Background/Purpose: Recent treatments for subacromial impingement syndrome (SIS) are palliative. Dextrose injection which is called prolotherapy has emerged as a treatment option for chronic situations such as tendinitis and bursitis. The aim of the study is to investigate the effects of dextrose injection in patients with chronic shoulder pain caused by subacromial impingement syndrome.

Methods: In this single-center, randomized placebo controlled, single blind, prospective study, 80 patients with chronic SIS who met the study criteria received two dextrose injections in the affected shoulder at two weeks intervals. The patients were randomly assigned into two therapy groups, either dextrose or other control (lidocaine) groups. The injections were repeated two times with two weeks between injections. Clinical assessments included measurement of range of motion (ROM), pain assessment via Visual Analog Scale (VAS), shoulder functions and daily living activities through University of California (UCLA) shoulder rating scale, the Constant-Murley shoulder outcome score and The Quick Disabilities Arm, Shoulder and Hand (q-DASH) questionnaire were performed at the pre-injection visit, and at the 1-, 3- and 6- month follow-up visits. Magnetic resonance imaging (MRI) evaluation was conducted before the first injection and compared with MRI’s taken again on the third month following the second injection.

Results: There were no adverse events reported. The study demonstrated significant improvements  in VAS, UCLA, Constant and q-DASH scores in both injection groups. However, there was no significant difference between the two groups in terms of all these clinical scales. Shoulder flexion, abduction, internal and external rotations showed significant improvements in both groups in the first 3 months in accordance to other findings. Nevertheless, while the range of shoulder flexion did not improve in the control group during the last three months, this range of motion continued to improve significantly in treatment group over the same period.

Conclusion: Long-lasting improvements in ROM compared with the lidocaine injection demonstrated could potentially be used to inspire larger, blinded, and randomized clinical trials to determine the most efficient dextrose concentration, the optimal dosage interval, detailed findings on the MRIs and compare  with other treatment techniques for the treatment of chronic SIS.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-effects-of-prolotherapy-in-patients-with-subacromial-impingement-syndrome/