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Titre : | Dextrose Prolotherapy Versus Control Injections in Painful Rotator Cuff Tendinopathy (2016) |
Auteurs : | Hélène Bertrand ; Kenneth Dean Reeves ; Cameron J. Bennett |
Type de document : | Article |
Dans : | Archives of Physical Medicine and Rehabilitation (2016/1, 2016) |
Article en page(s) : | pp. 17-25 |
Langues: | Anglais |
Descripteurs : |
HE Vinci Epaule ; Glucose ; Médecine régénérative ; Rééducation et réadaptation |
Mots-clés: | Regenerative medicine ; Rotator cuff ; Coiffe des rotateurs ; Shoulder ; Tendinopathy ; Tendinopathie |
Résumé : |
Objective To compare the effect of dextrose prolotherapy on pain levels and degenerative changes in painful rotator cuff tendinopathy against 2 potentially active control injection procedures. Design Randomized controlled trial, blinded to participants and evaluators. Setting Outpatient pain medicine practice. Participants Persons (N=73) with chronic shoulder pain, examination findings of rotator cuff tendinopathy, and ultrasound-confirmed supraspinatus tendinosis/tear. Interventions Three monthly injections either (1) onto painful entheses with dextrose (Enthesis-Dextrose), (2) onto entheses with saline (Enthesis-Saline), or (3) above entheses with saline (Superficial-Saline). All solutions included 0.1% lidocaine. All participants received concurrent programmed physical therapy. Main Outcome Measures Primary: participants achieving an improvement in maximal current shoulder pain ≥2.8 (twice the minimal clinically important difference for visual analog scale pain) or not. Secondary: improvement in the Ultrasound Shoulder Pathology Rating Scale (USPRS) and a 0-to-10 satisfaction score (10, completely satisfied). Results The 73 participants had moderate to severe shoulder pain (7.0+2.0) for 7.6+9.6 years. There were no baseline differences between groups. Blinding was effective. At 9-month follow-up, 59% of Enthesis-Dextrose participants maintained ≥2.8 improvement in pain compared with Enthesis-Saline (37%; P=.088) and Superficial-Saline (27%; P=.017). Enthesis-Dextrose participants' satisfaction was 6.7+3.2 compared with Enthesis-Saline (4.7+4.1; P=.079) and Superficial-Saline (3.9+3.1; P=.003). USPRS findings were not different between groups (P=.734). Conclusions In participants with painful rotator cuff tendinopathy who receive physical therapy, injection of hypertonic dextrose on painful entheses 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. These differences could not be attributed to a regenerative effect. Dextrose prolotherapy may improve on the standard care of painful rotator cuff tendinopathy for certain patients. |
Disponible en ligne : | Oui |
En ligne : | https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/science/article/pii/S0003999315010916 |