Dextrose prolotherapy for rotator cuff lesions: the challenges and the future

• Published in: Hong Kong medical journal = Xianggang yi xue za zhi Vol. 24; no. 5; pp. 538 - 539
• Main Authors: Sit, R Ws, Rabago, D
• Format: Journal Article
• Language: English
• Published: China Hong Kong Academy of Medicine 01.10.2018
• Subjects: Arthritis; Back pain; Carpal tunnel syndrome; Chronic pain; Clinical trials; Epidural; Knee; Osteoarthritis; Patients; Public health; Rotator cuff; Steroids; Hong Kong China; United States > US; China
• ISSN: 1024-2708; 2226-8707
• DOI: 10.12809/hkmj187528

Hypertonic dextrose is thought to facilitate healing and subsequent pain control through tissue change or proliferation, potentially mediated by an inflammatory mechanism, thus improving joint stability and biomechanics, and ultimately decreasing pain.4 However, other mechanisms have been proposed and are evidence-based, including the direct sensorineural effect of dextrose on pain control.5 6 This potential effect has been suggested in clinical studies of epidural injection of dextrose for chronic recalcitrant low back pain,7 and dextrose injections for carpal tunnel syndrome and Achilles tendinosis.8 9 Studies have shown that prolotherapy is efficacious in the management of knee osteoarthritis and tendinopathy.10 11 We agree that the evidence to support its use in the context of RCLs is less robust and that more and better evidence is needed to determine its precise contribution to care of RCLs. [...]it is reasonable to begin prolotherapy for RCLs using a whole joint approach with the clinical standard of 15% dextrose for extra-articular injections and 25% for intra-articular injections.12 13 However, in time, formal assessment of different concentrations will be needed. [...]validated and guideline-recommended self-reported and objectively assessed patient outcomes specific to shoulder injury should be used to assess the effects of prolotherapy.16 In conclusion, we agree that dextrose prolotherapy is not yet the first-line treatment for RCLs but clinicians can feel comfortable with its use in carefully selected patients who are refractory to other conservative treatments.