Dextrose Prolotherapy for Osteoarthritic thumbs and Finger
Reeves KD, Hassanein K. Randomized prospective placebo controlled double blind study of dextrose prolotherapy for osteoarthritic thumbs and finger (DIP, PIP and Trapeziometacarpal) joints: Evidence of Clinical Efficacy. Jnl Alt Compl Med 2000;6(4):311-320.
Dr. Reeves' Notes: 10% dextrose superior to hypotonic lidocaine in finger and thumb OA. Injection was primarily periarticular here (medial and lateral) and in this study 10% dextrose was superior with no obvious effect of control solution.
Subjects had finger pain an average of 5 years and met radiographic criteria for finger osteoarthritis. Treatment consisted of injection of 1/2 ml of 10% dextrose versus hypotonic lidocaine on either side of the joint using a tiny needle and slight sedation for discomfort. Rest pain was not a good variable to look at since it was often absent at study onset, but movement pain improved significantly more (42% versus 15%; p = .027) as did range of motion (+8 degrees versus minus 8.1 degrees; p = .003) Note an average joint was calculated for each patient to avoid statistical magnification by multiple joints in each patient.
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OBJECTIVES: To determine the clinical benefit of dextrose prolotherapy (injection of growth factors or growth factor stimulators) in osteoarthritic finger joints.
DESIGN: Prospective randomized double-blind placebo-controlled trial.
SETTINGS/LOCATION: Outpatient physical medicine clinic.
SUBJECTS: Six months of pain history was required in each joint studied as well as one of the following: grade 2 or 3 osteophyte, grade 2 or 3 joint narrowing, or grade 1 osteophyte plus grade 1 joint narrowing. Distal interphalangeal (DIP), proximal interphalangeal (PIP), and trapeziometacarpal (thumb CMC) joints were eligible. Thirteen patients (with seventy-four symptomatic osteoarthitic joints) received active treatment, and fourteen patients (with seventy-six symptomatic osteoarthritic joints) served as controls.
INTERVENTION: One half milliliter (0.5 mL) of either 10% dextrose and 0.075% xylocaine in bacteriostatic water (active solution) or 0.075% xylocaine in bacteriostatic water (control solution) was injected on medial and lateral aspects of each affected joint. This was done at 0, 2, and 4 months with assessment at 6 months after first injection.
OUTCOME MEASURES: One-hundred millimeter (100 mm) Visual Analogue Scale (VAS) for pain at rest, pain with joint movement and pain with grip, and goniometrically-measured joint flexion. RESULTS: Pain at rest and with grip improved more in the dextrose group but not significantly. Improvement in pain with movement of fingers improved significantly more in the dextrose group (42% versus 15% with a p value of .027). Flexion range of motion improved more in the dextrose group (p = .003). Side effects were minimal.
CONCLUSION: Dextrose prolotherapy was clinically effective and safe in the treatment of pain with joint movement and range limitation in osteoarthritic finger joints.