Ultrasound-guided injections for supraspinatus tendinopathy: corticosteroid versus glucose prolotherapy – a randomized controlled clinical trial

Cole, Brandi F; Lam, Patrick H.; Hackett, Maree L.; Murrell, George A. C.

doi:10.1177/1758573217708199

Cited by 25 publications

(29 citation statements)

References 12 publications

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“…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.…”

Section: Resultsmentioning

confidence: 99%

“…Cole et al conducted a double‐blind randomized trial of 36 patients randomized to either ultrasound‐guided injection of 25% dextrose prolotherapy into the hypoechoic/anechoic area of the supraspinatus tendon or ultrasound‐guided subacromial injection of 40 mg methylprednisolone. All included patients received a postinjection protocol consisting of reduced physical activity and lifting for 2 weeks followed by a home physiotherapy protocol with review of techniques and adherence at 6‐week and 3‐month follow‐up.…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Study Characteristics and Demographicsmentioning

confidence: 99%

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

Catapano

Zhang

Mittal

et al. 2019

PM&R

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Study Characteristics and Demographicsmentioning

confidence: 99%

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

Catapano

Zhang

Mittal

et al. 2019

PM&R

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“…Regarding the tendon healing mechanism, we think a 2-month follow-up period may be insufficient for proper analysis. Considering the natural tendon healing process and features of atelocollagen as a scaffold for cell proliferation, we believe a healing period of at least 4 to 12 months is needed [ 14 , 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical outcome of ultrasound-guided atelocollagen injection for patients with partial rotator cuff tear in an outpatient clinic: a preliminary study

Chae

Won

Yoo

2020

Clin Shoulder Elbow

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Background: Atelocollagen has been studied for restoration of rotator cuff tendon. In this study, we attempted to evaluate the clinical outcome of ultrasound-guided atelocollagen injection in an outpatient clinic for patients with partial rotator cuff tear.Methods: We recruited 42 outpatients who visited our hospital from May 2019 to September 2019. Atelocollagen injection was performed in patients with partial rotator cuff tear diagnosed by magnetic resonance imaging and ultrasound. American Shoulder and Elbow Surgeons (ASES), Constant, Korean Shoulder Score (KSS) and Simple Shoulder Test (SST) scores, and range of motion were assessed before injection and after two months. Statistically, we analyzed the clinical results using the Wilcoxon signed rank test.Results: Finally, 15 patients were enrolled for analysis. There was no significant difference between pre- and post-injection in terms of range of motion, ASES (57.0 vs. 60.4), Constant (56.4 vs.58.9), KSS (64.6 vs.68.5), and pain-visual analog scale (4.2 vs.3.7), except function-visual analog scale (F-VAS; 6.3 vs.7.1) and SST (6.6 vs.6.9). A significant difference was found in SST (P=0.046) and F-VAS (P=0.009). According to the ultrasound results at 2 months, we found hyperechoic materials in three of seven patients. The most common complication of atelocollagen injection was post-injection pain (53%, 8/15).Conclusions: Ultrasound-guided atelocollagen injection for partial rotator cuff tear showed no significant change in terms of clinical outcomes, except for F-vas and SST score. Tendon regeneration was not clear due to the remnants of atelocollagen present at 2-month follow-up ultrasound. There seems to be alarming post-injection pain for 2 to 3 days in the patients who received atelocollagen injection in an outpatient clinic.

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“…Two studies analyzed the effects of prolotherapy [24,26]. The mean values of VAS, ASES and WORC obtained from the analysis are at the three follow up times respectively: 4.37 ± 1.…”

Section: Prolotherapymentioning

confidence: 99%

The Efficacy of Injections for Partial Rotator Cuff Tears: A Systematic Review

Sanctis

Franceschetti

Dona

et al. 2020

JCM

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(1) Background: Even though rotator cuff tears are the most frequent tendon injuries in adults, the effectiveness of conservatively treated partial-thickness tears still remains a matter of debate. The purpose of this review is to compare corticosteroid injections to other drugs in the treatment of partial rotator cuff tears, focusing on the effectiveness of this therapeutic modality in terms of pain and shoulder functionality. (2) Methods: A systematic electronic search was performed using the PubMed (MEDLINE), EMBASE and Cochrane Library databases. All studies comparing the use of corticosteroids and other infiltrative techniques in the treatment of partial lesions (excluding studies that considered subacromial impingement as inclusion criteria) were pooled, data were extracted and statistically analyzed. (3) Results: Nine studies were included in this systematic review. Those studies, composed by a total of 494 shoulders treated, have been published from 1985 to 2019. All compared techniques have shown a significant improvement over baseline condition. PRP (Platelet Rich Plasma) injections have been shown to be significantly more effective in both functional and pain control only in the long term. (4) Conclusions: None of the techniques prevail indisputably on the others. Anyway, the treatment of partial rotator cuff tears with PRP injections seems to lead to significantly better outcomes in terms of pain and shoulder function in long term follow up. Whereas in short and medium term follow up, PRP injections was superior only in terms of shoulder function. The small number of studies on prolotherapy did not enable us to provide an opinion on the outcomes of this technique.

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Ultrasound-guided injections for supraspinatus tendinopathy: corticosteroid versus glucose prolotherapy – a randomized controlled clinical trial

Abstract: Both glucose prolotherapy and corticosteroid were generally well tolerated; however, glucose prolotherapy offered no additional benefit over subacromial corticosteroid injection for supraspinatus tendinopathy.

Cited by 25 publications

References 12 publications

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

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

Clinical outcome of ultrasound-guided atelocollagen injection for patients with partial rotator cuff tear in an outpatient clinic: a preliminary study

The Efficacy of Injections for Partial Rotator Cuff Tears: A Systematic Review

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