Hypertonic dextrose and morrhuate sodium injections (prolotherapy) for lateral epicondylosis (tennis elbow): results of a single-blind, pilot-level, randomized controlled trial.

Abstract

OBJECTIVE:

Chronic lateral epicondylosis is common, debilitating, and often refractory. Prolotherapy (PrT) is an injection therapy for tendinopathy. The efficacy of two PrT solutions for chronic lateral epicondylosis was evaluated.

DESIGN:

This study is a three-arm randomized controlled trial. Twenty-six adults (32 elbows) with chronic lateral epicondylosis for 3 mos or longer were randomized to ultrasound-guided PrT with dextrose solution, ultrasound-guided PrT with dextrose-morrhuate sodium solution, or watchful waiting ("wait and see"). The primary outcome was the Patient-Rated Tennis Elbow Evaluation (100 points) at 4, 8, and 16 wks (all groups) and at 32 wks (PrT groups). The secondary outcomes included pain-free grip strength and magnetic resonance imaging severity score.

RESULTS:

The participants receiving PrT with dextrose and PrT with dextrose-morrhuate reported improved Patient-Rated Tennis Elbow Evaluation composite and subscale scores at 4, 8, and/or 16 wks compared with those in the wait-and-see group (P < 0.05). At 16 wks, compared with baseline, the PrT with dextrose and PrT with dextrose-morrhuate groups reported improved composite Patient-Rated Tennis Elbow Evaluation scores by a mean (SE) of 18.7 (9.6; 41.1%) and 17.5 (11.6; 53.5%) points, respectively. The grip strength of the participants receiving PrT with dextrose exceeded that of the PrT with dextrose-morrhuate and the wait and see at 8 and 16 wks (P < 0.05). There were no differences in magnetic resonance imaging scores. Satisfaction was high; there were no adverse events.

CONCLUSIONS:

PrT resulted in safe, significant improvement of elbow pain and function compared with baseline status and follow-up data and the wait-and-see control group. This pilot study suggests the need for a definitive trial.

• Authors: David Rabago, Ken S Lee, Michael Ryan, Amrish O Chourasia, Mary E Sesto, Aleksandra Zgierska, Rick Kijowski, Jessica Grettie, John Wilson, Daniel Miller
• Journal: American journal of physical medicine & rehabilitation (Am J Phys Med Rehabil) Vol. 92 Issue 7 Pg. 587-96 (Jul 2013) ISSN: 1537-7385 [Electronic] United States
• PMID: 23291605 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• Glucose Solution, Hypertonic
• Sodium Morrhuate

Topics

• Adult
• Chronic Disease
• Drug Therapy, Combination
• Female
• Follow-Up Studies
• Glucose Solution, Hypertonic (therapeutic use)
• Humans
• Injections, Intra-Articular
• Male
• Middle Aged
• Pain Measurement
• Pilot Projects
• Quality of Life
• Range of Motion, Articular (drug effects, physiology)
• Reference Values
• Risk Assessment
• Severity of Illness Index
• Single-Blind Method
• Sodium Morrhuate (therapeutic use)
• Tennis Elbow (diagnostic imaging, drug therapy)
• Treatment Outcome
• Ultrasonography, Doppler