Prolotherapy for Chronic Tennis Elbow?
This study looked at 26 adults (32 elbows in total) with chronic lateral epicondylosis. Patients followed up at 4, 8, and 16 weeks after initial assessment to assess change. The study was a three-arm RCT comparing two prolotherapy groups (dextrose, or sodium morrhuate), and a control group (watchful waiting). Improvement was assessed primarily by the Patient-Rated Tennis Elbow Evaluation (out of 100 points), and secondarily through pain-free grip strength and MRI scores.
Patients receiving either prolotherapy treatment reported a statistically significant improvement at 4, 8, and 16 weeks compared to the control, and at 16 weeks the PRTEE score was improved by 18.7 (9.6, 41.1%) , and 17.5 (11.6, 53.5%) points for dextrose, and sodium morrhuate respectively. Overall, patient satisfaction was high in the prolotherapy groups, with no adverse outcomes. MRI scores were no different between groups however the improvement of grip strength noted in the prolotherapy groups was greater in the group receiving dextrose.
The proposed mechanism of prolotherapy's actions centres around a chemical irritant promoting localized inflammation, granulocyte and macrophage infiltration, and the subsequent release of cytokines and growth factors promoting cellular proliferation and collagen deposition. Tendinosis appears to be a degenerative process characterized by the presence of dense populations of fibroblasts, vascular hyperplasia, and disorganized collagen which explains why prolotherapy is an effective treatment for chronic tennis elbow and similar injuries.
Source: Rabago, D et al. Hypertonic Dextrose and Morrhuate Sodium Injections (Prolotherapy) for Lateral Epicondylosis (Tennis Elbow): Results of a Single-blind, Pilot-Level, Randomized Controlled Trial
http://www.ncbi.nlm.nih.gov/pubmed/23291605
Additional reading: http://www.ncbi.nlm.nih.gov/pubmed/22972856