Comparison of Clinical and Ultrasound Imaging Outcomes Between Corticosteroid and Hypertonic Dextrose Injections for Chronic Supraspinatus Tendinopathy

Che-Li Lin; Ming-Ta Yang; Yu-Hao Lee; Yi-Wen Chen; Timporn Vitoonpong; Shih-Wei Huang

doi:10.1177/23259671221129603

Comparison of Clinical and Ultrasound Imaging Outcomes Between Corticosteroid and Hypertonic Dextrose Injections for Chronic Supraspinatus Tendinopathy

Orthop J Sports Med. 2022 Nov 15;10(11):23259671221129603. doi: 10.1177/23259671221129603. eCollection 2022 Nov.

Authors

Che-Li Lin^{1

2}, Ming-Ta Yang^{3

4}, Yu-Hao Lee^{5

6}, Yi-Wen Chen^{5

6}, Timporn Vitoonpong⁷, Shih-Wei Huang^{5

6}

Affiliations

¹ Department of Orthopedic Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City.
² Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei.
³ Center for General Education, Taipei Medical University, Taipei.
⁴ Clinical Research Center, Taipei Medical University Hospital, Taipei.
⁵ Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei.
⁶ Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei.
⁷ Rehabilitation Department, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.

Abstract

Background: Both corticosteroids and hypertonic dextrose injections are commonly used for chronic supraspinatus tendinopathy.

Purpose: To compare the supraspinatus echogenicity and clinical effects of echo-guided hypertonic dextrose versus corticosteroid injection for treating chronic supraspinatus tendinopathy.

Study design: Cohort study; Level of evidence, 3.

Methods: The authors performed a secondary data analysis of a previous clinical trial including patients who received normal saline versus hypertonic dextrose injection; patients who received corticosteroid injection were recruited between August 2017 and July 2021. Baseline patient data were matched among these 3 groups at a 1:1:1 ratio. At baseline and 2, 6, and 12 weeks after the intervention, the authors compared morphological changes (supraspinatus thickness and echogenicity) and clinical parameters (visual analog scale [VAS] for pain, Shoulder Pain and Disability Index [SPADI], and range of motion [ROM]). Analysis of variance was used to compare mean changes from baseline among the groups.

Results: A total of 75 patients (25 in each group) were included. At 2-week follow-up, both the dextrose and the steroid groups exhibited improvement in VAS scores (mean difference [MD] from baseline: -2.0 in dextrose group; -3.3 in steroid group (P < .001)), SPADI scores (MD from baseline: -10.6 in dextrose group; -24.6 in steroid group (P < .001)), and flexion ROM (MD from baseline: 13.6° in dextrose group; 21.1° in steroid group) (P =.001). At 6 weeks after injection, the hypertonic dextrose group exhibited more favorable echogenic improvement in supraspinatus tendon morphology compared with the other 2 groups (P < .001). However, the steroid group showed significantly more improvement in clinical parameters compared with the other 2 groups at both week 6 (MD from baseline: VAS, -3.2; SPADI, -26.6; flexion ROM, 21.5°) and week 12 (MD from baseline: VAS, -2.5; SPADI, -20.4; flexion ROM, 15.2°) (P < .001 for all).

Conclusion: Hypertonic dextrose injection improved supraspinatus echogenicity after 6 weeks but provided short-term symptomatic relief in the patients with chronic supraspinatus tendinopathy when compared with corticosteroid or saline injections. Steroid injection exerted a more favorable clinical effect at weeks 6 and 12 but demonstrated a negative effect on the supraspinatus.

Keywords: corticosteroid; morphology; prolotherapy; rotator cuff; supraspinatus; tendinopathy; tendinosis.