Hypertonic Dextrose Prolotherapy Injection Improves Clinical Outcomes in Shoulder Impingement Syndrome with Diabetes Mellitus: A Quasi-Experimental Study
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Background: Shoulder impingement syndrome (SIS) is the most common cause of shoulder pain. Current conservative management approaches often require years for patients to achieve pain relief. This study aimed to identify the effects of hypertonic dextrose prolotherapy (HDP) injections on pain levels and shoulder functionality in SIS patients with diabetes mellitus. 
Methods: A quasi-experimental study was conducted recruiting SIS patients at Hajj Regional Hospital, Surabaya, Indonesia, from January 2022 to December 2023. The study group was divided into two: the HDP group, which received a 5 mL injection of HDP at a concentration of 20%, and the control group, which received pharmacotherapy and regular rehabilitation therapy. While the control group received regular pharmacotherapy and rehabilitation therapy only. The study outcomes assessed were the Numeric Rating Scale (NRS) and shoulder Active Range of Motion (AROM). The evaluation was conducted three times: before the intervention, immediately after the intervention, and two weeks after the intervention. 
Results: A total of 20 study participants were divided into two groups: 10 in the HDP group and 10 in the control group. Inter- and intragroup analyses showed significant differences in NRS mean values between the HDP and control groups (p < 0.05). Similarly, AROM analysis showed significant differences in mean values between the HDP and control groups, both inter- and intra-group (p < 0.05). Conclusions: HDP injection reduces pain intensity and improves shoulder AROM within two weeks after injection.
Horowitz EH and Aibinder WR. Shoulder impingement syndrome. Phys Med Rehabil Clin N Am. 2023;34:311–34.
Garving C, Jakob S, Bauer I, Nadjar R, Brunner UH. Impingement syndrome of the shoulder. Dtsch Arzteblatt Int. 2017;114:765–76.
Braman JP, Zhao KD, Lawrence RL, Harrison AK, Ludewig PM. Shoulder impingement revisited: evolution of diagnostic understanding in orthopedic surgery and physical therapy. Med Biol Eng Comput. 2014;52:211–9.
Lin CL, Huang CC, Huang SW. Effects of hypertonic dextrose injection in chronic supraspinatus tendinopathy of the shoulder: a randomized placebo -controlled trial. Eur J Phys Rehabil Med. 2019;55:480–7.
Lin CL, Chen YW, Wu CW, Liou TH, Huang SW. Effect of hypertonic dextrose injection on pain and shoulder disability in patients with chronic supraspinatus tendinosis: a randomized double-blind controlled study. Arch Phys Med Rehabil. 2022;103:237–44.
Bielewicz J, Daniluk B, Kamieniak P. VAS and NRS, same or different? Are visual analog scale values and numerical rating scale equally viable tools for assessing patients after microdiscectomy? Pain Res Manag. 2022;2022:5337483.
Wang L, Yu G, Zhang R, Wu G, He L, Chen Y. Positive effects of neuromuscular exercises on pain and active range of motion in idiopathic frozen shoulder: a randomized controlled trial. BMC Musculoskelet Disord 2023;24:50.
Michalak N, Banks D, Kane L, Siefferman J. Dextrose prolotherapy for the treatment of chronic shoulder pain in patients with joint hypermobility: a case series. Clin Med Insights Arthritis Musculoskelet Disord. 2024;17:11795441241264821.
Seenauth C, Inouye V, Langland JO. Dextrose prolotherapy for chronic shoulder pain: a case report. Altern Ther Health Med. 2018;24:56–60.
Zhu M, Rabago D, Chung VC-H, Reeves KD, Wong SYS, Sit RWS. Effects of hypertonic dextrose injection (prolotherapy) in lateral elbow tendinosis: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2022;103:2209–18.
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.
Teymouri A, Birang N, Fakheri M, Nasiri A. Comparison of the efficacy of ultrasound-guided dextrose 25% hypertonic prolotherapy and intra-articular normal saline injection on pain, functional limitation, and range of motion in patients with knee osteoarthritis; a randomized controlled trial. BMC Musculoskelet Disord. 2025;26:313.
Vomer RP, Larick RS, Milon R, York E. The effect of intra-articular hypertonic dextrose prolotherapy on pain, quality of life, and functional outcome scores in patients with knee osteoarthritis. Cureus. 2023;15:e48096.
Salsabil JR, Pane RV, Hasan H, Al Hajiri AZZ. Hypertonic dextrose prolotherapy injection in grade IV knee osteoarthritis with obesity: a case report. Acta Medica Indones. 2024;56:349–55.
Arias-Vázquez PI, Tovilla-Zárate CA, González-Graniel K, Burad-Fonz W, González-Castro TB, López-Narváez ML, et al. Efficacy of hypertonic dextrose infiltrations for pain control in rotator cuff tendinopathy: systematic review and meta-analysis. Acta Reumatol Port. 2021;46(2):156–70.
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 Journal Orthopaedi and Traumatology Surabaya (JOINTS) (
 Journal Orthopaedi and Traumatology Surabaya (JOINTS) (