94 Patients treated with Prolotherapy with the hopes of avoiding surgery

Here is a summary of our research: Hauser RA, Hauser MA. A Retrospective Study on Hackett-Hemwall Dextrose Prolotherapy for Chronic Shoulder Pain at an Outpatient Charity Clinic in Rural Illinois. Journal of Prolotherapy. 2009;1(4):205-216. The article in its entirety can be downloaded as a PDF

• We studied a sample of 94 patients with an average of 53 months of unresolved shoulder pain who were treated quarterly with Prolotherapy.
• An average of 20 months following their last Prolotherapy session, patients were contacted and asked numerous questions in regard to their levels of pain and a variety of physical and psychological symptoms, as well as activities of daily living, before and after their last Prolotherapy treatment.
• The results of this study showed that patients had a statistically significant decline in their level of pain, stiffness, and crunching sensations (crepitation), with Prolotherapy, including the 39% of patients who were told by their medical doctors that there were no other treatment options for their pain, and the twenty-one percent who were told that surgery was their only option.
• Over 82% of all patients experienced improvements in sleep, exercise ability, anxiety, depression, and overall disability with Prolotherapy. Ninety-seven percent of patients received pain relief with Prolotherapy.

Conclusion: In this study, patients with chronic shoulder pain reported significant improvements in many clinically relevant parameters and overall quality of life after receiving Hackett-Hemwall dextrose Prolotherapy.

In our research, published in Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders, (1) Ross Hauser, MD, and Danielle R. Steilen-Matias, MMS, PA-C  contributed to findings suggesting Dextrose Prolotherapy has been able to reduce pain and disability of traumatic and nontraumatic rotator cuff conditions.

• The research revealed that treatment of moderate to severe rotator cuff tendinopathy due to injury with injections of hypertonic dextrose on painful entheses (the ligament and tendon attachments to the bone) resulted in superior long-term pain improvement and patient satisfaction compared with blinded saline injection over painful entheses, with intermediate results for entheses injection with saline.

Other research

• A study published in the journal Archives of Physical Medicine and Rehabilitation found that treatment of moderate to severe rotator cuff tendinopathy with injections of hypertonic dextrose (Prolotherapy) on painful entheses (the tendon attachments to the bone) resulted in superior long-term pain improvement and patient satisfaction. (2)
• Another study, also published in the journal Archives of Physical Medicine and Rehabilitation, demonstrated that dextrose Prolotherapy improved pain, disability, isometric strength, and shoulder active range of motion in patients with refractory chronic non-traumatic rotator cuff disease. (3)
• In the journal, Alternative Therapies in Health and Medicine, (4) doctors presented a case study at the Medical Center at Southwest College of Naturopathic Medicine in Tempe. Here, a middle-aged male with a long-term history of untreated shoulder pain received injections into the glenohumeral joint space, the acromioclavicular joint, the subacromial space, and the insertion of the supraspinatus.
  • Results: Following 3 sessions of Prolotherapy, the patient reported a 90% reduction in pain and full restoration of normal activity. 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.
• A March 2019 study in the Journal of Ultrasound in Medicine (5) found that ultrasound-guided Prolotherapy with a 15% dextrose solution is an effective and safe therapeutic option for moderate-to-severe acromial enthesopathy and acromioclavicular joint arthropathy.

A November 2020 study in the Journal of Back and Musculoskeletal Rehabilitation (6) assessed the effectiveness of Prolotherapy in shoulder disorders. To do this, the researchers evaluated existing studies to see if they could form a consensus on how effective, or not effective, Prolotherapy can be.

Here are the summary learning points:

• “Wide variation exists regarding usage patterns of prolotherapy.”
  • Explanatory note: These variations included the number of injections given within a treatment (some of the studies these researchers assessed were a single-injection treatment. Similar to the way cortisone is given. In our 28 years of experience, we never offer a single shot of Prolotherapy as “the treatment.” It is not effective. Read more, you will see these researchers came to this conclusion as well.)
• “Interestingly, amongst the Prolotherapy studies evaluated in this review, the two in which significant pain relief was sustained long-term both utilized multiple injections, and the three with either non-significant or non-sustained pain relief used a single injection.”
  • Explanatory note: Multiple injections at treatment are superior to a single injection at treatment. This is what we have been saying for three decades.

The researchers suggested: “Prolotherapy (appears) to be a safe treatment option with perhaps greater efficacy for shoulder pathology when provided through a series of injections using higher concentrations of dextrose.”

In this video, Danielle R. Steilen-Matias, MMS, PA-C, discusses Prolotherapy for shoulder pain and arthritis and how we determine if someone is a good candidate!

It is not uncommon for us to see patients after shoulder surgery who continue to have shoulder instability issues. Other times, we will see patients after shoulder surgery who have continued pain. It may be the same pain that they had before surgery, or it may be a different type of pain. What we find in many of these people is that even though healing is occurring and the shoulder looks well, the pain they are having is related to the nerves that may have been impacted during the surgery. We treat these patients with Nerve-release injection therapy, or more commonly, hydrodissection.

Poor candidate for Prolotherapy

This x-ray shows an image of a patient that we would consider a poor candidate for Prolotherapy treatment. There is the loss of cartilage in the glenohumeral joint, and the patient has developed multiple bone spurs. These bone spurs significantly restricted his range of motion.

A patient who would be considered a fair candidate for Prolotherapy

In this X-ray, we see a patient with shoulder impingement and a moderately limited range of motion with abduction and external rotation. The X-ray image reveals a significant decrease in cartilage, which limited the patient’s shoulder and arm range of motion. This patient was considered a fair candidate for treatment, and realistic expectations of treatment outcomes should be discussed.

A patient who would be considered a good candidate for Prolotherapy

In this X-ray image, we see a patient who would be considered a good candidate for Prolotherapy. The overall architecture and integrity of the shoulder have been maintained in the joint. There is some loss of joint space. Because the overall shoulder structure has been maintained and the patient exhibited a full range of motion in his shoulder, this patient was considered a good candidate for Prolotherapy.

More articles

Shoulder pain injections | Comparing PRP, Cortisone and Prolotherapy

Published research papers from our doctors at Caring Medical on Shoulder Disorders

• Prolotherapy: A Non-Invasive Approach to Lesions of the Glenoid Labrum; A Non-Controlled Questionnaire Based Study
  • This paper was published in The Open Rehabilitation Journal.
  • Hauser RA, Dolan E, Orlofsky A. Prolotherapy: a non-invasive approach to lesions of the glenoid labrum; a non-controlled questionnaire-based study. The Open Rehabilitation Journal. 2013 Dec 27;6(1).[Google Scholar]
• A Retrospective Study on Hackett-Hemwall Dextrose Prolotherapy for Chronic Shoulder Pain at an Outpatient Charity Clinic in Rural Illinois
  • This paper was published in the Journal of Prolotherapy.
  • Hauser RA, Hauser MA. A retrospective study on Hackett-Hemwall dextrose Prolotherapy for chronic shoulder pain at an outpatient charity clinic in rural Illinois. J Prolotherapy. 2009;4:205-16. [Google Scholar]

References

1 Hauser RA, Lackner JB, Steilen-Matias D, Harris DK. A systematic review of dextrose prolotherapy for chronic musculoskeletal pain. Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders. 2016 Jan;9:CMAMD-S39160. [Google Scholar]
2 Bertrand H, Reeves KD, Bennett CJ, Bicknell S, Cheng AL. Dextrose prolotherapy versus control injections in painful rotator cuff tendinopathy. Archives of physical medicine and rehabilitation. 2016 Jan 31;97(1):17-25. [Google Scholar]
3 Lee DH, Kwack KS, Rah UW, Yoon SH. Prolotherapy for refractory rotator cuff disease: retrospective case-control study of 1-year follow-up. Archives of physical medicine and rehabilitation. 2015 Nov 1;96(11):2027-32. [Google Scholar]
4 Seenauth C, Inouye V, Langland JO. Dextrose Prolotherapy for Chronic Shoulder Pain: A Case Report. Alternative Therapies in Health & Medicine. 2017 Dec 1;23(7).  [Google Scholar]
5 Hsieh PC, Chiou HJ, Wang HK, Lai YC, Lin YH. Ultrasound‐Guided Prolotherapy for Acromial Enthesopathy and Acromioclavicular Joint Arthropathy: A Single‐Arm Prospective Study. Journal of Ultrasound in Medicine. 2018 Aug 31. [Google Scholar]
6 Robinson DM, Eng C, Makovitch S, Rothenberg JB, DeLuca S, Douglas S, Civitarese D, Borg-Stein J. Non-operative orthobiologic use for rotator cuff disorders and glenohumeral osteoarthritis: A systematic review. Journal of Back and Musculoskeletal Rehabilitation. 2020(Preprint):1-6. [Google Scholar]