Clinical noteHigh-Resolution Ultrasound and Magnetic Resonance Imaging to Document Tissue Repair After Prolotherapy: A Report of 3 Cases
Section snippets
Case Descriptions
Prolotherapy involves injections of small amounts (0.5−1.0mL) of the proliferative solution at multiple enthesis points (for tendon, ligament, and fascia) and/or musculotendinous junctions. When joints are treated, an intra-articular injection is commonly performed. In most cases, 2 to 6 treatment sessions are required over 2 to 12 months to reach maximum effect.11 Standard protocol includes restriction from nonsteriodal anti-inflammatory drugs 1 to 2 days before treatment and 10 to 14 days
Discussion
These cases show the potential utility of high-resolution ultrasound to document pathology in soft tissues and tissue responses to treatment. Ultrasound images of animal tendons have been correlated with histology studies.12 In the evaluation of tendons, Van Holsbeek has observed that “ultrasound has a significant advantage over MRI … tissues with few mobile protons emit little or no signal and, therefore, the internal architecture of the tendon is not well demonstrated [on MRI].”13(p77) The
Conclusions
Ultrasound imaging can show tissue growth and repair. These case reports appear to confirm that prolotherapy does stimulate tissue growth in tendon (patellar), ligament (anterior talofibular), and meniscus (medial meniscus) and that this is an organized growth with a return toward a normal appearance on ultrasound. Further clinical studies with ultrasound confirmation are recommended. The development of quantitative methods to analyze ultrasound images will be valuable in blinded efficacy
Acknowledgment
I thank Vince Wiseman, MD, for assistance in reviewing the MRI studies.
References (15)
Prolotherapy: regenerative injection therapy
- et al.
Side effects and adverse events related to interligamentous injection of sclerosing solutions (prolotherapy) for back and neck pain: a survey of practitioners
Arch Phys Med Rehabil
(2006) Prolotherapy: basic science, clinical studies and technique
Ligament and tendon relaxation treated by prolotherapy
(1956)Point of view
Spine
(2004)- et al.
Critical review of prolotherapy for osteoarthritis, low back pain, and other musculoskeletal conditions: a physiatric perspective
Am J Phys Med Rehabil
(2004) - et al.
Prolotherapy injections, saline injections, and exercises for chronic low-back pain: a randomized study
Spine
(2003)Spine
(2004)
Cited by (20)
Everything old is new again: New developments in prolotherapy
2015, Techniques in Regional Anesthesia and Pain ManagementCitation Excerpt :Prolotherapy is indicated for almost any ligament laxity or enthesopathy. Just a few examples include treatment of the enthesopathy that causes rotator cuff tendinopathy,11,12 lateral epicondylitis,13 whiplash,6,14 temporomandibular joint (TMJ) dysfunction,15,16 knee osteoarthritis and ligament instability,17,18 meniscal tears,19 Osgood-Schlatter disease,20 plantar fasciitis,21 Achilles tendonitis,22 sacroiliac and pelvic girdle dysfunction,23,24 axial low back pain after spinal surgery,25 and chronic low back pain.26 The Table shows some of the indications that have been described for prolotherapy.
Ultrasonography in regenerative injection (prolotherapy) using dextrose, platelet-rich plasma, and other injectants
2010, Physical Medicine and Rehabilitation Clinics of North AmericaCitation Excerpt :Typical prolotherapy technique with dextrose includes injection of multiple extraarticular structures (in addition to the intraarticular injection) that are easily accessible with MSKUS, such as the peripheral medial meniscus and adjacent medial collateral ligament. A case report has been published showing repair of a complex degenerative medial meniscus tear in a 59-year-old woman.32 The ultrasound findings were confirmed before and after treatment on MRI.
Effect of Regenerative Injection Therapy on Function and Pain in Patients with Knee Osteoarthritis: A Randomized Crossover Study
2012, Pain Medicine (United States)Citation Excerpt :In some laboratory conditions, RIT resulted in increases in ligament mass, ligament thickness, cross-sectional strength, and osteotendinous junction strength [15–17]. In clinical case studies, magnetic resonance imaging and ultrasound attest to tissue repair postinjection [18,19]. The underpinning mechanisms potentially responsible for these effects include the elimination of nerve fibers associated with neovascularization [20–22], inflammation and tissue repair, increase in cross-sectional area of ligaments and tendons [15,16,23], and the disruption and subsequent healing of the collagen fibril [20,21,24].
Ultrasound-guided pain management for chronic musculoskeletal pain
2022, Journal of Medical UltrasoundA Comparative Study of Short-Term Efficacy of Intra-articular Hypertonic Saline and Hypertonic Dextrose Prolotherapy in Knee Osteoarthritis: A Randomized Controlled Trial (RCT)
2022, Journal of Rehabilitation Sciences and ResearchUltrasound-Guided Prolotherapy for Acromial Enthesopathy and Acromioclavicular Joint Arthropathy: A Single-Arm Prospective Study
2019, Journal of Ultrasound in Medicine
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