Effects of Dextrose Prolotherapy in Rotator Cuff Disease

Effects of Dextrose Prolotherapy in Rotator Cuff Disease: A Randomized Controlled Study

The aim of this prospective, randomized, controlled trial was to evaluate the clinical and ultrasonographic effects of dextrose prolotherapy on pain, shoulder function, range of motion, and ultrasonographic findings in patients with MRI-confirmed chronic rotator cuff disease. Participants were randomly assigned to receive either dextrose prolotherapy or lidocaine-saline injections. Both groups followed a standardized home-based exercise program.

Rotator cuff disease is a major cause of persistent shoulder pain and functional limitation. Although exercise therapy, nonsteroidal anti-inflammatory drugs, and subacromial corticosteroid injections are commonly used as first-line treatments, many patients remain symptomatic despite conservative management. Dextrose prolotherapy has emerged as a potential treatment option for chronic musculoskeletal disorders; however, evidence from randomized controlled trials in chronic rotator cuff disease remains limited and inconsistent.

This prospective, randomized, controlled trial enrolled 60 patients with MRI-confirmed chronic rotator cuff disease who met the eligibility criteria. Participants were randomly assigned using a computer-generated randomization sequence to receive either dextrose prolotherapy or lidocaine-saline injections. In the dextrose prolotherapy group, injections were administered at baseline, week 3, and week 6 using an ultrasound-guided anatomical marking technique under aseptic conditions. In the lidocaine-saline injection group, injections were administered at the same time points using the same ultrasound-guided anatomical marking technique and injection protocol. Both groups participated in a standardized home-based exercise program throughout the study.

Outcome assessments were performed at baseline and at 4 and 12 weeks after the final injection. The primary outcome was activity-related pain measured using the Visual Analog Scale (VAS). Secondary outcomes included pain at rest, nocturnal pain, the Shoulder Pain and Disability Index (SPADI), the UCLA Shoulder Rating Scale, active shoulder range of motion, and the Ultrasound Shoulder Pathology Rating Scale (USPRS). Outcome assessments were performed by an investigator blinded to treatment allocation.

Inclusion Criteria:

• Age between 30 and 65 years
• Shoulder pain lasting longer than 3 months
• Resistance to conservative treatment for at least 3 months
• Diagnosis of rotator cuff disease confirmed by clinical examination and magnetic resonance imaging (MRI)

Exclusion Criteria:

• Presence of rheumatic disease or other systemic inflammatory diseases
• Uncontrolled diabetes mellitus
• Local or systemic infection
• History of previous shoulder surgery
• Bleeding tendency (acquired or hereditary) or use of anticoagulant therapy with INR >2
• Shoulder injection within the previous 8 weeks
• Allergy to local anesthetics
• Passive shoulder abduction <100° or external rotation <25°
• Rotator cuff calcification with diameter >0.8 cm detected on radiography or ultrasonography
• Full-thickness rotator cuff tear
• Presence of severe comorbid disease