Does Dextrose Prolotherapy Work for Rotator Cuff Pain?
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By Dr. Jeffrey Peng, MD · Published March 6, 2025 · 7 min read
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Rotator cuff disorders are among the most common causes of shoulder pain, contributing significantly to lost function and decreased quality of life. When conservative measures such as physical therapy and activity modification fall short, many patients are offered cortisone injections. While cortisone provides strong short-term pain relief and anti-inflammatory effects, growing evidence suggests potential downsides with repeated use — including tissue weakening over time.
This has prompted clinicians to explore alternative injection-based therapies, one of which is dextrose prolotherapy. Prolotherapy involves injecting a hypertonic (high-concentration) solution into injured or painful tissue to stimulate a healing response. Dextrose — a sugar molecule nearly identical to glucose — has been used for this purpose since the 1950s. The theory is that concentrated dextrose triggers a controlled inflammatory reaction, recruiting growth factors and chemical mediators that promote local tissue repair.
We already have evidence that dextrose prolotherapy can improve symptoms in conditions like knee osteoarthritis (Sert et al., 2020). But does it work for the rotator cuff? Below is a summary of what the latest clinical trials show.
Can Dextrose Prolotherapy Improve Chronic Rotator Cuff Pain?
A randomized controlled trial by Bertrand et al. (2016) enrolled 73 participants with chronic shoulder pain and ultrasound-confirmed rotator cuff tendinopathy. Participants received three monthly injections of either dextrose onto painful entheses (tendon-bone junctions), saline onto entheses, or superficial saline injections above the entheses. All groups also received concurrent physical therapy.
At 9-month follow-up, 59% of the dextrose group maintained clinically meaningful pain improvement, compared with 37% of the enthesis-saline group and just 27% of the superficial-saline group. Patient satisfaction scores were also significantly higher in the dextrose group.
What makes this study particularly noteworthy is the patient population. On average, participants had moderate to severe shoulder pain lasting approximately 7.5 years. These were not early-stage patients — they had already tried and failed multiple treatment options. The fact that dextrose prolotherapy still produced meaningful improvements in this refractory population is encouraging.
Does a Single Dextrose Injection Help Rotator Cuff Tendinopathy?
A second randomized controlled trial by Lin et al. (2022) examined 57 patients with chronic supraspinatus tendinosis. Unlike the Bertrand study, this trial used only a single ultrasound-guided injection of either 20% dextrose or saline.
The dextrose group showed significantly better pain and disability scores at 2 weeks, but these benefits did not persist to 6 weeks. By that point, there was no meaningful difference between groups in pain or function.
However, the study also tracked tendon morphology using ultrasound. The dextrose group demonstrated significantly reduced tendon thickness — a marker of improved tendon health — at both 6 and 12 weeks compared to baseline. This structural improvement was not observed in the control group.
One important critique of this study is the single-injection design. Most prolotherapy protocols recommend three to eight treatment sessions spaced two to four weeks apart. The short-lived symptom relief may simply reflect an insufficient number of treatments. The fact that a single injection still produced measurable structural tendon changes is arguably the more promising finding, suggesting that a full course of treatment could yield both symptomatic and structural benefits.
What Does the Overall Evidence Show?
A systematic review by Catapano et al. (2020) pooled results from five randomized controlled trials encompassing 272 total participants. The review highlighted that prolotherapy protocols vary widely across studies — some used multi-site injection approaches targeting several areas around the shoulder, while others used a single-site injection into the supraspinatus tendon. Some administered a series of treatments, while others used only one.
The key finding: dextrose prolotherapy using multi-site injection protocols produced significantly better pain outcomes compared to controls, whereas single-site injection protocols did not. Additionally, serial treatments appeared to outperform single treatments. The complication rate was very low, with only 6 out of 272 participants experiencing any adverse events — limited to mild, transient increases in pain lasting one to two days.
The authors concluded that dextrose prolotherapy is a potentially effective addition to physical therapy for patients with rotator cuff tendinopathy, but that further research is needed to determine the optimal injection technique, dextrose concentration, volume, and injection location.
Where Does Dextrose Prolotherapy Fit in Rotator Cuff Treatment?
Based on the current evidence, dextrose prolotherapy shows promise as a treatment option for rotator cuff tendinopathy — particularly for patients who want to avoid surgery, have already received multiple cortisone injections, and are still experiencing pain. The multi-site, multi-session approach appears to be more effective than a single injection.
In my practice, I would place dextrose prolotherapy slightly below platelet-rich plasma (PRP) injections for rotator cuff disorders. Both treatments have mixed evidence, with some studies showing benefit and others showing no significant difference over control. However, PRP is more extensively studied and the overall body of evidence leans slightly more in its favor. That said, dextrose prolotherapy is typically less expensive than PRP, which may make it an attractive first-line regenerative option for some patients.
The bottom line: dextrose prolotherapy is not yet well enough studied to be considered a standard treatment for rotator cuff tendinopathy, but early results are encouraging. More clinical trials are needed to identify the best protocols — and patients interested in this treatment should discuss it with a physician experienced in regenerative medicine and injection-based therapies. If you would like to explore whether prolotherapy or other non-surgical treatments are right for your shoulder condition, consider scheduling a consultation.
References
1. Bertrand H, Reeves KD, 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. doi:10.1016/j.apmr.2015.08.412
2. Lin CL, Chen YW, Wu CW, Liou TH, Huang SW. Effect of hypertonic dextrose injection on pain and shoulder disability in patients with chronic supraspinatus tendinosis: a randomized double-blind controlled study. Arch Phys Med Rehabil. 2022;103(2):237-244. doi:10.1016/j.apmr.2021.07.812
3. Catapano M, Zhang K, Mittal N, Sangha H, Onishi K, de Sa D. Effectiveness of dextrose prolotherapy for rotator cuff tendinopathy: a systematic review. PM R. 2020;12(3):288-300. doi:10.1002/pmrj.12268
4. Sert AT, Sen EI, Esmaeilzadeh S, Ozcan E. The effects of dextrose prolotherapy in symptomatic knee osteoarthritis: a randomized controlled study. J Altern Complement Med. 2020;26(5):409-417. doi:10.1089/acm.2019.0335
Medical Disclaimer: This content is for educational purposes only and does not substitute for the medical advice of a physician. Always consult your healthcare provider before beginning any new treatment program. The information presented reflects the opinion of Dr. Jeffrey Peng and does not represent the views of his employers or affiliated hospital systems.
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