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local anesthetic applied Injection Points: Typically include the AC joint capsule and coracoclavicular ligament attachments Solution Used: 15-25% dextrose + 1% lidocaine or procaine Guidance: Can be done freehand or under ultrasound guidance for precision Post-Injection Care Mild soreness or swelling is expected for 13 days Avoid anti-inflammatory medications (they may blunt the desired response) Gentle range of motion exercises encouraged Physical therapy may be added at any time Treatment Frequency Prolotherapy is typically performed every 34 weeks 36 sessions are usually recommended depending on severity and how you are progressing Clinical Evidence Supporting Prolotherapy for AC Joint Injury While large randomized controlled trials are limited for AC separation specifically, prolotherapy has demonstrated efficacy in multiple musculoskeletal conditions involving ligament and joint instability: Rabago et al

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Their work includes chronic dosing studies extending to 6 weeks, comprehensive tissue examination at necropsy, and genetic toxicology assessment using standardized protocols accepted by regulatory agencies worldwide

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doi: 10.3389/fphar.2024.1392325 Received 27 February 2024 Accepted 13 August 2024 Published 23 August 2024 Volume 15 - 2024 Edited by Josipa Vlainic, Rudjer Boskovic Institute, Croatia Reviewed by Arindam Ghosh Mazumder, Baylor College of Medicine, United States Katarzyna Stachowicz, Polish Academy of Sciences, Poland Updates Copyright 2024 Hakimi Naeini, Rajabi-Maham, Azizi and Hosseini

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