Long-term effect of Prolotherapy on symptomatic rotator cuff tendinopathy
Introduction: The objective of this study was to assess a long-term clinical effect of Prolotherapy on chronic symptomatic rotator cuff tendinopathy.
Methods: We conducted a retrospective, uncontrolled study in the outpatient setting with 12 months follow-up. Adults diagnosed clinically and radiologically with rotator cuff tendinopathy that has been persisting for a minimum of six months were included. Patients received 15% extra-articular and 25% intra-articular hyperosmolar dextrose injections, repeated at weeks 5, 9, 13, 17 and 21. Primary outcome measure was validated Shoulder Pain and Disability Index (SPADI). Secondary outcome measure was validated visual pain analogue scale (VAS 0-10). The third outcome measures were patient’s satisfaction with Prolotherapy and adverse reactions after injections.
Results: Twenty-one patients, 14 male and 7 female were treated with 6 sessions of hyperosmolar dextrose Prolotherapy repeated every 4 weeks. Average SPADI before starting the treatment was 73.995 ± 13.6, while 12 months after completed treatment was 20.84 ± 26.03 (P< 0.0001). Average VAS score before starting the treatment was 8.14 ± 1.2, while 12 months after completed treatment was 2.29 ± 2.8 (P<0.0001). Out of 21 patients, 18 (85.71%) would recommend Prolotherapy to other people with the similar condition, and no one participant reported any side effect that was not resolved within one week after the treatment.
Conclusion: Hyperosmolar dextrose Prolotherapy may result in significant reduction of pain and disability index in adult patients with chronic rotator cuff tendinopathy, without eliciting long-lasting side effects. Results of this pilot study need to be validated in prospective controlled randomized trials.
Tashjian RZ1. Epidemiology, natural history, and indications for treatment of rotator cuff tears. Clin Sports Med. 2012;31(4):589-604.
Gaujoux-Viala C, Dougados M, L Gossec L. Efficacy and safety of steroid injections for shoulder and elbow tendonitis: a meta-analysis of randomised controlled trials. Ann Rheum Dis 2009;68:1843-1849. http://www.ncbi.nlm.nih.gov/pubmed/19054817
Green S, Buchbinder R, Glazier R, Forbes A. Systematic review of randomised controlled trials of interventions for painful shoulder: selection criteria, outcome assessment, and efficacy. BMJ 1998;316:354-359.
Rabago D, Slattengren A, Zgierska A. Prolotherapy in primary care practice. Prim Care. 2010 Mar;37(1):65-80.
Lee DH, Kwack KS, Rah UW, Yoon SH. Prolotherapy for refractory rotator cuff disease: retrospective case-control study of one year follow-up. Arch Phys Med Rehabil. 2015 Aug 5. pii: S0003-9993(15)00594-8. doi: 10.1016/j.apmr.2015.07.011. [Epub ahead of print]
Bertrand H, Reeves KD, Bennett CJ, Bicknell S, Cheng A-L, Dextrose Prolotherapy versus Control Injections in Painful Rotator Cuff Tendinopathy. Arch Phys Med Rehabil August 21, 2015. doi: 10.1016/j.apmr.2015.08.412
Breckenridge JD, McAuley JH. Shoulder Pain and Disability Index (SPADI). J Physiother. 2011;57(3):197.
Paul A, Lewis M, Shadforth, Croft PR, van der Windt DAWM, Hay EM. A comparison of four shoulder-specific questionnaires in primary care. Ann Rheum Dis 2004;63:1293-1299.
Schmitt JS, Di Fabio RP. Reliable change and minimum important difference (MID) proportions facilitated group responsiveness comparisons using individual threshold criteria. Journal of Clinical Epidemiology 2004;57(10):1008-1018.
Breckenridge JD1, McAuley JH. Shoulder Pain and Disability Index (SPADI). J Physiother. 2011;57(3):197. doi: 10.1016/S1836-9553(11)70045-5.
Ryan M, Wong A, Taunton J. Favorable Outcomes After Sonographically Guided Intratendinous Injection of Hyperosmolar Dextrose for Chronic Insertional and Midportion Achilles Tendinosis. Am J Roentgenol. 2010;194(4):1047-53. DOI:10.2214/AJR.09.3255
Reeves KD Hassanein K Long term effects of dextrose prolotherapy for anterior cruciate ligament laxity: A prospective and consecutive patient study. Alt Ther Health Med May-Jun 2003; 9(3):58-62.
Khan SA; Kumar A; Varshney MK; Trikha V; Yadav CS: Dextrose prolotherapy for recalcitrant coccygodynia. J Orthop Surg 2008; 16(1):27-9.
Rabago D, Patterson J, Mundt M et al. Dextrose Prolotherapy for Knee Osteoarthritis: A Randomized Controlled Trial. Ann Fam Med 2013;11(3): 229–237.
Centeno CJ, Elliott J, Elkins WL, Freeman M. Fluoroscopically Guided Cervical Prolotherapy for with Blinded Pre and Post Radiographic Reading. Pain Physician. 2005;8:67-72.
Ryan MB, Wong AD, Gillies JH, Wong J, Traunton JE. Sonographically guided intratendinous injections of hyperosmolar dextrose/lidocaine: a pilot study for the treatment of chronic plantar fasciitis. Br J Sports Med 2009;(43):303–306.
Scarpone M, Rabago DP, Zgierska A, Arbogast G, Snell E. The efficacy of prolotherapy for lateral epicondylosis: a pilot study. Clin J Sport Med (United States), May 2008; 18(3) 248-54
M. J., Yelland; C. O., Mar; S., Pirozzo; M. L., Schoene; Wyatt, Lawrence H. Prolotherapy injections for chronic low-back pain: a systematic review. Journal of the American Chiropractic Association . 2004; 41 (12):28-28.2/3p.
Reeves D. Summary of completed research in Prolotherapy and bioregenerative injection. [cited 14 November 2015] Available from: http://www.drreeves.com/
Murphy M, Godson C, Cannon S, Kato S, Mackenzie HS, Martin F, et al. Suppression subtractive hybridization identifies high glucose levels as a stimulus for expression of connective tissue growth factor and other genes in human mesangial cells. J Biol Chem 1999;274 (9):5830-5834.
Yoshii Y, Zhao C, Schmelzer JD, Low PA, An K-N, Amadio PC. Effects of hypertonic dextrose injections in the rabbit carpal tunnel Journal of Orthopaedic Research 2011; (29):7.