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

Am J Phys Med Rehabil. 2013 Jul;92(7):587-96. doi: 10.1097/PHM.0b013e31827d695f.

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.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • 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*
  • Range of Motion, Articular / physiology
  • Reference Values
  • Risk Assessment
  • Severity of Illness Index
  • Single-Blind Method
  • Sodium Morrhuate / therapeutic use*
  • Tennis Elbow / diagnostic imaging
  • Tennis Elbow / drug therapy*
  • Treatment Outcome
  • Ultrasonography, Doppler

Substances

  • Glucose Solution, Hypertonic
  • Sodium Morrhuate