Effect of Hypertonic Dextrose Injection on Pain and Shoulder Disability in Patients with Chronic Supraspinatus Tendinosis: A Randomized Double-Blind Controlled Study.

Abstract

OBJECTIVES\nTo investigate the effect of hypertonic dextrose injection on pain and disability in patients with chronic supraspinatus tendinosis. Our secondary aim was to evaluate its effect on the tendon range of motion (ROM) and morphology.\n\n\nDESIGN\nRandomized double-blind placebo-controlled trial SETTING: Outpatient clinic PARTICIPANTS: Individuals (N\u202f=\u202f57) with symptomatic chronic supraspinatus tendinosis INTERVENTIONS: Participants were randomly administered ultrasound-guided injections of 20% hypertonic dextrose (n\u202f=\u202f29, study group) or 5% normal saline (n\u202f=\u202f28, control group).\n\n\nMAIN OUTCOME MEASURES\nThe 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.\n\n\nRESULTS\nThe study group exhibited significant improvements (mean difference [MD]; 95%CI) in the VAS (MD -2.1, 95%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 to 22.5, P < .001) and 6 (MD 8.9, 95%CI 2.4 to 15.4, P\u202f=\u202f.003) compared with baseline. The thickness of the supraspinatus tendon improved at Weeks 6 (MD .50, 95%CI .26 to .74, P < .001) and 12 (MD .61, 95%CI .37 to .84, P < .001) compared with baseline. The ratio of histograms also improved at Weeks 6 (MD .19, 95%CI .06 to .32, P\u202f=\u202f.002) and 12 (MD .26, 95%CI .10 to .41, P < .001) compared with baseline.\n\n\nCONCLUSION\nHypertonic 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.