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Effect of Hypertonic Dextrose Injection on Pain and Shoulder Disability in Patients with Chronic Supraspinatus Tendinosis: A Randomized Double-Blind Controlled Study

  • Che-Li Lin
    Affiliations
    From the Department of Orthopedic Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan

    Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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  • Yi-Wen Chen
    Affiliations
    Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan

    Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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  • Chin-Wen Wu
    Affiliations
    Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan

    Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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  • Tsan-Hon Liou
    Affiliations
    Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan

    Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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  • Shih-Wei Huang
    Correspondence
    Corresponding author Shih-Wei Huang, MD, Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, 291 Jhongjheng Road, Jhonghe, New Taipei City 235, Taiwan.
    Affiliations
    Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan

    Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
    Search for articles by this author
Published:October 02, 2021DOI:https://doi.org/10.1016/j.apmr.2021.07.812

      Abstract

      Objectives

      To investigate the effect of hypertonic dextrose injection on pain and disability in patients with chronic supraspinatus tendinosis. The secondary aim was to evaluate its effect on the tendon range of motion (ROM) and morphology.

      Design

      Randomized double-blind placebo-controlled trial.

      Setting

      Outpatient clinic.

      Participants

      Individuals (N=57) with symptomatic chronic supraspinatus tendinosis.

      Interventions

      Participants were randomly administered ultrasound-guided injections of 20% hypertonic dextrose (study group, n=29) or 5% normal saline (control group, n=28).

      Main Outcome Measures

      The primary outcome measure was visual analog scale (VAS) scores for pain and Shoulder Pain and Disability Index (SPADI) scores. Secondary outcomes included the ROM and ultrasound examination findings of the supraspinatus tendon at baseline and at 2, 6, and 12 weeks postintervention.

      Results

      The study group exhibited significant improvements in the VAS (mean difference [MD], −2.1; 95% confidence interval [CI], −2.7 to −1.4; P<.001) and SPADI (MD, −11.6; 95% CI, −16.5 to −6.7; P<.001) scores compared with baseline scores at week 2. However, the effect was not sustained to week 6. Flexion ROM increased at weeks 2 (MD, 14.1; 95% CI, 5.7-22.5; P<.001) and 6 (MD, 8.9; 95% CI, 2.4-15.4; P=.003) compared with baseline. The thickness of the supraspinatus tendon improved at weeks 6 (MD, .50; 95% CI, .26-.74; P<.001) and 12 (MD, .61; 95% CI, .37-.84; P<.001) compared with baseline. The ratio of histograms also improved at weeks 6 (MD, .19; 95% CI, .06-.32; P=.002) and 12 (MD, .26; 95% CI, .10-.41; P<.001) compared with baseline.

      Conclusion

      Hypertonic dextrose injection could provide short-term pain and disability relief in patients with chronic supraspinatus tendinosis. Ultrasound imaging at week 6 revealed changed tendon morphology.

      Keywords

      List of abbreviations:

      AROM (active range of motion), DPT (dextrose prolotherapy), ER (external rotation), ICC (intraclass correlation coefficient), IR (internal rotation), MD (mean difference), ROI (region of interest), ROM (range of motion), SPADI (Shoulder Pain and Disability Index), TRPV1 (transient receptor potential vanilloid-1), VAS (visual analog scale)
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