Article

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. DESIGN: Randomized controlled trial, blinded
to participants and evaluators. SETTING: Outpatient pain medicine practice.
PARTICIPANTS: Persons (N=73) with chronic shoulder pain, examination findings of
rotator cuff tendinopathy, and ultrasound-confirmed supraspinatus tendinosis / tear. INTERVENTIONS: 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. MAIN OUTCOME MEASURES: 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.
CI - Copyright (c) 2016 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS