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Ravikumar C, Sasikala B, Krishnakumar Raja VB, Elavenil P. Evaluation of the efficacy of autologous conditioned serum versus dextrose prolotherapy in internal derangement of the TMJ - A pilot study. J Craniomaxillofac Surg 2024; 52:477-483. [PMID: 38368212 DOI: 10.1016/j.jcms.2024.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 11/19/2023] [Accepted: 01/16/2024] [Indexed: 02/19/2024] Open
Abstract
It was the aim of the study to compare the effectiveness of autologous conditioned serum (ACS) and dextrose prolotherapy (DP) solutions, in treating patients with TMJ internal derangement (ID). 24 participants with TMJ ID (Wilkes II-V) were recruited and randomized into study and control groups, with 12 patients each, treated with IA injection of ACS and DP, respectively. Pain, mouth opening, joint sounds, and jaw deviation were evaluated, with patients reviewed at 2 weeks, 1 month, and 2 months intervals. Based on the nature of the variables, appropriate descriptive statistics and statistical tests were applied. The pain score was zero in the study group after 2 months of treatment, which was statistically significant (p = 0.006). Deviation was also significantly reduced (p < 0.001) and mouth opening significantly improved (p = 0.004) in the ACS-treated patients. ACS demonstrated superiority over DP in the management of TMJ dysfunction. Therefore, ACS can be considered an ideal, minimally invasive treatment option for TMJ ID. Clinical trial registry number: (CTRI/2021/10/037043).
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Affiliation(s)
- C Ravikumar
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram, Chennai, India
| | - B Sasikala
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram, Chennai, India.
| | - V B Krishnakumar Raja
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram, Chennai, India
| | - P Elavenil
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram, Chennai, India
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Babaei-Ghazani A, Eftekharsadat B, Soleymanzadeh H, ZoghAli M. Ultrasound-Guided Pes Anserine Bursitis Injection Choices: Prolotherapy or Oxygen-Ozone or Corticosteroid: A Randomized Multicenter Clinical Trial. Am J Phys Med Rehabil 2024; 103:310-317. [PMID: 37752656 DOI: 10.1097/phm.0000000000002343] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
OBJECTIVE Pes anserine bursitis is the most common cause of periarticular knee pain. The aim of the study was to evaluate the efficacy of local injection-based therapies with different materials. DESIGN The enrolled patients were randomly allocated to three groups to receive different interventions. Outcome measures included pain severity using the visual analog scale and the Western Ontario and McMaster Universities osteoarthritis index that was evaluated before the intervention, 1 and 8 wks after that. RESULTS This trial was performed on 72 participants, with male-to-female ratio of 0.14 and with a mean age of 61.49 ± 9.35 yrs. Corticosteroids in the first group, oxygen-ozone in the second group, and dextrose 20% in the third group, were injected into the pes anserine bursa under ultrasound guidance. Interaction between time and group showed a statistically significant improvement in visual analog scale and Western Ontario and McMaster Universities Arthritis Index ( P ≤ 0.05) in favor of corticosteroids and oxygen-ozone groups after 1 wk and in favor of oxygen-ozone and prolotherapy groups after 8 wks. CONCLUSIONS All three treatment options are effective for patients with pes anserine bursitis. This study showed that the effects of oxygen-ozone injection and prolotherapy last longer than those of corticosteroid injection.
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Affiliation(s)
- Arash Babaei-Ghazani
- From the Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, School of Medicine, Iran University of Medical Sciences, Tehran, Iran (AB-G); Department of Physical Medicine and Rehabilitation, University of Montreal Health Center, Montreal, Canada (AB-G); Physical Medicine and Rehabilitation Research Center, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran (BE); Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran (HS); and Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran (MZ)
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Foti C, Vellucci C, Santoro A. Regenerative Medicine Solutions for Rotator Cuff Injuries in Athletes: Indications and Outcomes. Sports Med Arthrosc Rev 2024; 32:46-50. [PMID: 38695503 DOI: 10.1097/jsa.0000000000000399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
Rotator cuff (RC) injuries include a wide range of pathologic states. Athletes are perhaps the most susceptible to RC injuries ranging from tendinopathy to partial or full-thickness tears, due to functional overload and repetitive movements, causing abstention from sports for long periods. Regenerative medicine keeps giving us multiple choices to fight the disability caused by these pathologies. A literature search was performed, and findings related to the structure-function of rotator cuff units, pathophysiology of injuries, regenerative medicine treatments, and future strategies were outlined. Platelet-rich plasma (PRP) has a greater number of articles and clinical trials, accompanied by stem cells progenitor, prolotherapy, and new approaches such as microfragmented adipose tissue and exosomes. RC injuries in athletes can cause pain, functional impotence, and the risk of recurrence, and can lead them to stop playing sports. Regenerative medicine offers a range of treatments, but some of them need further studies to underline their actual validity.
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Affiliation(s)
- Calogero Foti
- Department of Physical and Rehabilitation Medicine, Clinical Sciences and Translational Medicine, Tor Vergata University, Rome, Italy, EU
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Barik S, Raj V, Kumar V. Prolotherapy for knee osteoarthritis: comment on "Demonstrating the effectiveness of Platelet Rich Plasma and Prolotherapy treatments in knee osteoarthritis" by Ceylan et al. Ir J Med Sci 2023; 192:2859-2860. [PMID: 37010774 DOI: 10.1007/s11845-023-03354-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 04/04/2023]
Affiliation(s)
- Sitanshu Barik
- Department of Orthopedics, All India Institute of Medical Sciences, Deoghar, India.
| | - Vikash Raj
- Department of Orthopedics, All India Institute of Medical Sciences, Deoghar, India
| | - Vishal Kumar
- Department of Orthopedics, All India Institute of Medical Sciences, Deoghar, India
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Öztürk MU, Baygutalp F. A comparative analysis of prolotherapy efficacy in patients with knee osteoarthritis across varied dextrose concentrations. Clin Rheumatol 2023; 42:3321-3331. [PMID: 37540383 DOI: 10.1007/s10067-023-06723-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 07/01/2023] [Accepted: 07/25/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE To compare the effectiveness of prolotherapy with dextrose concentrations of 5%, 10%, and 20% in patients diagnosed with knee osteoarthritis. METHODS This study was planned as a prospective, randomized controlled interventional trial. Prolotherapy at 5% dextrose concentration in group 1, 10% in group 2, and 20% in group 3 was applied to the knee intra-articularly and periarticularly at 0, 3, and 6 weeks, and a home exercise program was given. Group 4 received a home exercise program. All groups received hotpack therapy at weeks 0, 3, and 6. Outcome measures included the visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), knee range of motion, timed up and go test, and Short Form-36. RESULTS A total of 128 patients were divided into 4 groups. At the 6th and 12th weeks, VAS scores were significantly lower in groups 2 and 3 than in group 4 (p < 0.05). At the 12th week, the WOMAC pain score was significantly lower in group 3 than in group 4, and WOMAC physical function and WOMAC total scores were significantly lower in groups 1, 2, and 3 than in group 4 (p < 0.05). Week 6 active and passive knee flexion and week 12 passive knee flexion were significantly higher in group 3 than in group 4 (p < 0.05). CONCLUSIONS Although no significant difference was observed among the dextrose prolotherapy groups, higher dextrose concentrations demonstrated a greater improvement compared to the control group. Therefore, the use of 20% dextrose is recommended due to its significant superiority. Long-term follow-up and placebo-controlled studies are needed. TRIAL REGISTRATION ClinicalTrial.gov Identifier: NCT05537077, registration date: 09.03.2022, retrospectively registered. Key Points • The utilization of dextrose prolotherapy has gained popularity in the management of osteoarthritis, aiming to harness its regenerative and proliferative properties. However, the comparative efficacy of various concentrations of dextrose prolotherapy in treating knee osteoarthritis remains unexplored in the literature. This study aimed to address this gap by comparing different concentrations of dextrose prolotherapy in the treatment of knee osteoarthritis. The findings revealed no statistically significant difference among the various concentrations of dextrose prolotherapy for knee osteoarthritis treatment.
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Affiliation(s)
- Muhammet Uğur Öztürk
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Atatürk University, Erzurum, Turkey.
| | - Fatih Baygutalp
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Atatürk University, Erzurum, Turkey
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Martínez-Barro D, Rivera-Bello JD, Cruz-López JM, Hernández-Amaro H, Rojano-Mejía D. [Functionality/isokinetic work of quadriceps in patients with gonarthrosis managed with prolotherapy]. Rev Med Inst Mex Seguro Soc 2023; 61:788-795. [PMID: 37995333 DOI: 10.5281/zenodo.10064325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/25/2023] [Indexed: 11/25/2023]
Abstract
Background Prolotherapy may be a good option in the complementary treatment of knee osteoarthritis (OA) patients, specifically for the increase of functionality. Objective To determine the effectiveness of prolotherapy in OA grade II - III in the functionality and muscular work of knee flexors and extensors. Material and methods a double-blind randomized controlled clinical trial was conducted. It included patients diagnosed with OA grades II-III. The experimental group was infiltrated in both knees with 6 ml of 25% glucose solution and 0.05% lidocaine; control group with 0.45% saline solution and 0.05% lidocaine. All patients received a comprehensive rehabilitation program. The isokinetic work of the knee flexor and extensor muscles, pain and functionality were measured, prior to infiltration and at 3-month follow-up. To compare the difference in means, the Student's T test was applied, considering P<0.05 as significant. The project was approved by the local ethics and research committee. Results 37 patients were recruited, 17 in the prolotherapy group. There were no intergroup differences in functionality, isokinetic knee flexor/extensor work, and pain at baseline, or during follow-up up to 12 weeks. Conclusions In the present study we identify that both prolotherapy and saline infiltration increased functionality, strength, and decreased pain; however, no statistically significant difference was found between the two group.
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Affiliation(s)
- Daniel Martínez-Barro
- Instituto Mexicano del Seguro Social, Unidad de Medicina Física y Rehabilitación Norte de la UMAE Traumatología, Ortopedia y Rehabilitación, "Dr. Victorio de la Fuente Narváez", Servicio de Rehabilitación. Ciudad de México, México
| | - Joel Dair Rivera-Bello
- Hospital Ángeles Pedregal, Servicio de Neurofisiología Clínica. Ciudad de México, México
| | - Jannet Mercedes Cruz-López
- Instituto Mexicano del Seguro Social, Hospital General Regional No. 1 "Vicente Guerrero", Servicio de Rehabilitación. Acapulco, Guerrero, México
| | - Hermelinda Hernández-Amaro
- Instituto Mexicano del Seguro Social, UMAE Traumatología, Ortopedia y Rehabilitación, "Dr. Victorio de la Fuente Narváez", División de Educación en Salud. Ciudad de México, México
| | - David Rojano-Mejía
- Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Coordinación de Investigación en Salud. Ciudad de México, México
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Fong HPY, Zhu MT, Rabago DP, Reeves KD, Chung VCH, Sit RWS. Effectiveness of Hypertonic Dextrose Injection ( Prolotherapy) in Plantar Fasciopathy: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Arch Phys Med Rehabil 2023; 104:1941-1953.e9. [PMID: 37098357 DOI: 10.1016/j.apmr.2023.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 02/21/2023] [Accepted: 03/14/2023] [Indexed: 04/27/2023]
Abstract
OBJECTIVE To systematically review the effectiveness of hypertonic dextrose prolotherapy (DPT) in plantar fasciopathy (PF) compared with other non-surgical treatments. DATA SOURCES PubMed/MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, Allied and Complementary Medicine Database, Global Health, Ovid Nursing Database, Dimensions, and WHO ICTRP were searched from inception to April 30th, 2022. STUDY SELECTION Two independent reviewers selected randomized controlled trials (RCTs) that evaluated the effectiveness of DPT in PF compared with non-surgical treatments. Outcomes included pain intensity, foot and ankle function, and plantar fascia thickness. DATA EXTRACTION Two independent reviewers conducted data extraction. Risk of bias (RoB) assessment was conducted using the Cochrane Risk of Bias 2 (RoB 2) tool, and certainty of evidence was assessed with Grading of Recommendation Assessment, Development, and Evaluation (GRADE). DATA SYNTHESIS Eight RCTs (n=469) met the inclusion criteria. Pooled results favored the use of DPT versus normal saline (NS) injections in reducing pain (weighted mean difference [WMD] -41.72; 95% confidence interval [CI] -62.36 to -21.08; P<.01; low certainty evidence) and improving function [WMD -39.04; 95% CI -55.24 to -22.85; P<.01; low certainty evidence] in the medium term. Pooled results also showed corticosteroid (CS) injections was superior to DPT in reducing pain in the short term [standardized mean difference 0.77; 95% CI 0.40 to 1.14; P<.01; moderate certainty evidence]. Overall RoB varied from "some concerns" to "high". The overall certainty of evidence presented ranges from very low to moderate based on the assessment with the GRADE approach. CONCLUSION Low certainty evidence demonstrated that DPT was superior to NS injections in reducing pain and improving function in the medium term, but moderate certainty evidence showed that it was inferior to CS in reducing pain in the short term. Further high-quality RCTs with standard protocol, longer-term follow-up, and adequate sample size are needed to confirm its role in clinical practice.
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Affiliation(s)
- Hugo P Y Fong
- The Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong, China
| | - Meng-Ting Zhu
- The Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong, China
| | - David P Rabago
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA
| | | | - Vincent C H Chung
- The Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong, China
| | - Regina W S Sit
- The Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong, China.
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Abstract
OBJECTIVE The aim of this study was to compare the efficacy of dextrose prolotherapy in conjunction with arthrocentesis and dextrose prolotherapy alone in the management of symptomatic TMJ hypermobility. METHODS Twenty-four patients suffering from TMJ symptomatic hypermobility received 10% dextrose injections for three sessions at four-week intervals. Twelve patients (P group) received prolotherapy alone; the other 12 (PA group) also underwent a single arthrocentesis session. Patients were evaluated for maximal incisal opening, maximal incisal opening without pain, pain at rest, pain during chewing function, TMJ sound, and locking episode frequency. RESULTS Pain scores were significantly reduced in both groups, and the locking episode frequency was decreased to a greater extent in the PA than the P group, at both the short and long terms. CONCLUSION Prolotherapy is effective in the management of TMJ hypermobility. However, prolotherapy with arthrocentesis may be superior to prolotherapy alone in the management of TMJ hypermobility.
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Affiliation(s)
- Fatih Taşkesen
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Burak Cezairli
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ordu University, Ordu, Turkey
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Zahid A, Qamar K, Tabassum A, Abaid M, Bashir Kiani MR, Aslam M. Ameliorative Effects of Prolotherapy on Histomorphology of Tibial Articular Cartilage of Chemically Induced Osteoarthritic Knee Joint in a Rat Model. J Coll Physicians Surg Pak 2023; 33:836-841. [PMID: 37553918 DOI: 10.29271/jcpsp.2023.08.836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 07/17/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE To determine the ameliorative effects of prolotherapy on monosodium iodoacetate (MIA) induced and histomorphological changes in the articular cartilage of tibial condyles at rat knee joint. STUDY DESIGN An experimental study. Place and Duration of the Study: Department of Anatomy, Army Medical College Rawalpindi, NUMS, Rawalpindi, from August to November 2021. METHODOLOGY Thirty adult male Sprague Dawley rats were divided into three groups, each having 10 rats. Group A was control. Group B was injected with single dose of 1mg MIA intraarticularly in the right knee to induce osteoarthritic changes. Group C was injected with single dose of 1mg MIA intraarticularly, in right knee was followed by 0.1ml Prolotherapy (3ml of 25% dextrose, 2ml of 2% xylocaine, 1ml of injection neurobion, and 1ml of injection methecobal) as intra articular injection at week 2, 6 and 10 in right knee. Rats were sacrificed after one month of the last dose of Prolotherapy. Articular cartilage was collected for gross and histological examination and compared among the groups. RESULTS Articular cartilage belonging to control group A was normal. While group B showed statistically significant deterioration in gross appearance (p = 0.001**), reduction in number of chondrocytes (p = 0.005*) and thickness of articular cartilage (p = 0.001**) in comparison to group A. In group C due to prolotherapy statistically significant improvement in gross appearance (p = 0.034*), increase in number of chondrocytes (p = 0.003*), and thickness of articular cartilage (p = 0.001**) was observed as compared to group B. CONCLUSION Prolotherapy significantly ameliorates histomorphology of tibial articular cartilage against MIA induced osteoarthritic changes in rat knee joint. KEY WORDS Articular cartilage, Knee joint, Monosodium iodoacetate, Osteoarthritis, Prolotherapy.
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Affiliation(s)
- Aqsa Zahid
- Department of Anatomy, National University of Medical Sciences, Rawalpindi, Pakistan
- Department of Histopathology, National University of Medical Sciences, Rawalpindi, Pakistan
| | - Khadija Qamar
- Department of Anatomy, National University of Medical Sciences, Rawalpindi, Pakistan
- Department of Histopathology, National University of Medical Sciences, Rawalpindi, Pakistan
| | - Asima Tabassum
- Department of Anatomy, National University of Medical Sciences, Rawalpindi, Pakistan
- Department of Histopathology, National University of Medical Sciences, Rawalpindi, Pakistan
| | - Mehwish Abaid
- Department of Anatomy, National University of Medical Sciences, Rawalpindi, Pakistan
- Department of Histopathology, National University of Medical Sciences, Rawalpindi, Pakistan
| | - Muhammad Rizwan Bashir Kiani
- Department of Anatomy, National University of Medical Sciences, Rawalpindi, Pakistan
- Department of Histopathology, National University of Medical Sciences, Rawalpindi, Pakistan
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Sam N, Yusuf I, Idris I, Adnan E, Haryadi RD, Hamid F, Usman A, Johan MP, Zainuddin AA, Bukhari A. The level of ratio between matrix metalloproteinase-1 (MMP-1) and tissue inhibitor matrix metalloproteinase-1 (TIMP-1) after prolotherapy intervention and the functional outcome in patient with frozen shoulder: A randomized controlled trial. Medicine (Baltimore) 2023; 102:e34356. [PMID: 37505166 PMCID: PMC10378817 DOI: 10.1097/md.0000000000034356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 06/16/2023] [Accepted: 06/26/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE To determine the effect of prolotherapy on functional outcome changes, along with ratio of matrix metalloproteinase-1 (MMP-1)/tissue inhibitor matrix metalloproteinase-1 (TIMP-1) as an indicator of tissue repair in the glenohumeral joint in frozen shoulder patients. DESIGN Single-blinded randomized controlled trial. SUBJECTS/PATIENTS Participants with frozen shoulder. METHODS The prolotherapy group is the study group, and the normal saline (NS) group is the control group. Each group was given injections at weeks 0, 2, 4, and 6. Level of biomarker levels was measured at week 6 and week 12 after there. Functional outcomes were measured at weeks 0, 6, and 12. RESULTS A significant difference in week 6 and week 12 was demonstrated in the ratio of MMP-1/TIMP-1 level between the prolotherapy group and the normal saline group (P value = .002). Both groups performed well regarding the Numerical Rating Scale score and functional outcome. Compared to the normal saline group, prolotherapy changed the mean range of motion in flexion and internal rotation. CONCLUSION Prolotherapy is considered to play a role in repairing cartilage based on biomarker assessment, particularly the ratio of MMP-1/TIMP-1-prolotherapy effectiveness in improving functional outcome and Numerical Rating Scale score.
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Affiliation(s)
- Nuralam Sam
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Irawan Yusuf
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Irfan Idris
- Department of Physiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Endy Adnan
- Rheumatology Divison, Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Ratna Darjanti Haryadi
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Firdaus Hamid
- Doctor from Department of Microbiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Andry Usman
- Department of Orthopedic, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Muhammad Phetrus Johan
- Department of Orthopedic, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Andi Alfian Zainuddin
- Department of Public Health, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Agussalim Bukhari
- Department of Clinical Nutrition, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
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Boz M, Sahin AA. Comparing the effectiveness of prolotherapy and percutaneous dry needling in the treatment of lateral epicondylitis: a retrospective cohort study. Eur Rev Med Pharmacol Sci 2023; 27:5596-5603. [PMID: 37401297 DOI: 10.26355/eurrev_202306_32798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
OBJECTIVE Lateral epicondylitis (LE) can result in a functional loss in patients because of pain and has recently become more prevalent. This study compared the effects of minimally invasive prolotherapy (PRO) and percutaneous dry needling (PDN) on LE treatment. PATIENTS AND METHODS Patients were divided into three groups; Group 1 included patients undergoing PDN, Group 2 included those undergoing PRO, and Group 3 included those undergoing PDN+PRO. All these treatments were administered three times and at a 3-week interval in each patient. Data on the visual analog scale (VAS) and patient-rated tennis elbow evaluation (PRTEE) scale scores of the patients were collected at weeks 0, 3, and 6 and month 6 and retrospectively analyzed. RESULTS The VAS and PRTEE scores decreased in all groups. The decrease in Group 3 was higher than that in the other groups (p<0.001). Upon evaluating within-group differences in VAS and PRTEE scores, the scores at week 3, week 6, and month 6 gradually decreased compared with the baseline in all groups (p<0.001). CONCLUSIONS PDN and PRO are minimally invasive and can successfully treat LE. A combination of PDN+PRO provides better results than PDN or PRO alone. As the materials we used in these treatments are relatively inexpensive and readily available, we believe our study will help reduce the national healthcare costs allocated for the treatment of LE.
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Affiliation(s)
- M Boz
- Department of Orthopaedic and Traumatology, Turgut Ozal University Malatya Training and Research Hospital, Malatya, Turkey.
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Ciftci YGD, Tuncay F, Kocak FA, Okcu M. Is Low-Dose Dextrose Prolotherapy as Effective as High-Dose Dextrose Prolotherapy in the Treatment of Lateral Epicondylitis? A Double-Blind, Ultrasound Guided, Randomized Controlled Study. Arch Phys Med Rehabil 2023; 104:179-187. [PMID: 36243123 DOI: 10.1016/j.apmr.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To investigate the effects of prolotherapy (PrT) on pain, functionality, clinical improvement and to compare the 5% low and 15% high dose dextrose PrT in chronic lateral epicondylitis. DESIGN A double-blind, parallel groups, randomized controlled study. SETTINGS Outpatient Clinic. PARTICIPANTS Sixty patients (N=60), aged 44.30±10.31 years old, with chronic lateral epicondylitis were allocated randomly into 3 groups. INTERVENTIONS To Group 1 5% dextrose PrT, to Group 2 15% dextrose PrT, to Group 3 0.9% saline injections were done at 3 times (weeks 0, 3, 6), to the entheses of forearm extensors and annular ligament. MAIN OUTCOME MEASURES The primary outcomes were handgrip strength, visual analog scale-rest (VAS-R), visual analog scale-activity (VAS-A), pressure-pain threshold, and Quick Disability of the Arm, Shoulder and Hand (Q-DASH). The secondary outcomes were clinical improvement (Disease Global Assessment Questionnaire), side effects, and complications. Primary outcomes were collected at baseline week 0, week 3, and 12. Secondary outcomes were collected at weeks 3 and 12. RESULTS In Group 2, VAS-A and VAS-R (at week 3), handgrip strength and pressure-pain threshold (at week 12) were significantly different than other groups (P<.05). In Groups 1 and 2, there was a difference in primary outcomes at week 12 than baseline (P<.05). In Group 3, there was no difference in VAS-R, VAS-A, and handgrip strength at weeks 3 and 12 than baseline (P>.05). CONCLUSION In chronic lateral epicondylitis, 5% and 15% dextrose PrT is more effective in pain, handgrip strength, functionality, and clinical improvement than %0.9 saline. There was no difference in functionality, clinical improvement, side effects, and complications between the PrT groups. 15% dextrose PrT was more effective in handgrip strength and pressure-pain threshold at week 12 and pain at week 3. We recommend 15% dextrose PrT based on this study.
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Affiliation(s)
- Yıldız Gonca Dogru Ciftci
- Department of Physical Medicine and Rehabilitation, Sisli Etfal Hamidiye Research Hospital, Istanbul, Turkey.
| | - Figen Tuncay
- Department of Physical Medicine and Rehabilitation, Kirsehir Ahi Evran University Faculty of Medicine, Kirsehir, Turkey
| | - Fatmanur Aybala Kocak
- Department of Physical Medicine and Rehabilitation, Kirsehir Ahi Evran University Faculty of Medicine, Kirsehir, Turkey
| | - Mehmet Okcu
- Department of Physical Medicine and Rehabilitation, Marmara University Faculty of Medicine, Istanbul, Turkey
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Martínez-Pizarro S. Prolotherapy with dextrose to reduce pain in osteoarthritis of the knee. Reumatol Clin (Engl Ed) 2022; 18:251-252. [PMID: 35489813 DOI: 10.1016/j.reumae.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/06/2020] [Indexed: 06/14/2023]
Affiliation(s)
- Sandra Martínez-Pizarro
- Unidad de Consultas Externas, Departamento de Enfermería, Hospital Comarcal La Inmaculada de Huércal Overa, Almería, Spain.
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Arias-Vázquez PI, Castillo-Avila RG, Tovilla-Zárate CA, Quezada-González HR, Arcila-Novelo R, Loeza-Magaña P. Efficacy of prolotherapy in pain control and function improvement in individuals with lateral epicondylitis: A Systematic Review and Meta-analysis. ARP Rheumatol 2022; 1:152-167. [PMID: 35810374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
AIM The objective of this study was to evaluate the efficacy of prolotherapy when treating individuals with lateral epicondylitis through a systematic review and meta-analysis. METHODS The search for articles was carried out in electronic databases including PUBMED, CENTRAL, WEB OF SCIENCE, SCIELO and Google Scholar, published up to July 2021. We used the following keywords: prolotherapy OR proliferation therapy OR hypertonic dextrose injections AND tennis elbow OR lateral epicondylitis. The effectiveness was expressed as mean difference or standardized mean difference ((d) and 95% CI). MAJOR RESULTS Nine clinical trials that used prolotherapy in the treatment of lateral epicondylitis were included. In the pooled analysis, prolotherapy was effective in pain control in the medium (d = -0.85, 95% CI -1.29 to -0.41, p (z) 0.0001) and long terms (d = -1.05, 95% CI -2.06 to -0.03, p (z) 0.04). It was also effective in improving function in the medium term (d = -1.21, 95% CI -1.64 to -0.78, p (z) 0.00001). CONCLUSIONS Prolotherapy was effective for reducing pain in the medium and long terms, as well as for improving function in the medium term, in individuals with lateral epicondylitis. However, the risk of bias of the studies caused that the quality of evidence was moderate; more studies with a low risk of bias are necessary to corroborate the efficacy of prolotherapy in patients with lateral epicondylitis.
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Affiliation(s)
- Pedro Iván Arias-Vázquez
- Rehabilitation Medicine, Sports Medicine, Universidad Juárez Autónoma de Tabasco, Tabasco Mexico
| | | | | | | | | | - Pavel Loeza-Magaña
- Rehabilitation Medicine, Sports Science,National Medical Center 20 November ISSSTE. Mexico City
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Won SJ, Kim DY, Kim JM. Effect of platelet-rich plasma injections for chronic nonspecific low back pain: A randomized controlled study. Medicine (Baltimore) 2022; 101:e28935. [PMID: 35212300 PMCID: PMC8878905 DOI: 10.1097/md.0000000000028935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/08/2022] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND Patient with chronic nonspecific low back pain is weakened ligament, and prolotherapy is the effective treatment but their use remains controversial. These ligaments can be strengthened by platelet-rich plasma injection. We hypothesized that the effectiveness of platelet-rich plasma injection and prolotherapy may decrease pain and improved disability of patient with chronic low back pain. METHODS This study was a prospective, double-blind, randomized controlled trial and was conducted for 3 years for patient enroll and follow-up. Thirty-four patients with chronic nonspecific low back pain (duration of at least 3 months) refectory to conventional management were randomized to platelet-rich plasma injection and lidocaine injection. Patients were treated with weekly platelet-rich plasma or lidocaine injections at the lumbopelvic ligaments for 2 weeks and then weekly prolotherapy with 15% glucose for 2 weeks and followed up 6 months. Visual analog scale, Oswestry Disability Index, and Roland-Morris Disability Questionnaire were evaluated at initial, 4 weeks, 3 months, and 6 months. Four patients did not complete this trial. Three were in the platelet-rich plasma injection and 1 was in the lidocaine injection. RESULTS The intensity of pain was significantly decreased in platelet-rich plasma injections at 6 months as compared lidocaine injections; between-group differences were 0.9 (95% confidence interval 0.10-1.75 [P = .027]). All participants were significantly decreased pain and disability index at 4 weeks, 3 months, and 6 months but there were no significant differences between groups except for visual analog scale at 6 months. The baseline parameters were no significant differences in both groups. CONCLUSIONS In chronic nonspecific low back pain, the platelet-rich plasma injection in combination with prolotherapy is an effective intervention and either lidocaine or platelet-rich plasma injection significantly reduced disability. And injection at the lumbopelvic ligaments using the platelet-rich plasma and prolotherapy is also an effective treatment for pain.
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Affiliation(s)
- Sun Jae Won
- Department of Rehabilitation Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Da-ye Kim
- Department of Rehabilitation Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Min Kim
- Department of Rehabilitation Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Kazempour Mofrad M, Rezasoltani Z, Dadarkhah A, Kazempour Mofrad R, Abdorrazaghi F, Azizi S. Periarticular Neurofascial Dextrose Prolotherapy Versus Physiotherapy for the Treatment of Chronic Rotator Cuff Tendinopathy: Randomized Clinical Trial. J Clin Rheumatol 2021; 27:136-142. [PMID: 32975923 DOI: 10.1097/rhu.0000000000001218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVE Rotator cuff tendinopathy is a common cause of shoulder pain. We aimed to compare periarticular (neurofascial) dextrose prolotherapy versus physiotherapy for treatment of chronic rotator cuff tendinopathy in the short term. METHODS We carried out a randomized clinical trial with 2 arms at a university hospital. In total, 66 patients with chronic rotator cuff tendinopathy, proven by magnetic resonance imaging, were randomly allocated to 2 groups. The outcomes were change in shoulder pain intensity (primary) and disability (secondary) index using a questionnaire for Shoulder Pain and Disability Index. For physiotherapy, participants received superficial heat, transcutaneous electrical nerve stimulation, and pulsed ultrasound. Also, they carried out an exercise program, 10 sessions of 30 minutes for 3 weeks. For prolotherapy, we used 8 mL of 12.5% dextrose and 40 mg of 2% lidocaine. The mixture was injected 2 times with 1-week interval superficially around the shoulder joint and to tender points along the suprascapular nerve. RESULTS Neurofascial dextrose was more effective than physiotherapy for alleviating pain in 2 weeks (p < 0.001), and they were similar 3 months after the interventions (p = 0.055). For disability, dextrose was more effective than physiotherapy 2 weeks and 3 months (both p < 0.001) after the interventions. However, the changes in the physiotherapy group seemed to be more sustained. CONCLUSIONS Both interventions are effective for the short-term management of rotator cuff tendinopathy. However, prolotherapy is more successful as the initial treatment. Besides, the treatment time is much shorter for dextrose prolotherapy compared with physiotherapy.
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Affiliation(s)
- Morteza Kazempour Mofrad
- From the Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Shahid Beheshti University of Medical Sciences
| | - Zahra Rezasoltani
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Aja University of Medical Sciences
| | - Afsaneh Dadarkhah
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Aja University of Medical Sciences
| | | | - Fateme Abdorrazaghi
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Aja University of Medical Sciences
| | - Sirous Azizi
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Aja University of Medical Sciences
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Arias-Vázquez PI, Tovilla-Zárate CA, González-Graniel K, Burad-Fonz W, González-Castro TB, López-Narváez ML, Castillo-Avila RG, Arcila-Novelo R. Efficacy of hypertonic dextrose infiltrations for pain control in rotator cuff tendinopathy: systematic review and meta-analysis. Acta Reumatol Port 2021; 46:156-170. [PMID: 34243180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The aim of our study was to assess the efficacy of hypertonic dextrose infiltrations for pain control in individuals with rotator cuff tendinopathy and to assess the characteristics of the treatment and the presence of side effects or adverse reactions through a systematic review and meta-analysis. METHODS The search for the articles was performed in the electronic databases PUBMED, EMBASE, SCOPUS, SCIELO, DIALNET and Google Scholar, published up to August 2020. The keywords used were "prolotherapy" or "proliferation therapy" or "hypertonic dextrose infiltrations" or "hypertonic dextrose injection" and "Rotator Cuff" or "Rotator Cuff Injury" or "Rotator Cuff Tear" or "Rotator Cuff Tendinosis" or "supraspinatus". The effectiveness of hypertonic dextrose infiltrations was expressed as standardized mean difference (d) and 95% CI. RESULTS In the pooled analysis, hypertonic dextrose infiltrations were an effective intervention to reduce long-term pain in patients with rotator cuff tendinopathy when compared to controls; furthermore, in the individual analyses, hypertonic dextrose infiltrations were more effective in the short, medium and long terms than non-invasive treatments, and more effective in the long-term than infiltrations with local anesthetics. On the other hand, hypertonic dextrose infiltrations were not more effective than injections with corticosteroids or PRP. Finally, no complications or serious adverse effect were observed when hypertonic dextrose infiltrations were used. CONCLUSIONS We found that hypertonic dextrose infiltrations reduced pain in individuals with rotator cuff in the long-term. Hypertonic dextrose infiltrations could be an alternative to non-invasive treatments when no favorable results can be achieve. However, due to the small number of studies included in this meta-analysis, new studies are necessary to clarify the efficacy and safety of this intervention.
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Affiliation(s)
- Pedro Iván Arias-Vázquez
- División Académica Multidisciplinaria de Comalcalco, Comalcalco, Tabasco, México. Universidad Juárez Autónoma de Tabasco
| | - Carlos Alfonso Tovilla-Zárate
- División Académica Multidisciplinaria de Comalcalco, Comalcalco, Tabasco, México. Universidad Juárez Autónoma de Tabasco
| | - Karla González-Graniel
- División Académica Multidisciplinaria de Comalcalco, Comalcalco, Tabasco, México. Universidad Juárez Autónoma de Tabasco
| | | | - Thelma Beatriz González-Castro
- Universidad Juárez Autónoma de Tabasco, División Académica de Ciencias de la Salud, Villahermosa, Tabasco, México. División Académica Multidisciplinaria de Jalpa de Méndez, Jalpa de Méndez, Tabasco, México
| | | | - Rosa Giannina Castillo-Avila
- División Académica de Ciencias de la Salud, Villahermosa, Tabasco, México. Universidad Juárez Autónoma de Tabasco
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Rabago D, Ralston B, Zaharoff A. Prolotherapy: An Evidence-Based Adjunctive Therapy for Knee Osteoarthritis. Am Fam Physician 2021; 103:395. [PMID: 33788526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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Apaydin H, Bazancir Z, Altay Z. Injection Therapy in Patients with Lateral Epicondylalgia: Hyaluronic Acid or Dextrose Prolotherapy? A Single-Blind, Randomized Clinical Trial. J Altern Complement Med 2020; 26:1169-1175. [PMID: 32931308 DOI: 10.1089/acm.2020.0188] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective: To compare the effects of hyaluronic acid (HA) and dextrose prolotherapy (DPT) injections in patients with chronic lateral epicondylalgia (LE). Materials and Methods: Thirty-two patients with at least 6 months of signs and symptoms of LE were randomly allocated into two groups: an HA group (n = 16) and a DPT group (n = 16). HA injection was performed as a single dose of 30 mg/2 mL 1500 kDa high-molecular-weight preparation (baseline). DPT injection was administered with 15% dextrose solution in three doses (baseline, third week, and sixth week). Severity of pain using the visual analog scale score, grip strength with a hand dynamometer, and physical function as determined by the Quick-Disabilities of the Arm, Shoulder, and Hand (Q-DASH) score were determined. Results: DPT was favored over HA for improvements from 0 to 12 weeks for pain with activity (4.81 ± 1.2 vs. 3.18 ± 2.3; p = 0.04), pain at night (5.1 ± 1.9 vs. 4.1 ± 2.2; p = 0.03), and pain at rest (3.8 ± 2.09 vs. 2.7 ± 1.7; p = 0.04). Q-DASH scores improved significantly more from 0 to 12 weeks in the DPT group (43.5 ± 17.6 vs. 28.4 ± 13.4; p = 0.04). No between-group improvement was observed for grip pain (7.3 ± 6.4 vs. 4.8 ± 3.2; p = 0.38). Conclusions: HA and DPT injections were both effective in reducing pain and increasing grip strength and function in patients with chronic LE. DPT injection was more effective in the short term than HA injection, in terms of pain relief and functional outcome. The study was registered at ClinicalTrials.gov under the identifier number NCT04395417.
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Affiliation(s)
- Hakan Apaydin
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Zilan Bazancir
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Zühal Altay
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Inonu University, Malatya, Turkey
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Seenauth C, Inouye V, Langland JO. Dextrose Prolotherapy for Chronic Shoulder Pain: A Case Report. Altern Ther Health Med 2018; 24:56-60. [PMID: 29101774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Context • Shoulder pain is one of the most common pain complaints reported by patients. Consensus is lacking on its ideal treatment, and many different treatments are available and used. Prolotherapy is an injection-based therapy that has shown significant results in treating many common musculoskeletal pain conditions, including osteoarthritis, lateral epicondylosis, and low-back pain. Objective • The study intended to evaluate the use of dextrose prolotherapy in the treatment of shoulder pain. Design • The research team performed a case study. Setting • The study occurred at the Medical Center at Southwest College of Naturopathic Medicine (Tempe, AZ, USA). Participant • The participant was a middle-aged male with a long-term history of untreated shoulder pain. Intervention • Injections were placed in the patient's glenohumeral joint space, the acromioclavicular joint, the subacromial space, and the insertion of the supraspinatus. Each location was injected with a solution of 50% dextrose diluted with 1% lidocaine, 0.25% bupivacaine, and 1 mg methylcobalamin. The final concentration of dextrose in the solution was approximately 22.8%. Outcome Measures • The patient completed questionnaires (numerical rating scale, verbally reported at the beginning of each visit) indicating his level of pain on a scale of 0 to 10, with 0 = no pain and 10 = worst pain. Results • Following 3 sessions of prolotherapy, the patient reported a 90% reduction in pain and full restoration of normal activity. Conclusions • The findings suggest that dextrose prolotherapy may be an effective treatment for chronic shoulder pain and may be an alternative to surgery or other more costly and invasive interventions.
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Potter BK. CORR Insights ®: Prolotherapy Induces an Inflammatory Response in Human Tenocytes In Vitro. Clin Orthop Relat Res 2017; 475:2128-2129. [PMID: 28597118 PMCID: PMC5498400 DOI: 10.1007/s11999-017-5407-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 06/05/2017] [Indexed: 01/31/2023]
Affiliation(s)
- Benjamin K Potter
- Orthopaedic Surgery, Uniformed Services University-Walter Reed Department of Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Building 19; 2nd Floor - Orthopaedics, Bethesda, MD, 20889, USA.
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