What is better for rotator cuff tendinopathy: dextrose prolotherapy, platelet-rich plasma, or corticosteroid injections?
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(2020) 47:40
Egyptian Rheumatology and Rehabilitation
RESEARCH
Open Access
What is better for rotator cuff tendinopathy: dextrose prolotherapy, platelet-rich plasma, or corticosteroid injections? A randomized controlled study Hala M. Abd Elsabour Sabaah1*
and Mary A. Nassif2
Abstract Background: Rotator cuff tendinopathy (RCT) is a leading cause of shoulder pain and disability. Management is mainly conservative, but the limited ability of tendons to regenerate is the main cause of unsatisfactory results. So, we conducted our study to compare the efficacy of deep prolotherapy (glucose 25%), platelet-rich plasma (PRP), and betamethasone corticosteroid for treatment of RCT to find the most effective one based on clinical, functional, and radiological assessment. Results: Regarding visual analog scale (VAS), it was significantly (p < 0.001) improved after injection among group 1 (prolotherapy group) and group 3 (steroid group) patients, while no significant improvement was noted among group 2 (PRP group) (p = 0.212) patients. The Western Ontario Rotator Cuff (WORC) Index significantly improved among the studied groups (p < 0.001, p = 0.049, and p < 0.001, respectively) after injection. Regarding the range of motion (ROM), a significant improvement (p = 0.029) was achieved in group 1 after injection but no significant improvements were noted among group 2 and 3 patients (p = 0.529 and 0.121, respectively). There was a significant improvement among group 1 and 2 patients (p < 0.001 and p = 0.020, respectively) regarding the grade of tendon lesions but no improvement occurred among group 3 patients (p = 0.470). Conclusion: Prolotherapy injections improve shoulder ROM, VAS, WORC index, and rotator cuff tendon healing while PRP injections improve WORC index and tendon healing but steroid injection has no effect on healing. Trial registration: PACTR202005610509496. Retrospective registration on May 25, 2020, Pan African Clinical Trial Registry. Keywords: Rotator cuff tendinopathy, Prolotherapy, Platelet-rich plasma, Corticosteroids
Background Rotator cuff tendinopathy (RCT) or rotator cuff disease (RCD) is a leading cause of shoulder pain and a significant source of disability and loss of work. It is a common disorder, and its prevalence increases with age and with occupations involving overhead activities [1]. * Correspondence: [email protected] 1 Physical medicine, Rheumatology and Rehabilitation Department, Ain Shams University, 56 Ramsis St., Abbasseya, Cairo 1-1566, Egypt Full list of author information is available at the end of the article
Sometimes, tendon healing is unsatisfactory with the resultant tendinosis which progresses to partial tear then full-thickness tear. Histopathological study of chronic tendinopathy showed a disturbance in collagen fibers with increased vessel number and leukocyte count denoting inflammatory reaction in chronic tendinopathy [2]. RCT can be diagnosed by musculoskeletal ultrasound (MSUS) as it is rapid, inexpensive, non-invasive, has virtually no side effects and allows the
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