Effect of Hypertonic Dextrose Injection on Pain and Shoulder Disability in Patients with Chronic Supraspinatus Tendinosis: A Randomized Double-Blind Controlled Study |
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| Institution: | 1. From the Department of Orthopedic Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan;2. Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan;3. Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan;4. Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan;1. Central Virginia Veterans Affairs Health Care System, Richmond, VA;2. Department of Psychology, Virginia Commonwealth University, Richmond, VA;3. Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA;4. Sheltering Arms Institute, Richmond, VA;5. Virginia Commonwealth University Health System, Richmond, VA;6. Department of Psychiatry, MA General Hospital, Boston, MA;7. Department of Psychiatry, Harvard Medical School, Boston, MA;8. Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, TX;9. Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN;10. Rehabilitation Hospital of Indiana, Indianapolis, IN;11. Department of Rehabilitation Counseling, Virginia Commonwealth University, Richmond, VA;12. Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, AL;13. Mayo Clinic College of Medicine and Science, Rochester, MN;14. Department of Rehabilitation Medicine, University of Washington, Seattle, WA;15. Moss Rehabilitation Research Institute, Elkins Park, PA;p. Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA;q. Massachusetts General Hospital, Boston, MA;r. Brigham and Women''s Hospital, Boston, MA;s. Harvard Medical School, Boston, MA;t. Department of Physical Medicine and Rehabilitation, Center for Neuroscience, Safar Center for Resuscitation Research, Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA;u. Department of Neuroscience, Center for Neuroscience, Safar Center for Resuscitation Research, Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA;1. From the Brain injury Rehabilitation Service, Westmead Hospital, Wentworthville;2. The University of Sydney School of Medicine, Sydney;3. Discipline of Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, the University of Sydney, Sydney;4. Research and Education Network, Westmead Hospital, Wentworthville;5. NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia;1. Health Services and Systems Research, Duke-NUS Medical School, Singapore;2. Department of Medicine (General Internal Medicine), Duke University Medical Center, Durham, NC;3. Department of Internal Medicine, Singapore General Hospital, Singapore;4. Department of Rehabilitation Medicine, Changi General Hospital, Singapore;5. Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore;6. Department of Neurology, Singapore General Hospital campus, National Neuroscience Institute, Singapore;7. Department of Statistics and Applied Probability, National University of Singapore, Singapore;8. Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina;1. The Center for Health Assessment Research and Translation, University of Delaware, Newark, Delaware;2. Department of Physical Therapy, University of Delaware, Newark, Delaware;3. Department of Psychological and Brain Sciences, University of Delaware, Newark, Delaware;4. Shirley Ryan AbilityLab, Chicago, Illinois;5. Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois;6. Craig Hospital, Englewood, Colorado;7. Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan;8. Mary Free Bed Rehabilitation Hospital, Grand Rapids, Michigan;9. Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine, Grand Rapids, Michigan;10. Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida;11. Kessler Foundation, East Hanover, New Jersey;12. Rutgers-New Jersey Medical School, Newark, New Jersey;13. Boston University School of Public Health, Boston, Massachusetts;1. Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul;2. Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea;1. Center for Health Assessment Research and Translation, College of Health Sciences, University of Delaware, Newark, DE;2. Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, MA;3. Departments of Physical Therapy and Psychological & Brain Sciences, University of Delaware, Newark, DE |
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| Abstract: | ObjectivesTo 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.DesignRandomized double-blind placebo-controlled trial.SettingOutpatient clinic.ParticipantsIndividuals (N=57) with symptomatic chronic supraspinatus tendinosis.InterventionsParticipants were randomly administered ultrasound-guided injections of 20% hypertonic dextrose (study group, n=29) or 5% normal saline (control group, n=28).Main Outcome MeasuresThe 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.ResultsThe 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.ConclusionHypertonic 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. |
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| Keywords: | Prolotherapy |
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