Efficacy of Neural Prolotherapy for Treatment of Anserine Bursitis "NPCAB"
Condition: Anserine Bursitis
MeSH terms: Bursitis
Study type: Interventional

Summary: 
      Anserine bursitis is a common etiology of medial knee pain. It could be severe enough to
      limit the patient's functional abilities with affection of the quality of life. The etiology
      of AB is unknown. It could be bursitis, tendinitis or other unknown etiology.

      The treatment of AB includes conservative and surgical treatment. Conservative treatment
      consists of non-pharmacologic treatment and pharmacologic treatment. Local corticosteroid
      injection is a treatment for refractory chronic anserine bursitis.

      Neural prolotherapy is the subcutaneous perineural injection of isotonic dextrose 5% in water
      solution at the fascial penetration point of the sensory nerve where it reaches the
      subcutaneous plane and along its course. It can be used for the treatment of chronic anserine
      bursitis.

      This study aimed to determine the efficacy of neural prolotherapy subcutaneous perineural
      injection versus corticosteroid local soft tissue injection therapy for relieving pain and
      improvement of function among patients with chronic anserine bursitis.
    

Detailed description: 
      Anserine bursitis is a common etiology of medial knee pain. It could be severe enough to
      limit the patient's functional abilities with affection of the quality of life. The etiology
      of AB is unknown. It could be bursitis, tendinitis or other unknown etiology.

      The treatment of AB includes conservative and surgical treatment. Conservative treatment
      consists of non-pharmacologic treatment and pharmacologic treatment. Their aim is pain
      relieve, with subsequent improvement of function and quality of life. The non-pharmacologic
      treatment consisted of activity modification with avoidance of precipitating activities and
      physiotherapy. The pharmacologic treatment consists of non-steroidal anti-inflammatory drugs,
      analgesics whether oral as acetaminophen or topical preparations; or local soft tissue
      injection of corticosteroid. Surgical treatment is indicated after failure of conservative
      treatment in chronic severe and resistant cases only.

      Local corticosteroid injection is a treatment for refractory chronic anserine bursitis. The
      mechanism of action of corticosteroid is the suppression of the inflammatory process
      associated with anserine bursitis. Subsequently, improvement of anserine bursitis takes
      place.

      Neural prolotherapy is the subcutaneous perineural injection of isotonic dextrose 5% in water
      solution at the fascial penetration point of the sensory nerve where it reaches the
      subcutaneous plane and along its course. It can be used for the treatment of chronic anserine
      bursitis.

      The mechanism of action of neural prolotherapy in anserine bursitis could be due to
      stimulation the release of a group of growth factors that enhance soft tissue healing in
      response to isotonic dextrose 5% in water solution injection. Subcutaneous injection of
      isotonic dextrose 5% in water solution was found to stimulate human cells to start
      proliferation, increase in cell protein and DNA synthesis. It stimulates the release of a
      group of growth factors as transforming growth factor-β and other growth factors. Another
      mechanism of neural prolotherapy is the treatment of neurogenic inflammation.

      This study aimed to determine the efficacy of neural prolotherapy subcutaneous perineural
      injection versus corticosteroid local soft tissue injection therapy for relieving pain and
      improvement of function among patients with chronic anserine bursitis.
    

Intervention name(s): isotonic dextrose 5% in water (D5W) solution; corticosteroid with local anaesthetics (40 mg of triamcinolone acetonide (40 mg/ml) with 1.5 ml mepivacaine HCl 3% )
Intervention type(s): Drug; Drug
Intervention description(s): Neurol prolotherapy (NP) is the subcutaneous perineural injection of isotonic dextrose 5% in water (D5W) solution.; Corticosteroid with local anaesthetics (40 mg of triamcinolone acetonide (40 mg/ml) with 1.5 ml mepivacaine HCl 3% ) (local anesthetic). They were given as a single local soft tissue injection at the point of maximal tenderness on the lower medial aspect of the knee region.
Other intervention name(s): Subcutaneous nerual prolotherapy
Intervention MeSH terms: Triamcinolone; Triamcinolone Acetonide; Triamcinolone hexacetonide; Anesthetics; Mepivacaine; Anesthetics, Local; Triamcinolone diacetate
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Anserine bursitis; Neural prolotherapy; Perineural injection