title: Dextrose Prolotherapy Versus Control Injections in Painful Rotator Cuff Tendinopathy.
abstract: OBJECTIVE
  To compare the effect of dextrose prolotherapy on pain levels and degenerative changes in painful rotator cuff tendinopathy against 2 potentially active control injection procedures.
  
  
  METHODS
  Randomized controlled trial, blinded to participants and evaluators.
  
  
  METHODS
  Outpatient pain medicine practice.
  
  
  METHODS
  Persons (N=73) with chronic shoulder pain, examination findings of rotator cuff tendinopathy, and ultrasound-confirmed supraspinatus tendinosis/tear.
  
  
  METHODS
  Three monthly injections either (1) onto painful entheses with dextrose (Enthesis-Dextrose), (2) onto entheses with saline (Enthesis-Saline), or (3) above entheses with saline (Superficial-Saline). All solutions included 0.1% lidocaine. All participants received concurrent programmed physical therapy.
  
  
  METHODS
  Primary: participants achieving an improvement in maximal current shoulder pain ≥2.8 (twice the minimal clinically important difference for visual analog scale pain) or not. Secondary: improvement in the Ultrasound Shoulder Pathology Rating Scale (USPRS) and a 0-to-10 satisfaction score (10, completely satisfied).
  
  
  RESULTS
  The 73 participants had moderate to severe shoulder pain (7.0±2.0) for 7.6±9.6 years. There were no baseline differences between groups. Blinding was effective. At 9-month follow-up, 59% of Enthesis-Dextrose participants maintained ≥2.8 improvement in pain compared with Enthesis-Saline (37%; P=.088) and Superficial-Saline (27%; P=.017). Enthesis-Dextrose participants' satisfaction was 6.7±3.2 compared with Enthesis-Saline (4.7±4.1; P=.079) and Superficial-Saline (3.9±3.1; P=.003). USPRS findings were not different between groups (P=.734).
  
  
  CONCLUSIONS
  In participants with painful rotator cuff tendinopathy who receive physical therapy, injection of hypertonic dextrose on painful entheses resulted in superior long-term pain improvement and patient satisfaction compared with blinded saline injection over painful entheses, with intermediate results for entheses injection with saline. These differences could not be attributed to a regenerative effect. Dextrose prolotherapy may improve on the standard care of painful rotator cuff tendinopathy for certain patients.
authors: Department of Family Practice, School of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Helene
authors: H
authors: Bertrand
authors: Department of Physical Medicine and Rehabilitation, University of Kansas, Kansas City, KS. Electronic address: DeanReevesMD@gmail.com.
authors: Kenneth Dean
authors: KD
authors: Reeves
authors: Private Practice, West Vancouver, British Columbia, Canada.
authors: Cameron J
authors: CJ
authors: Bennett
authors: Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Simon
authors: S
authors: Bicknell
authors: School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, MO.
authors: An-Lin
authors: AL
authors: Cheng
mesh_terms: D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D000529:Complementary Therapies; D004311:Double-Blind Method; D005081:Exercise Therapy; D005260:Female; D005947:Glucose / Q000008:administration & dosage*; D006801:Humans; D007270:Injections, Intra-Articular; D007509:Irritants / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017006:Rotator Cuff; D020069:Shoulder Pain / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D052256:Tendinopathy / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D014463:Ultrasonography
chemical_list: D007509:Irritants; D005947:Glucose
keywords: Glucose; Regenerative medicine; Rehabilitation; Rotator cuff; Shoulder; Tendinopathy