Advertisement

Is Low-Dose Dextrose Prolotherapy as Effective as High-Dose Dextrose Prolotherapy in the Treatment of Lateral Epicondylitis? A Double-Blind, Ultrasound Guided, Randomized Controlled Study

Published:October 12, 2022DOI:https://doi.org/10.1016/j.apmr.2022.09.017

      Abstract

      Objectives

      To investigate the effects of prolotherapy (PrT) on pain, functionality, clinical improvement and to compare the 5% low and 15% high dose dextrose PrT in chronic lateral epicondylitis.

      Design

      A double-blind, parallel groups, randomized controlled study.

      Settings

      Outpatient Clinic.

      Participants

      Sixty patients (N=60), aged 44.30±10.31 years old, with chronic lateral epicondylitis were allocated randomly into 3 groups.

      Interventions

      To Group 1 5% dextrose PrT, to Group 2 15% dextrose PrT, to Group 3 0.9% saline injections were done at 3 times (weeks 0, 3, 6), to the entheses of forearm extensors and annular ligament.

      Main Outcome Measures

      The primary outcomes were handgrip strength, visual analog scale-rest (VAS-R), visual analog scale-activity (VAS-A), pressure-pain threshold, and Quick Disability of the Arm, Shoulder and Hand (Q-DASH). The secondary outcomes were clinical improvement (Disease Global Assessment Questionnaire), side effects, and complications. Primary outcomes were collected at baseline week 0, week 3, and 12. Secondary outcomes were collected at weeks 3 and 12.

      Results

      In Group 2, VAS-A and VAS-R (at week 3), handgrip strength and pressure-pain threshold (at week 12) were significantly different than other groups (P<.05). In Groups 1 and 2, there was a difference in primary outcomes at week 12 than baseline (P<.05). In Group 3, there was no difference in VAS-R, VAS-A, and handgrip strength at weeks 3 and 12 than baseline (P>.05).

      Conclusion

      In chronic lateral epicondylitis, 5% and 15% dextrose PrT is more effective in pain, handgrip strength, functionality, and clinical improvement than %0.9 saline. There was no difference in functionality, clinical improvement, side effects, and complications between the PrT groups. 15% dextrose PrT was more effective in handgrip strength and pressure-pain threshold at week 12 and pain at week 3. We recommend 15% dextrose PrT based on this study.

      Keywords

      List of abbreviations:

      DGAQ (Disease Global Assessment Questionnaire), PrT (prolotherapy), Q-DASH (Quick Disability of the Arm, Shoulder and Hand), VAS-A (visual analog scale-activity), VAS-R (visual analog scale-rest)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Krogh T
        • Fredberg U
        • Ammitzbøl C
        • Ellingsen T.
        Ultrasonographic characteristics of the common extensor tendon of the elbow in asymptomatic individuals: thickness, color doppler activity, and bony spurs.
        Orthop J Sports Med. 2017; 52325967117704186
        • Sayampanathan AA
        • Basha M
        • Mitra AK.
        Risk factors of lateral epicondylitis: a meta-analysis.
        Surgeon. 2020; 18: 122-128
        • Silverstein B
        • Welp E
        • Nelson N
        • Kalat J.
        Claims incidence of work-related disorders of the upper extremities: Washington state, 1987 through 1995.
        Am J Public Health. 1998; 88: 1827-1833
        • Duncan J
        • Duncan R
        • Bansal S
        • Davenport D
        • Hacker A.
        Lateral epicondylitis: the condition and current management strategies.
        Br J Hosp Med (Lond). 2019; 80: 647-651
        • Wadsworth TG.
        Tennis elbow: conservative, surgical, and manipulative treatment.
        Br Med J (Clin Res Ed). 1987; 294: 621-624
        • Rabago D
        • Lee KS
        • Ryan M
        • et al.
        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; 92: 587-596
        • Rabago D
        • Slattengren A
        • Zgierska A.
        Prolotherapy in primary care practice.
        Prim Care. 2010; 37: 65-80
        • Sims SEG
        • Miller K
        • Elfar JC
        • Hammert WC.
        Non-surgical treatment of lateral epicondylitis: a systematic review of randomized controlled trials.
        Hand (N Y). 2014; 9: 419-446
        • Chiarotto A
        • Maxwell LJ
        • Ostelo RW
        • Boers M
        • Tugwell P
        • Terwee CB.
        Measurement properties of visual analogue scale, numeric rating scale, and pain severity subscale of the brief pain inventory in patients with low back pain: a systematic review.
        J Pain. 2019; 20: 245-263
        • Roberts HC
        • Denison HJ
        • Martin HJ
        • et al.
        A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach.
        Age Ageing. 2011; 40: 423-429
        • Somprasong S
        • Mekhora K
        • Vachalathiti R
        • Pichaiyongwongdee S.
        Correlation between pressure pain threshold and soft tissue displacement in muscle pain conditions.
        J Med Assoc Thai. 2015; 98: S68-S73
        • Endicott J
        • Spitzer RL
        • Fleiss JL
        • Cohen J.
        The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance.
        Arch Gen Psychiatry. 1976; 33: 766-771
        • Cuschieri S.
        The CONSORT statement.
        Saudi J Anaesth. 2019; 13: S27-S30
        • Oh S
        • Ettema AM
        • Zhao C
        • et al.
        Dextrose-induced subsynovial connective tissue fibrosis in the rabbit carpal tunnel: a potential model to study carpal tunnel syndrome?.
        Hand. 2008; 3: 34-40
        • Scarpone M
        • Rabago DP
        • Zgierska A
        • Arbogast G
        • Snell E.
        The efficacy of prolotherapy for lateral epicondylosis: a pilot study.
        Clin J Sport Med. 2008; 18: 248-254
        • Yelland M
        • Rabago D
        • Ryan M
        • et al.
        Prolotherapy injections and physiotherapy used singly and in combination for lateral epicondylalgia: a single-blinded randomised clinical trial.
        BMC Musculoskelet Disord. 2019; 20: 509
        • Goh S-L
        • Jaafar Z
        • Gan Y-N
        • et al.
        Efficacy of prolotherapy in comparison to other therapies for chronic soft tissue injuries: a systematic review and network meta-analysis.
        PLoS One. 2021; 16e0252204
        • Park JH
        • Song IS
        • Lee JB
        • et al.
        Ultrasonographic findings of healing of torn tendon in the patients with lateral epicondylitis after prolotherapy.
        J Korean Soc Med Ultrasound. 2003; 22: 177-183
        • Chung MW
        • Hsu CY
        • Chung WK
        • Lin YN.
        Effects of dextrose prolotherapy on tendinopathy, fasciopathy, and ligament injuries, fact or myth? A systematic review and meta-analysis.
        Medicine (Baltimore). 2020; 99: e23201
        • Woo MS
        • Park J
        • Ok SH
        • et al.
        The proper concentrations of dextrose and lidocaine in regenerative injection therapy: in vitro study.
        Korean J Pain. 2021; 34: 19-26
        • Tang JB
        • Xu Y
        • Ding F
        • Wang XT.
        Tendon healing in vitro: promotion of collagen gene expression by bFGF with NF-kappaB gene activation.
        J Hand Surg Am. 2003; 28: 215-220
        • Güran Ş
        • Çoban ZD
        • Karasimav Ö
        • et al.
        Dextrose solution used for prolotherapy decreases cell viability and increases gene expressions of angiogenic and apopitotic factors.
        Gulhane Med J. 2018; 60: 42
        • Dechow E
        • Davies RK
        • Carr AJ
        • Thompson PW.
        A randomized, double-blind, placebo-controlled trial of sclerosing injections in patients with chronic low back pain.
        Rheumatology (Oxford). 1999; 38: 1255-1259
        • Reeves KD
        • Hassanein K.
        Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity.
        Altern Ther Health Med. 2000; 6 (77-80): 68-74
        • Bayat M
        • Raeissadat SA
        • Babaki MM
        • Rahimi-Dehgolan S.
        Is dextrose prolotherapy superior to corticosteroid injection in patients with chronic lateral rpicondylitis?: a randomized clinical trial.
        Orthop Res Rev. 2019; 11: 167-175
        • Lyftogt J.
        Pain conundrums: which hypothesis? Central nervous system sensitization versus peripheral nervous system autonomy.
        Australas Musculoskeletal Med. 2008; 13: 2
        • Maniquis-Smigel L
        • Dean Reeves K
        • Rosen HJ
        • Lyftogt J
        Analgesic effect of caudal 5% dextrose in water in chronic low back pain. a randomized controlled trial of epidural injection.
        Anesth Pain Med. 2016; 7: e42550
        • Drucker M
        • Cardenas E
        • Arizti P
        • Valenzuela A
        • Gamboa A.
        Experimental studies on the effect of lidocaine on wound healing.
        World J Surg. 1998; 22 (discussion 397-8): 394-397
        • Solmaz I
        • Orscelik A
        • Koroglu O.
        Modified prolotherapy by 5% dextrose: Two years experiences of a traditional and complementary medicine practice center in Turkey.
        J Back Musculoskelet Rehabil. 2022; 35: 763-770
        • Nguyen RT
        • Borg-Stein J
        • McInnis K.
        Applications of platelet-rich plasma in musculoskeletal and sports medicine: an evidence-based approach.
        PM R. 2011; 3: 226-250
        • Pereira PJS
        • Lerner EA.
        Gate control theory springs a leak.
        Neuron. 2017; 93: 723-724
        • Acosta-Olivo CA
        • Millán-Alanís JM
        • Simental-Mendía LE
        • et al.
        Effect of normal saline injections on lateral epicondylitis symptoms: a systematic review and meta-analysis of randomized clinical trials.
        Am J Sports Med. 2020; 48: 3094-3102