Dextrose injections may trigger healing in tendons

Internal Medicine News,  June 1, 2007  by Kate Johnson

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QUEBEC CITY -- Hyperosmolar dextrose injected into ailing tendons may cause tissue damage that triggers a healing response, reported Michael Ryan, a doctoral candidate at the University of British Columbia in Vancouver.

Mr. Ryan and his coinvestigators have previously reported good to excellent outcomes with this approach, known as prolotherapy, in treating both infrapatellar and Achilles tendinopathies.

He reported on their most recent pilot investigation into the treatment of chronic plantar fasciitis at the joint annual meeting of the Canadian Academy of Sport Medicine and the Association Quebecoise des Medecins du Sport.

The study involved 23 patients with chronic plantar fasciitis (average duration, 28 months) who had failed conservative treatment. Their level of dysfunction was extremely high--some of them could not walk without a walking boot.

The patients' injured plantar fasciae, seen on ultrasound, had the characteristic features of anechoic foci, neovascularity, hypoechogenic regions, and calcification/cortical defects, Mr. Ryan reported. The investigators injected a 50% dextrose solution diluted with 2% lignocaine into painful sites and anechoic clefts/tears using a 27-gauge needle under ultrasound guidance.

The patients received an average of five injections 6 weeks apart, for an average treatment duration of 33 weeks. After treatment, 14 patients reported good to excellent results, with 12 reporting complete symptom resolution and return to function.

These clinical outcomes corresponded to structural improvements seen on ultrasound, including a reduction in the number of intrasubstance tears (from 7 to 2), hypoechoic areas (from 10 to 3), calcifications (from 7 to 1), and neovascularities (from 2 to 0).

Prolotherapy, which was first described by Hippocrates, is thought to work by adding injury to an already injured site, triggering the body's natural healing response.

"By creating an osmotic shock around the site of the injection, we create an inflammatory response in the tendon, which may be absent in some patients. Typically, individuals who are 28 months symptomatic are considered to have an abnormal immune response, and this irritation stimulates healing by bringing blood to the area and releasing growth factors," Mr. Ryan explained.

He noted that imaging may not always be necessary, which makes prolotherapy in the primary care setting feasible. "If the tendon is easy to palpate, such as the Achilles or the infrapatellar tendon, it's very easy to find the injection spot," he said.

BY KATE JOHNSON

Montreal Bureau

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