Ross Hauser, MD; Danielle Matias, PA-C; Demi Foster, APRN

Prolotherapy is an in-office injection treatment that research and medical studies have shown to be an effective, trustworthy, reliable alternative to surgical and non-effective conservative care treatments. In our opinion, based on extensive research and clinical results, Prolotherapy is superior to many other treatments in relieving the problems of chronic joint and spine pain and, most importantly, in getting people back to a happy and active lifestyle. For extensive medical citations and research please see our comprehensive Prolotherapy information page.

In our more than 31 years of experience in helping people post-surgery, we have seen many rotator cuff failures. To be fair, failures can be described in many different ways. Most commonly, failure is seen when the shoulder was worse off after the surgery or the surgery did not achieve all the patient’s goals but still provided some pain relief and some function. We have seen many patients respond positively.

Prolotherapy research

In February 2019, (1) Sports specialist and orthopedic surgeons in Turkey published their findings on the effectiveness of Prolotherapy in helping the patient with failed rotator cuff repair surgery. This research was published in the Turkish Journal of Physical Medicine and Rehabilitation.

• A total of 15 patients (5 males, 10 females; average age 50; youngest patient 33, oldest patient 71 years old) with failed rotator cuff repair surgery who had at least six months of complaints and were did not respond to at least three months of conservative methods were included.
• Ultrasound-guided Prolotherapy injections were performed and the patients were instructed to carry out a home-based exercise program. Clinical assessment of shoulder function was performed using a visual analog scale (VAS) for pain, Shoulder Pain and Disability Index (SPADI), Western Ontario Rotator Cuff (WORC) Index, patient satisfaction, and shoulder range of motion. All patients were examined at baseline, at Week 3, 6, and 12, and at the final follow-up visit.

The intra-group comparison showed that the patients achieved significant improvements at all time points, compared to baseline as measured by VAS, SPADI, WORC index, and shoulder range of motion. Twelve patients (80%) reported excellent or good outcomes.

CONCLUSION: “Our study results show that prolotherapy is effective in the treatment of patients with failed rotator cuff repair surgery with significant improvements in the shoulder functions and pain relief.”

These results are in general agreement with what we have seen in our clinic.

Prolotherapy injections for rotator cuff tears and rotator cuff tendinopathy

PRP maybe helpful in preventing re-tear rates

Dr. Eric Hoffman, MBBS, FRCS, PhD, MD wrote an editorial in the journal Arthroscopy (2) where he outlines the problems of offering definitive evidence that PRP can make shoulder surgeries more successful. “Studies investigating the effect of PRP on shoulder rotator cuff healing, clinical outcomes, and retear rates suggest that PRP has no effect on outcome and healing but potentially reduces re-tear rates. However, study quality is compromised by low samples sizes, inadequate randomization protocols, and heterogeneity. . . PRP preparation varies among studies, and a variety of patient factors such as smoking; comorbidity; rotator cuff tear size, configuration, and grade; and functional demands are difficult to control even if a randomized study protocol is undertaken. Until there are reliable and valid data available, the use of PRP in rotator cuff repair is not strongly supported and is at the discretion of the treating surgeon. The current evidence shows the superiority of PRP over hyaluronic acid and corticosteroids, and there is promise that PRP could be a useful adjunct promoting rotator cuff healing following surgical repair.”

The problem of post-surgical nerve pain

In this video, Danielle R. Steilen-Matias, MMS, PA-C discusses treating a patient with nerve pain following shoulder surgery.

Video blurbs:

• It is not uncommon for us to see patients after shoulder surgery who continue to have shoulder instability issues and 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.

Caring Medical Research

Ross Hauser, MD discusses the Prolotherapy treatment results that were published a few years ago on part of our article series on the use of Hackett-Hemwall dextrose Prolotherapy, as well as shows a treatment demonstration from a Prolotherapy symposium he taught in 2021

We have seen many people with many problems following their rotator cuff surgeries. If you have questions about your Rotator Cuff problems You can get help and information from our Caring Medical staff.

More reading

Failed rotator cuff surgery – There are many people who have had very successful rotator cuff repair surgeries. These are typically not the people that we see in our office. We see the people after surgery who have been diagnosed or classified as a “failed rotator cuff surgery patient.” In this article, we will explore non-surgical options for the problems of continued pain and loss of function following rotator cuff surgery.

Read our published research

Evidence-Based Use of Dextrose Prolotherapy for Musculoskeletal Pain: A Scientific Literature Review: This paper has been cited by 45 research studies as we were able to demonstrate level 1 and 2 evidence to support the use of dextrose Prolotherapy for osteoarthritic pain and function, tendinopathies, myofascial pain syndrome, sacroiliac pain, and myofascial pain syndrome. There is level 3 evidence in support of the use of dextrose Prolotherapy for diffuse muscusloskeletal pain involving the spine, pelvis and peripheral joints. Dextrose Prolotherapy should be recommended for such musculoskeletal conditions as tendinopathy, ligament sprains, Osgood-Schlatter disease and degenerative joint disease, including osteoarthritis.

References

1 Akpancar S, Örsçelik A, Seven MM, Koca K. The effectiveness of prolotherapy on failed rotator cuff repair surgery. Turkish Journal of Physical Medicine and Rehabilitation. 2019 Jun;65(4):394. [Google Scholar]
2 Hohmann E. Editorial Commentary: Platelet-Rich Plasma Reduces Retear Rates Following Rotator Cuff Repair but Does Not Improve Clinical Outcomes. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2022 Aug 1;38(8):2389-90. [Google Scholar]