hyaluronic Acid Versus Physiotherapy for the Treatment of Supraspinatus Tendinopathy: A Randomized Comparative Clinical Trial

Shoulder specific exercise therapy is effective in reducing chronic shoulder pain: A network meta-analysis

High- Versus Low-Molecular-Weight Hyaluronic Acid for the Treatment of Rotator Cuff Tendinopathy: A Triple-Blind Randomized Comparative Trial

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