Disclosures: Peter J. Lee, DO: No financial relationships or conflicts of interest

Case Diagnosis: A 91-year-old pre-diabetic male with worsening bilateral shoulder pain due to osteoarthritis and calcific tendinitis.

Case Description: The patient presented to clinic requesting corticosteroid injections due to severe bilateral shoulder pain. Physical exam demonstrated limited range of motion and impingement signs. Imaging displayed moderate glenohumeral joint osteoarthritis and calcific tendinitis. The patient, however, received bilateral knee injections two months prior. He was instead given bilateral suprascapular nerve blocks followed by bilateral single subacromial prolotherapy injections which provided resolution of his pain.

Setting: Outpatient Musculoskeletal ClinicAssessment/

Results: At 3-month, 9-month, and 2-year follow up, the patient continued to have complete resolution of bilateral shoulder pain. In this case, we present a patient with successful resolution of shoulder pain after single subacromial prolotherapy injections.

Discussion: Severe shoulder pain due to joint osteoarthritis or calcific tendinitis can significantly impair daily activities and rehabilitation. Corticosteroid injections aim to target severe pain, but have certain limitations including the frequency of use, chondrotoxicity, and hyperglycemia. Prolotherapy is a good alternative for severe pain where steroid injections are contraindicated.  Prolotherapy induces the inflammatory healing cascade to initiate regeneration and repair of injured tissues in and around the joint, stabilizing and eliminating the sources of musculoskeletal pain. The Hackett-Hemwall technique is commonly utilized in prolotherapy, which consists of injecting multiple areas around the affected joint. Our patient was instead given a suprascapular nerve block followed by a single prolotherapy subacromial injection to both shoulders.

Conclusion: Corticosteroid injections provide significant relief for severe shoulder pain from glenohumeral arthritis or calcific tendinitis but are met with limitations. In patients requiring an alternative treatment, a single subacromial prolotherapy injection may provide pain relief with fewer contraindications.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/single-subacromial-prolotherapy-injection-for-severe-shoulder-pain-a-case-study/