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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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Dextrose prolotherapy | Experimental | Participants in this group received ultrasound-guided dextrose prolotherapy injections at baseline, week 3, and week 6 using an anatomical marking technique, in addition to a standardized home-based exercise program. |
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| Lidocaine-saline injections | Active Comparator | Participants in this group received ultrasound-guided lidocaine-saline injections at baseline, week 3, and week 6 using the same anatomical marking technique and injection protocol as the prolotherapy group, in addition to a standardized home-based exercise program. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Dextrose prolotherapy injection | Other | Dextrose prolotherapy injections were administered at baseline, week 3, and week 6 using an ultrasound-guided anatomical marking technique. A 15% dextrose solution was prepared using 30% dextrose, saline, and 1% lidocaine. Extra-articular injections were administered with a 27-gauge needle using the peppering technique at five previously marked anatomical points, including the long head of the biceps tendon in the bicipital groove, the subscapularis insertion at the lesser tuberosity, the supraspinatus insertion at the greater tuberosity, the infraspinatus insertion at the greater tuberosity, and the coracoid process region. One milliliter was injected at each point. Subacromial injection was performed via a posterior approach using a 21-gauge needle, and 4 mL of solution was injected into the subacromial bursa. All participants also received a standardized home-based exercise program. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in activity-related pain measured by the Visual Analog Scale (VAS) | Activity-related pain was measured using a 10-cm Visual Analog Scale (VAS). Scores range from 0 to 10, with 0 indicating no pain and 10 indicating the worst imaginable pain. Higher scores indicate greater pain severity. | Baseline, 4 weeks, and 12 weeks after the final injection |
| Measure | Description | Time Frame |
|---|---|---|
| Change in rest pain measured by the Visual Analog Scale (VAS) | Resting shoulder pain was measured using a 10-cm Visual Analog Scale (VAS). Scores range from 0 to 10, with 0 indicating no pain and 10 indicating the worst imaginable pain. Higher scores indicate greater pain severity. | Baseline, 4 weeks, and 12 weeks after the final injection |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Selim Sezikli, MD | Istanbul University Istanbul Faculty of Medicine, Department of Physical Medicine and Rehabilitation | Principal Investigator |
| Demirhan Diracoglu, Prof. | Istanbul University Istanbul Faculty of Medicine, Department of Physical Medicine and Rehabilitation | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Istanbul University Istanbul Faculty of Medicine, Department of Physical Medicine and Rehabilitation | Istanbul | Fatih | 34034 | Turkey (Türkiye) |
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| ID | Term |
|---|---|
| D020069 | Shoulder Pain |
| ID | Term |
|---|---|
| D018771 | Arthralgia |
| D007592 | Joint Diseases |
| D009140 | Musculoskeletal Diseases |
| D010146 | Pain |
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Participants were randomized to receive either dextrose prolotherapy injections or lidocaine-saline injections in a parallel-group design.
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Participants and outcome assessors were blinded to group allocation. The physician performing the injections was not blinded.
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| Lidocaine-saline injection | Other | Lidocaine-saline injections were administered at baseline, week 3, and week 6 using the same ultrasound-guided anatomical marking technique and anatomical targets as the prolotherapy group. Extra-articular injections were prepared using saline and 1% lidocaine and were administered superficially at approximately 0.5-1 cm depth using a 26-gauge needle at five previously marked sites to mimic the prolotherapy injection procedure. One milliliter was injected at each site. Subacromial injection was performed via a posterior approach using a 21-gauge needle, and 4 mL of lidocaine-saline solution was injected into the subacromial bursa. All participants also received a standardized home-based exercise program. |
|
| Change in night pain measured by the Visual Analog Scale (VAS) |
Night shoulder pain was measured using a 10-cm Visual Analog Scale (VAS). Scores range from 0 to 10, with 0 indicating no pain and 10 indicating the worst imaginable pain. Higher scores indicate greater pain severity. |
| Baseline, 4 weeks, and 12 weeks after the final injection |
| Change in shoulder pain and disability measured by the Shoulder Pain and Disability Index (SPADI) | Shoulder pain and disability were assessed using the Shoulder Pain and Disability Index (SPADI). The SPADI consists of 13 items divided into pain and disability subscales. Scores range from 0 to 100, with higher scores indicating greater pain and functional impairment. | Baseline, 4 weeks, and 12 weeks after the final injection |
| Change in shoulder function measured by the UCLA Shoulder Rating Scale | Shoulder function was assessed using the UCLA Shoulder Rating Scale. The scale evaluates pain, function, active forward flexion, strength of forward flexion, and patient satisfaction. Scores range from 0 to 35, with higher scores indicating better shoulder function. | Baseline, 4 weeks, and 12 weeks after the final injection |
| Change in rotator cuff structural pathology measured by the Ultrasound Shoulder Pathology Rating Scale (USPRS) | Rotator cuff structural abnormalities were assessed using the Ultrasound Shoulder Pathology Rating Scale (USPRS) based on ultrasonographic findings. Higher scores indicate greater structural pathology. | Baseline, 4 weeks, and 12 weeks after the final injection |
| Change in shoulder active range of motion (ROM) | Active shoulder range of motion was measured using a goniometer, including flexion, abduction, internal rotation, and external rotation. Higher values indicate greater shoulder mobility. | Baseline, 4 weeks, and 12 weeks after the final injection |
| D009461 |
| Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |