CORTICOSTEROID INJECTIONS VERSUS PROLOTHERAPY FOR THE TREATMENT OF LATERAL EPICONDYLITIS: A RANDOMISED-CONTROLLED TRIAL

OBJECTIVE To compare the efficacy of corticosteroid injection versus prolotherapy for the treatment of chronic lateral epicondylitis. DESIGN A prospective, randomised-controlled study. PARTICIPANTS Thirty-six subjects with clinically determined chronic ( of duration three months or longer) lateral epicondylitis were recruited. All subjects noted pain intensity levels disturbing enough to prevent involvement in activities such as kneading dough, wringing clothes, lifting heavy weights and playing racquet sports. METHODS Subjects were randomised to get either corticosteroid injection or prolotherapy for treatment of chronic lateral epicondylitis. Each subject underwent injection at baseline followed by a second injection 3 weeks later. RESULTS Analysis in both the groups demonstrated statistically significant improvements in VAS and DASH scores within the prolotherapy group having significant changes recorded from baseline to 2 months and baseline to 6 months after initial treatment. The steroid group also recorded a clinically and statistically significant change for DASH only at both 2 month and 6 month followup. Analysis and comparison of the subjects completing the study gave no significant differences between the prolotherapy and the corticosteroid group for change in VAS or DASH, although at 1 year followup, 2 patients out of 20 patients reported sometimes pain in corticosteroid group while nobody reported pain in prolotherapy group. The study lacked sufficient power to draw conclusions from this finding. Aside from injection-associated pain, no other adverse reactions were documented. CONCLUSIONS Both corticosteroid and prolotherapy therapy were generally well tolerated and showed to provide benefit of short duration, however, prolotherapy gets preference on long term. Small sample size precludes determining whether one therapy is advantageous to the other. Larger controlled trials appear feasible and justified on the basis of these findings.