Consultant Changi General Hospital Singapore, Singapore
Objectives: Lateral epicondylitis, or tennis elbow, is a disabling overuse tendinopathy of the elbow caused by inflammation of the forearm extensors. Injectable treatments have been described when conservative management fails. We conducted a systematic review on the role of prolotherapy in this condition.
Design: We searched the PubMed and Embase databases for all randomized controlled trials that investigated prolotherapy in patients with lateral epicondylitis, supported by title searches in Google Scholar as well as the CINAHL and Web of Science databases. The outcome measures were defined as change in pain and change in disability. Articles were selected according to the PRISMA recommendations and evaluated according to the Cochrane risk of bias tool.
Results: 94 articles were found. After excluding duplicates, and screening of records as well as full texts, 7 studies (299 elbows in total) were included. 3 trials with variable quality compared prolotherapy to corticosteroid injections – 2 reported improvements in pain and disability outcomes at 12 weeks though the other did not find significant inter-group differences. 1 high-quality trial compared prolotherapy favourably to lifestyle counselling (wait-and-see approach) while another high-quality trial found prolotherapy to have better improvements in pain and elbow extension strength as compared to placebo. 2 moderate-quality trials compared prolotherapy to other interventions (shockwave therapy and physiotherapy) but it was not found to be superior in either. Meta-analysis of prolotherapy vs corticosteroid was weighed in favour of prolotherapy for change in pain (-1.40, 95% CI -3.29 to 0.50) and change in disability (-0.44, 95% -0.98 to 0.10).
Conclusions: Prolotherapy for lateral epicondylitis may confer better pain and functional improvements than corticosteroid injections, placebo, and watchful-waiting strategies, but not shockwave therapy or physiotherapy. There is a role for further evaluation of its suitability as an alternative to corticosteroid injections.