Dextrose Prolotherapy for Supraspinatus Partial Tear: A Case Report


Introduction: Rotator cuff (RC) tears account for about 20% of RC disorders and presents with severe shoulder pain that can significantly impact activities of daily life.

Case report: A 34-year-old male with a history of chronic right shoulder pain presents with tenderness at the lateral shoulder, positive subacromial impingement tests, painful end range of motion and pain score of 6. Ultrasound shows a partial supraspinatus tear at the bursal side. The patient was treated with 15% dextrose to the supraspinatus tendon intrasubstance 3 times, for 4 weeks.

Result: Significant pain improvement after the first treatment (VAS 1), with pain-free full range of motion until 4 weeks after treatment and sonographic evidence of supraspinatus tendon healing.

Discussion: Dextrose concentrations higher than 12.5% produce an osmotic gradient which stimulates the accumulation of growth factors and inflammatory cells, which in turn can initiate the wound healing process. In this case we can find that the healing process translates to good clinical outcome by ultrasound imaging.

Conclusion: Dextrose prolotherapy can be used as an option for supraspinatus tendon partial tear with good results.

Key words: rotator cuff, prolotherapy, dextrose

  1. Chang R-F LC-C, Lo C-M (Quantitative diagnosis of rotator cuff tears based on sonographic pattern recognition. PLoS ONE. 2019;14(2):e0212741.
  2. Lewis J, Tennent T, MacAuley D, Best T. How effective are diagnostic tests for the assessment of rotator cuff disease of the shoulder. Evidence Based Sports Medicine. 2007;327:60.
  3. Yamamoto A, Takagishi K, Osawa T, Yanagawa T, Nakajima D, Shitara H, et al. Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg [Internet]. 2010;19(1):116–20. Available from:
  4. JH. W. Mechanobiology of tendon. J Biomech. 2006;39(9):1563–82.
  5. Kirkendall DT GW. Function and biomechanics of tendons. Scand J Med Sci Sports. 1997;7:62–6.
  6. Naqvi GA JM, Harrington P. Accuracy of ultrasonography and magnetic resonance imaging for detection of full thickness rotator cuff tears. International Journal of Shoulder Surgery. 2009;3(4):94.
  7. Smith TO BT, Toms AP, Hing CB. Diagnostic accuracy of ultrasound for rotator cuff tears in adults: a systematic review and meta-analysis. Clin Radiol. 2011;66(11):1036–48.
  8. Bertrand H RK, Bennett CJ, Bicknell S, Cheng AL. Dextrose prolotherapy versus control injections in painful rotator cuff tendinopathy. Arch Phys Med Rehabil. 2016;97(1):17–25.
  9. Lee DH KK, Rah UW, Yoon SH. Prolotherapy for refractory rotator cuff disease: retrospective case-control study of 1-year follow-up. Arch Phys Med Rehabil. 2015;96(11):2027–32.
  10. Bertrand H, Reeves KD, Bennett CJ, Bicknell S, Cheng AL. Dextrose prolotherapy versus control injections in painful rotator cuff tendinopathy. Arch Phys Med Rehab. 2015;97(1)17–25.
  11. A W N. Complications associated with the use of corticosteroids in the treatment of athletic injuries. Clin J Sport Med. 2005;15(5):370–5.
  12. Topol GA RK, Hassanein KM. Efficacy of dextrose prolotherapy in elite male kicking-sport athletes with chronic groin pain. Arch Phys Med Rehabil. 2005;84(6):697–702.
  13. Di Paolo S GL, Ranieri E, Grandaliano G, Schena FP. High glucose concentration induces the overexpression of transforming growth factor-beta through the activation of a platelet-derived growth factor loop in human mesangial cells. Am J Pathol. 1996;149(6):2095–106.
  14. Oh JH HH, Yu MR, Lee HB. Sequential effects of high glucose on mesangial cell transforming growth factor-beta 1 and fibronectin synthesis. Kidney Int. 1998;54(6):1872–8.
  15. Murphy M GC, Cannon S, Kato S, Mackenzie HS, Martin F, Brady HR. Suppression subtractive hybridization identifies high glucose levels as a stimulus for expression of connective tissue growth factor and other genes in human mesangial cells. J Biol Chem. 1999;274(9):5830–4.
  16. Fukuda K KS, Inui Y, Higashiyama S, Matsuda Y, Igura T, Tamura S, et al. High concentration of glucose increases mitogenic responsiveness to heparin-binding epidermal growth factor-like growth factor in rat vascular smooth muscle cells. Arterioscler Thromb Vasc Biol. 1997;17(10):1962–8.
  17. Ohgi S JP. Glucose modulates growth of gingival fibroblasts and periodontal ligament cells: correlation with expression of basic fibroblast growth factor. J Periodontal Res. 1996;31(8):579–88.
  18. Pugliese G PF, Locuratolo N, Romeo G, Romano G, Giannini S, Cresci B, et al. Increased activity of the insulin-like growth factor system in mesangial cells cultured in high glucose conditions. Relation to glucose-enhanced extracellular matrix production. Diabetologia. 1996;39(7):775–84.
  19. Jo Y KW, Lee H. Healing of partial tear of the supraspinatus tendon after atelocollagen injection confirmed by MRI: A case report. Medicine (Baltimore). 2020;99(49):e23498.
  20. H E. Arthroscopic subacromial decompression: analysis of one- to three-year results. Arthroscopy. 1987;3(3):173–81.
  21. Sambandam SN KV, Gul A, Mounasamy V. Rotator cuff tears: An evidence based approach. World J Orthop. 2015;6(11):902–18.
  22. Akpancar S ÖA, Seven MM, Koca K. The effectiveness of prolotherapy on failed rotator cuff repair surgery. Turk J Phys Med Rehabil. 2019;65(4):394–401.
  23. Catapano M ZK, Mittal N, Sangha H, Onishi K, de Sa D. Effectiveness of dextrose prolotherapy for rotator cuff tendinopathy: a systematic review. PM&R. 2020 Mar;12(3). 2020;12(3):288–300. 

Articles related to the one you are viewing

There are currently no results to show, please try again later

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, which permits use, share — copy and redistribute the material in any medium or format, adapt — remix, transform, and build upon the material, as long as you give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. You may not use the material for commercial purposes. If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original. You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit