| 摘要: | Background
Rotator cuff disorder with bursitis is one of the most frequent pathologies of the shoulder, which may cause serious restriction of daily activities and reduce quality of life. There are many ways in treating rotator cuff disorder with bursitis, including medication, physical therapy, kinesiological taping, acupuncture and local injection. Protholotherapy, which inject hyperosmolar dextrose to soft tissue, is a novel management in musculoskeletal disorders. However, only few trials exist in studying hyperosmolar dextrose injection for rotator cuff disorder with bursitis and most of them have small sample size and not randomized. The aim of this study was to figure out the effects of sonographically guided subacromial bursa injection with hyperosmolar dextrose in rotator cuff disorder with bursitis by a randomized controlled trial.
Methods
Fourty-six patients with rotator cuff disorder with bursitis were enrolled into the study. The patients were randomized into two treatment groups receiving either 15% dextrose with local anesthetic injection (15% dextrose group, D15W), or normal saline with anesthetic injection (control group). Total 3 courses of treatment were done in an interval of two weeks. Visual analog scale (VAS) was used to measure pain intensity, including rest and maximum pain. Shoulder active flexion and abduction range of motion (ROM) were also recorded and Shoulder Pain and Disability Index (SPADI) were performed to evaluate pain and functional disability. Subacrominal bursa thickness and elasticity of supraspinatus tendon were assessed by musculoskeletal ultrasound. The evaluation was done at 3 time points: before therapy course, 1 week after 3rd course of therapy, and 1 month after 3rd course of therapy.
Results
Pain, active shoulder ROM, SPADI score, bursa thickness and elastography were determined to have improve significant in both groups after treatment compared to pretreatment (p for time <0.001). Besides, in all outcome measurement, D15W had better result than control group without significant difference (p for interaction > 0.05).
Conclusion
The intrabursal injection of hyperosmolar dextrose has a beneficial effect in treatment of rotator cuff disorder with bursitis, such as pain reduction, active shoulder ROM and shoulder function improvement, reduce subacromial bursa thickness and increase the elasticity of supraspinatus tendon. Meanwhile, intrabural normal saline and xylocaine injection had similar effect. Therefore, hyperosmolar dextrose or normal salin with xylocaine injection may be an alternative noninvasive method for patients with rotator cuff disorder with bursitis. |
