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This Journal Club Podcast is brought to you by Association of Academic Physiatrists and features research published in the American Journal of Physical Medicine & Rehabilitation.

Dr. David (DJ) Kennedy interviews Dr. David Rabago, author of the article entitled "Hypertonic Dextrose and Morrhuate Sodium Injections (Prolotherapy) for Lateral Epicondylosis (Tennis Elbow)." 

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. 

CONTRIBUTORS

• David Rabago, MD

Dr. Rabago is an assistant professor at the UW School of Medicine and Public Health, Department of Family Medicine. He divides his professional time between clinical and research activities. He has an active full spectrum continuity clinic. He is also active in teaching and clinical research. After residency training, Dr. Rabago received research training through a National Institutes of Health grant. His primary interest is therapy for chronic common musculoskeletal injury. Dr. Rabago is actively involved in the assessment of prolotherapy and other injection therapies for knee osteoarthritis and tendinopathy, and is the author of several peer reviewed publications in this area