What kinds of diagnostic studies are required before regenerative prolotherapy?

X-rays can rule out osseous fractures, and identify calcific tendinosis. Arthroscopy is invasive and often is a prelude to surgical removal of tissue. The study by Moseley on arthroscopic surgery for osteoarthritis of the knee demonstrated that surgery fails to provide benefit except in a select few patients on whom it is performed.

What about an MRI or arthroscopy for diagnosis?

I don't want to bring down other therapies, but in my mind a diagnostic study must make logical sense and be cost effective if it has a chance of helping patients. In my experience, many if not most of the patients who undergo an MRI of their knee or shoulder will end up with arthroscopic surgery. Most who undergo exploratory surgery will end up with cartilage removed. The reason for this is that while MRI is a very sensitive way to detect abnormalities of the joints, it does not have the specificity to distinguish whether the common abnormalities are actually causing the patient's pain or dysfunction. In other words, the vast majority of patients who undergo MRI will end up with arthroscopy and “cleaning up” of the cartilage. When the cartilage is removed, degenerative forces are accelerated, and a worsening of the condition often occurs. The only double-blind placebo controlled study of arthroscopic knee surgery I am aware of was conducted by researchers at Baylor University, and failed to find any statistical difference in outcome at any time over a 2 year follow-up period. So why bother spending $20,000 for a procedure that has been shown to be ineffective?

(See the full text article under Moseley, et al)