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Dextrose Prolotherapy

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Other Names

  • Prolotherapy
  • Dextrose Prolotherapy (DPT)

Background

  • This page refers to dextrose prolotherapy (DPT)
    • Defined as a regenerative therapy which uses an injectant to promote regeneration of tissue
    • Typically involves dextrose, but can also include Sodium morrhuate (5%) or DPG (dextrose, phenol, glycerin)
    • Dextrose concentrations range from 10-50%, however 25% seems to be the most commonly used
  • Physiology
    • Not entirely clear
    • Injection initiates a local inflammatory response, leading to a healing cascade
    • Release of growth factors, proliferation of fibroblasts, deposition of collagen
    • Strengthening joint, reducing pain

Indications

Upper Extremity

Subacromial Impingement

Rotator Cuff Tendinopathy

  • DPT vs Exercise Therapy
    • Both groups had significant improvement in VAS scores, range of motion; DPT group had more patient reported good or excellent outcomes[1]
  • DPT vs Saline
    • Superior outcomes compared to blinded injections over painful entheses[2]

Lateral Epicondylitis

  • Dextrose Prolotherapy vs Normal Saline
    • Compared to controls, DPT subjects reported improved pain scores and strength testing at 16 weeks[3]

Finger Osteoarthritis

  • DPT vs anesthetic only
    • Pain and grip strength trended towards benefit, improvement in finger range of motion[4]

First Carpometacarpal Arthritis

  • DPT vs Corticosteroid Injection
    • Similar short term results, DPT more effective at 6 months[5]

Axial

Chronic Low Back Pain

  • DPT vs Normal Saline
    • No differences between the groups[6]

Sacroiliac Joint Pain

Lower Extremity

Patellar Tendinopathy

Knee Osteoarthritis

  • Dextrose Prolotherapy vs Normal Saline
    • Study group found DPT superior to normal saline for pain, function, quality of life [7]
    • Compared DPT, saline injections and home exercises. DPT was superior to normal saline, home exercises for pain, function and stiffness[8]
    • Compared DPT to lidocaine injections. Improved pain and symptoms, radiographic measurements and ACL laxity[9]
  • Intra-articular (IA) vs Peri-articular (PA) Dextrose Prolotherapy
    • Compared IA and PA prolotherapy. Both groups demonstrated improvement in VAS, OKS, WOMAC, no difference between groups[10]
    • Compared IA and PA prolotherapy. Similar outcomes between groups, slightly better outcomes in PA group[11]
    • Compared IA to IA+PA DPT. Combined group had better improvements in clinical assessment, VAS, WOMAC[12]
  • Dextrose Prolotherapy vs Platelet Rich Plasma (PRP)
    • Compared DPT to PRP. Improvements at 8 weeks and 6 months greater in PRP group.[13]
    • Compared DPT to PRP with no statistically significant improvement in either group[14]
    • Compared DPT to PRP, Autologous Conditioned Serum (ACS), patients did better with ACS compared to DPT or PRP[15][16]
  • Dextrose Prolotherapy vs Hyaluronic Acid, Botulinum Toxin, Physical Therapy
    • DPT and botulinum toxin had greatest benefit in stiffnes, pain, daily function, sports function, quality of life[17]
  • Dextrose Prolotherapy vs Intra-articular Ozone
    • Both groups had significant improvement in WOMAC at 3 months, no difference between groups[18]
  • Dextrose Prolotherapy vs IA Erythropoetin, IA radiofrequency ablation
    • Similar benefit in all three groups, no difference in outcomes[19]

Achilles Tendonitis

Plantar Fasciitis

Contraindications

  • Avoid in acute, inflammatory conditions including
    • Arthritis flare
    • Bursitis
    • Tendinitis
    • Gout
    • Tendon or ligament rupture
    • Rheumatoid arthritis
  • Also recommend avoiding in
  • Side effects are mostly localized[23]
    • Swelling and soreness at site of injection (24-48 hours)
    • Bruising
    • Headaches
    • Allergic reaction
    • Transient numbness
    • Rarely, infection

Procedure

Equipment

Preparation

Anatomy

Technique

Aftercare

Complications

See Also

External

References

  1. ↑ Seven MM, Ersen O, Akpancar S, Ozkan H, Turkkan S, Yıldız Y, et al. Effectiveness of prolotherapy in the treatment of chronic rotator cuff lesions. Orthop Traumatol Surg Res. 2017; 103:427–33.
  2. ↑ Bertrand H, Reeves KD, Bennett CJ, Bicknell S, Cheng AL. Dextrose prolotherapy versus control injections in painful rotator cuff tendinopathy. Arch Phys Med Rehabil. 2016; 97:17–25.
  3. ↑ Scarpone M, Rabago DP, Zgierska A, Arbogast G, Snell E. The efficacy of prolotherapy for lateral epicondylosis: a pilot study. Clin J Sport Med. 2008; 18:248–54.
  4. ↑ Reeves KD, Hassanein K. Randomized, prospective, placebo-controlled double-blind study of dextrose prolotherapy for osteoarthritic thumb and finger (DIP, PIP, and trapeziometacarpal) joints: evidence of clinical efficacy. J Altern Complement Med. 2000; 6:311–20.
  5. ↑ Jahangiri A, Moghaddam FR, Najafi S. Hypertonic dextrose versus corticosteroid local injection for the treatment of osteoarthritis in the first carpometacarpal joint: a double-blind randomized clinical trial. J Orthop Sci. 2014; 19:737–43.
  6. ↑ Yelland MJ, Glasziou PP, Bogduk N, Schluter PJ, McKernon M. Prolotherapy injections, saline injections, and exercises for chronic low-back pain: a randomized trial. Spine (Phila Pa 1976). 2004; 29:9–16.
  7. ↑ Sit RWS, Wu RWK, Rabago D, et al. Efficacy of intra-articular hypertonic dextrose (Prolotherapy) for knee osteoarthritis: A randomized controlled trial. Ann Fam Med. 2020;18(3):235-242. doi:10.1370/afm.2520
  8. ↑ Rabago D, Patterson JJ, Mundt M, et al. Dextrose prolotherapy for knee osteoarthritis: a randomized controlled trial. Ann Fam Med. 2013;11(3):229-237. doi:10.1370/afm.1504
  9. ↑ Reeves KD, Hassanein K. Study of Dextrose Prolotherapy for Knee Osteoarthritis Randomized Prospective Double-Blind Placebo-Controlled Study of Dextrose Prolotherapy for Knee Osteoarthritis with or without ACL Laxity. Vol 6.; 2000.
  10. ↑ Farpour HR, Fereydooni F. Comparative effectiveness of intra-articular prolotherapy versus peri-articular prolotherapy on pain reduction and improving function in patients with knee osteoarthritis: A randomized clinical trial. Electron Physician. 2017;9(11):5663-5669. doi:10.19082/5663
  11. ↑ Rezasoltani Z, Taheri M, Mofrad MK, Mohajerani SA. Periarticular dextrose prolotherapy instead of intra-articular injection for pain and functional improvement in knee osteoarthritis. J Pain Res. 2017;10:1179-1187. doi:10.2147/JPR.S127633
  12. ↑ Soliman DMI, Sherif N, Omar O, El Zohiery A. Healing effects of prolotherapy in treatment of knee osteoarthritis healing effects of prolotherapy in treatment of knee osteoarthritis. Egypt Rheumatol Rehabil. 2016;43(2):47. doi:10.4103/1110-161x.181858
  13. ↑ Rahimzadeh P, Imani F, Faiz SHR, Entezary SR, Zamanabadi MN, Alebouyeh MR. The effects of injecting intra-articular platelet-rich plasma or prolotherapy on pain score and function in knee osteoarthritis. Clin Interv Aging. 2018;13:73-79. doi:10.2147/CIA.S147757
  14. ↑ EROĞLU, Ali, Aylin Sari, and Bekir DURMUŞ. "Platelet-Rich Plasma vs Prolotherapy in the Management Of Knee Osteoarthritis: Randomized Placebo-Controlled Trial." Spor Hekimligi Dergisi/Turkish Journal of Sports Medicine 51.2 (2016).
  15. ↑ Pishgahi A, Abolhasan R, Shakouri SK, et al. Effect of dextrose prolotherapy, platelet rich plasma and autologous conditioned serum on knee osteoarthritis: A randomized clinical trial. Iran J Allergy, Asthma Immunol. 2020;19(3):243-252. doi:10.18502/ijaai.v19i3.3452
  16. ↑ Pishgahi, Alireza, et al. “Effect of dextrose prolotherapy, platelet rich plasma and autologous conditioned serum on knee osteoarthritis: a randomized clinical trial.” Iranian Journal of Allergy, Asthma and Immunology (2020): 243-252.
  17. ↑ Rezasoltani Z, Azizi S, Najafi S, Sanati E, Dadarkhah A, Abdorrazaghi F. Physical therapy, intra-articular dextrose prolotherapy, botulinum neurotoxin, and hyaluronic acid for knee osteoarthritis: Randomized clinical trial. Int J Rehabil Res. 2020;43(3):219-227. doi:10.1097/MRR.0000000000000411
  18. ↑ Hashemi M, Jalili P, Mennati S, et al. The effects of prolotherapy with hypertonic dextrose versus prolozone (intraarticular ozone) in patients with knee osteoarthritis. Anesthesiol Pain Med. 2015;5(5):27585. doi:10.5812/aapm.27585
  19. ↑ Rahimzadeh P, Imani F, Faiz SHR, Entezary SR, Nasiri AA, Ziaeefard M. Investigation the efficacy of intra-articular prolotherapy with erythropoietin and dextrose and intra-articular pulsed radiofrequency on pain level reduction and range of motion improvement in primary osteoarthritis of knee. J Res Med Sci. 2014;19(8):696-702.
  20. ↑ Uğurlar M, Sönmez MM, Uğurlar ÖY, Adıyeke L, Yıldırım H, Eren OT. Effectiveness of four different treatment modalities in the treatment of chronic plantar fasciitis during a 36-month follow-up period: a randomized controlled trial. J Foot Ankle Surg. 2018; 57:913–8.
  21. ↑ Ersen Ö, Koca K, Akpancar S, Seven MM, Akyıldız F, Yıldız Y, et al. A randomized-controlled trial of prolotherapy injections in the treatment of plantar fasciitis. Turk J Phys Med Rehabil. 2017; 64:59–65.
  22. ↑ Kim E, Lee JH. Autologous platelet-rich plasma versus dextrose prolotherapy for the treatment of chronic recalcitrant plantar fasciitis. PM R. 2014; 6:152–8.
  23. ↑ Alderman D. Prolotherapy For Musculoskeletal Pain. Pract Pain Manag. 2007;(February):10-15.
Created by:
John Kiel on 5 September 2022 16:17:51
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Last edited:
26 January 2023 09:10:26
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