title: 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.
  
  
  METHODS
  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.affiliation: Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53715, USA.
authors.forename: David
authors.initials: D
authors.lastname: Rabago
authors.forename: Ken S
authors.initials: KS
authors.lastname: Lee
authors.forename: Michael
authors.initials: M
authors.lastname: Ryan
authors.forename: Amrish O
authors.initials: AO
authors.lastname: Chourasia
authors.forename: Mary E
authors.initials: ME
authors.lastname: Sesto
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Zgierska
authors.forename: Rick
authors.initials: R
authors.lastname: Kijowski
authors.forename: Jessica
authors.initials: J
authors.lastname: Grettie
authors.forename: John
authors.initials: J
authors.lastname: Wilson
authors.forename: Daniel
authors.initials: D
authors.lastname: Miller
mesh_terms: D000328:Adult; D002908:Chronic Disease; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005950:Glucose Solution, Hypertonic / Q000627:therapeutic use*; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010865:Pilot Projects; D011788:Quality of Life; D016059:Range of Motion, Articular / Q000187:drug effects* / Q000502:physiology; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D016037:Single-Blind Method; D012976:Sodium Morrhuate / Q000627:therapeutic use*; D013716:Tennis Elbow / Q000000981:diagnostic imaging / Q000188:drug therapy*; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler
chemical_list: D005950:Glucose Solution, Hypertonic; D012976:Sodium Morrhuate