T Nation

Prolotherapy Journal - Sternoclavicular Joint, Costochondritis, Shoulder Impingement

(The background is written in past tense, but I still have the pain though)

Hello,

I am an individual who has had ligament laxity all my life. I was the kid who could place their thumb completely flat on their arm. I have noticed since I was a child that my sternoclavicular joints (SCJ) have been unstable and seemed strange. They had never caused me any trouble until a year ago. I started to go to the gym two years ago and found that I would commonly get sternum and shoulder pain. The pain wasn’t permanent, and would go away after a few days. Over time though, the pain would linger longer and longer. Things that hurt my sternum the most were dips. My left shoulder hurt with any dumbell/barbell row, OHP etc. Come January of 2019, I was doing one arm hangs with my right arm were I felt a tearing sensation in a specific spot in my sternum, where the 2nd rib on the right connects to the sternum. The pain never went away. Around this time, my left shoulder also gave in, and the pain also became chronic after a session of doing dumbell rows. This was the file nail in the coffin.

I now had chronic pain in my sternum(called Costochindritis) and shoulder. No physios, chiropractors, muscle manipulators, masseurs, chinese medicine practitioners could help me. Ultrasound of my left shoulder came back clear. X-rays of my spine, chest, left shoulder came back clear. The pain in my sternum lingered, and would get worse if I slightly physically exerted myself. The pain in my shoulder would radiate down my arm into my fingers. I no longer was going to the gym and I felt as if I was withering away.

I dealt with the pain for a year with no clue of the reason, until one day I suspected it was due to my SCJ. I did some research, and I discovered that an unstable SCJ can cause sternum and shoulder pain! This was a breakthrough for me, and I began to read studies and articles. Surgery for the SCJ seemed to be the most common treatment but has a fairly high fatality rate due to the proximity of the vascularity of the neck. Another treatment rarely mentioned was Prolotherapy. My understanding of Prolotherapy is that it is an injection therapy involving using an irritant such as Dextrose solution or Sodium Morrhuate to cause a localised inflammatory response at the entheses of connective tissues such as tendons and ligaments. The irritant is usually refered to as a proliferant. Prolotherapy is commonly used to treat ligament laxity, which is exactly what I had.

I took a video of my Sternoclavicular joint instability, you can PM me for the video. This link is a album of snippets of the video.
https://imgur.com/a/g7Q4ufo -Note how my SCJ are uneven/ My right SCJ protrudes out slightly and my left SCJ snaps in and out, a thud can be heard sometimes.

I am going to write posts on my experience with prolotherapy. I am going to do the injections myself in my sternum, SCJ and potentially shoulder if I can reach the injection sites. I will be using a 25% Dextrose solution made from 50% dextrose with 0.9% Saline. I will do this by taking 10ml of 50% dextrose and 10ml of Saline. The solution must be hypertonic, this is why saline is being used instead of sterile water so that the solution stays hypertonic. I will then inject 1-2cc into each site using a “peppering fashion” by stabbing the ligaments by moving the needle up and down before injecting the proliferant. I will do many injections in the same area. I will be using a 25G needle for the injections and might use a 23G for the shoulder as I will have to go deeper. Lidocaine will not be used in the solution as it has been found to be toxic to cells; I may only apply it on the skin if needed due to any pain.

@Erasmus
@Ray567 - Had done prolotherapy on themselves in 2012, disappeared before giving final update
@gsg96 - Someone who had prolotherapy to their SCJ before

Update: This has been a long journey, and it isn’t over. I failed to do the prolotherapy myself twice, and those two attempts were my only ones. I wrote a report on what happened, but I won’t share it since it is for me only. But I will still give you guys some tips and things you need to know if you decide to do prolotherapy yourself.

First of all, practice. Rehearse it. Plan everything that you will do, especially with the injections. I used my old syringe which I recapped from my first attempt to practice how I would do it. Time yourself. How long does it take to empty the whole syringe? Are you going to draw the saline or the dextrose(glucose) first? Do you have somewhere to put the wraps away? Your bin? A box? Do you know how to properly recap a needle? You need to ask yourself these questions. Make sure the syringe works before doing anything. Also, make sure you don’t mix the vials or else you may not know how much % of dextrose you are using. I hope for your sake that you have learnt the anatomy of the area you are injecting too.

Make sure you get a draw needle, usually a blunt 18G. If for example, you were going to draw 10ml of dextrose from a vial, draw 12ml of air into the syringe and inject it into the vial. Dextrose is very hard to draw in a vacuum.

Take something such as Vitamin K2 to promote blood clotting so you don’t bleed as much. And MAKE SURE you have some sort of numbing agent such as lidocaine or whatnot. Be careful though, as lidocaine has been found to be toxic to cells. You may be more sore after it wears off but it will you help immensely in doing the prolotherapy yourself. Make sure you do not inject too much solution into a joint space or else you may rupture it/stretch it. For each ACJ, do a max of 5cc. For each SCJ maybe around 4cc. Use your own discretion.

Extra:
Use the end of a bic style pen to press into your skin to make a marking of were you will inject.
Shake the syringe lightly to mix the solution and then make sure you remove air bubbles.
Expect light resistance when injecting into a ligament/joint space
Make sure you perforate the ligament. This is when you insert the needle and thrust it in and out, but make sure the needle doesn’t come out of the skin. By doing this you create more trauma in the ligament which promotes better healing and the solution of dextrose/saline will be able to effect your ligaments more.

It’s a shame that there is so little information on this on the internet. Everything about SCJ instability and prolotherapy are scattered throughout the internet and many discussions are from decades ago. I have scoured websites looking for information and it is very hard to do so. I hope that someday someone with the same problem as me will find this thread.

Honestly, I was planning to write more but my spirit has been struck down. I cannot muster the desire to keep writing.