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Article Type

Original Study

Abstract

Background Lateral epicondylitis (LE) is the most common condition of elbow pain. Multiple intralesional steroid injections help in the treatment. Prolotherapy is a traditional injection method recently categorized as regenerative treatment. However, there is scarcity of literature that compares its effectiveness with steroids. Objective The aim was to compare the effectiveness of dextrose prolotherapy (DP) against local steroid injection in patients with LE in relieving pain and improving dysfunction. Participants and methods This parallel, randomized controlled trial was conducted at Outpatient Department, National Institute for Locomotor Disabilities (Divyangjan), (erstwhile National Institute for the Orthopaedically Handicapped) Kolkata, from January 2016 to January 2017. Patients with the clinical diagnosis of LE (in clinical stages 2, 3, and 4) were allocated to receive either DP (group A) or local steroid injection (group B). A total of 34 participants aged between 18 and 60 years who had symptoms for greater than or equal to 4 weeks was included. Injections were given to each patient at 0, 4, and 8 weeks. Data were collected at baseline and followed up at the fourth, eighth, and 16th weeks. The two interventions' differential response was recorded in terms of pain [visual analog scale (VAS)], upper-extremity activities (DASH; disabilities of the arm, shoulder and hand scale), and the pain-free grip strength (PFGS). Results Both groups A and B showed significant improvement (P < 0.05) in VAS, DASH, and PFGS at follow-ups compared with baseline. Compared with group B, at 4 weeks, group A had no statistically significant differences in the VAS (53.6 ± 12.6 vs 51.3 ± 15.5, P = 0.65), DASH score (26.2 ± 14.6 vs 26.7 ± 15.6, P = 0.93), and PFGS (16.3 ± 8.7 vs 12.3 ± 5.4, P = 0.14). Compared with group B, at 8 weeks, no statistically significant differences in the VAS (n = 15, difference of mean 0.4, 95% confidence interval [−7.4 to 8.2], P = 0.9), DASH (n = 15, 3.5 [−5.2 to 12.2], P = 0.4), and PFGS (n = 15, 4.7 [−0.8 to 10.2], P = 0.1) were noted between two groups. However, at 16 weeks, compared with group B, group A patients showed significant better improvement in VAS (n = 15, 14.0 [7.0–20.9], P = 0.0001) and PFGS (n = 15, 8.4 [2.3–14.5], P = 0.009) but not in DASH (n = 15, 8.4 [2.3–14.5], P = 0.4). Conclusions DP showed superiority in reducing LE pain and improving the grip strength as compared with local steroid injection. However, prolotherapy was associated with increased pain around the injection site in the first 48 h and transient weakness of wrist extensors (about 10 min) because of local spread of lignocaine in the common extensor-origin muscles, which was conservatively managed.

Keywords

Functional impairment, lateral epicondylitis, prolotherapy, steroid injection

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