Ultrasound-Guided Prolotherapy for Acromial Enthesopathy and Acromioclavicular Joint Arthropathy: A Single-Arm Prospective Study

J Ultrasound Med. 2019 Mar;38(3):605-612. doi: 10.1002/jum.14727. Epub 2018 Aug 31.


Objectives: Prolotherapy is an injection-based complementary treatment for various musculoskeletal diseases. The aim of this study was to evaluate the therapeutic efficacy of ultrasound-guided prolotherapy in the treatment of acromial enthesopathy and acromioclavicular joint arthropathy.

Methods: Thirty-one patients with chronic moderate-to-severe shoulder pain were recruited from September 2015 to September 2017. Ultrasound-guided prolotherapy was performed by injecting 10 mL of a 15% dextrose solution into the acromial enthesis of the deltoid or acromioclavicular joint capsule aseptically. Prolotherapy was given in 2 sessions separated by a 1-month interval. The pretreatment-to-posttreatment change in the pain visual analog scale (VAS) score was recorded as the primary outcome. The mean follow-up duration was 61.8 days. A paired t test was used to assess the difference in pretreatment and posttreatment VAS scores. A univariate logistic regression analysis was conducted to identify the demographic variables associated with substantial pain reduction after the intervention. Substantial pain reduction was defined as a posttreatment VAS score of 3 or less.

Results: Twenty of the 31 patients reported substantial pain reduction without adverse effects after the intervention. The mean VAS score reduction ± SD was 4.3 ± 2.6 (pretreatment, 6.8 ± 1.5; posttreatment, 2.5 ± 2.1; P < .01).

Conclusions: Ultrasound-guided prolotherapy with a 15% dextrose solution is an effective and safe therapeutic option for moderate-to-severe acromial enthesopathy and acromioclavicular joint arthropathy.

Keywords: acromial enthesopathy; acromioclavicular joint arthropathy; musculoskeletal; prolotherapy; ultrasound-guided injection.

MeSH terms

  • Acromioclavicular Joint / diagnostic imaging*
  • Acromioclavicular Joint / physiopathology
  • Acromion / diagnostic imaging
  • Acromion / physiopathology
  • Adult
  • Aged
  • Enthesopathy / diagnostic imaging
  • Enthesopathy / therapy*
  • Female
  • Glucose / administration & dosage
  • Glucose / therapeutic use
  • Humans
  • Injections, Intra-Articular
  • Joint Diseases / diagnostic imaging
  • Joint Diseases / physiopathology
  • Joint Diseases / therapy*
  • Male
  • Middle Aged
  • Pain / physiopathology
  • Pain Management / methods*
  • Prolotherapy / methods*
  • Prospective Studies
  • Treatment Outcome
  • Ultrasonography, Interventional / methods*


  • Glucose