College
Rowan-Virtua School of Osteopathic Medicine
Keywords
Lateral Epicondylitis, Musculoskeletal Injury, Hyaluronic Acid, Dextrose Prolotherapy, Injection Therapies
Date of Presentation
5-2-2024 12:00 AM
Poster Abstract
Background: Lateral epicondylitis (LE), commonly referred to as tennis elbow, is characterized by micro-tears to the tendon origin that attaches to the outer portion of the elbow, with the extensor carpi radialis brevis being the most commonly affected tendon. It presents most often amongst manual workers and athletes that participate in repetitive movements. Patients may experience burning and aching sensations that can potentially radiate down to the wrist. Hyaluronic acid is a primary component of synovial fluid and has anti-inflammatory properties and also provides lubrication to joints. Prolotherapy involves injection of an irritant, most commonly dextrose, into the common extensor origin space to stimulate the body’s natural immune response and induce proliferation of new cells. Both hyaluronic acid and prolotherapy injections have proven to be an effective treatment for lateral epicondylitis.
Purpose: This systematic review and meta-analysis compares the effectiveness of hyaluronic acid and dextrose prolotherapy injections in the treatment of lateral epicondylitis 4 weeks and 12 weeks post-injection.
Methods: The systematic review and meta-analysis followed the 2020 PRISMA guidelines. Five databases were screened (PubMed, Embase, Web of Science, Cochrane Library, Scopus) for studies that utilized either hyaluronic acid or dextrose prolotherapy. A total of 8 studies contained pre- and post-treatment Visual Analogue Scale (VAS) or Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH). All included studies contained follow up data up to 12 weeks post-injection. 2 dextrose prolotherapy studies contained 1 year VAS follow-up data and were excluded as there were no HA comparison group with 1 year data. The remaining studies consisted of 4 double-blinded, 3 single-blinded randomized controlled trials (RCTs) and 1 prospective clinical trial with a total of 427 for final analysis. Statistical analyses were performed using SPSS.
Results: Following treatment of the dextrose prolotherapy injections, there was a strong clinically significant decrease in VAS at 12 weeks compared to the hyaluronic acid injection (Cohen’s d = 3.31). Within the HA subgroup, there was slight improvement in VAS scores between 4 and 12 weeks (Difference of Cohen’s d = 0.86). Within the dextrose prolotherapy subgroup, there was significant improvement in VAS scores between 4 and 12 weeks (Cohen’s d = 4.15). No significant difference was identified for QuickDash scores between the two treatment modalities at 12 weeks.
Conclusion: While HA had a slight increase in VAS scores between 4 and 12 weeks, dextrose prolotherapy showed a significant improvement in VAS scores over the same time period. Throughout the studies analyzed, both injection therapies produced similar results at 4 weeks, with clinically significant improvements VAS scores seen at 12 weeks following dextrose prolotherapy.
Disciplines
Alternative and Complementary Medicine | Anesthesia and Analgesia | Medicine and Health Sciences | Musculoskeletal Diseases | Orthopedics | Pathological Conditions, Signs and Symptoms | Sports Medicine | Surgery | Surgical Procedures, Operative | Therapeutics | Wounds and Injuries
DOI
10.31986/issn.2689-0690_rdw.stratford_research_day.214_2024
Included in
Alternative and Complementary Medicine Commons, Anesthesia and Analgesia Commons, Musculoskeletal Diseases Commons, Orthopedics Commons, Pathological Conditions, Signs and Symptoms Commons, Sports Medicine Commons, Surgery Commons, Surgical Procedures, Operative Commons, Therapeutics Commons, Wounds and Injuries Commons
Comparing the Effectiveness of Hyaluronic Acid and Dextrose Prolotherapy Injections in the Treatment of Lateral Epicondylitis: A Systematic Review and Meta-Analysis
Background: Lateral epicondylitis (LE), commonly referred to as tennis elbow, is characterized by micro-tears to the tendon origin that attaches to the outer portion of the elbow, with the extensor carpi radialis brevis being the most commonly affected tendon. It presents most often amongst manual workers and athletes that participate in repetitive movements. Patients may experience burning and aching sensations that can potentially radiate down to the wrist. Hyaluronic acid is a primary component of synovial fluid and has anti-inflammatory properties and also provides lubrication to joints. Prolotherapy involves injection of an irritant, most commonly dextrose, into the common extensor origin space to stimulate the body’s natural immune response and induce proliferation of new cells. Both hyaluronic acid and prolotherapy injections have proven to be an effective treatment for lateral epicondylitis.
Purpose: This systematic review and meta-analysis compares the effectiveness of hyaluronic acid and dextrose prolotherapy injections in the treatment of lateral epicondylitis 4 weeks and 12 weeks post-injection.
Methods: The systematic review and meta-analysis followed the 2020 PRISMA guidelines. Five databases were screened (PubMed, Embase, Web of Science, Cochrane Library, Scopus) for studies that utilized either hyaluronic acid or dextrose prolotherapy. A total of 8 studies contained pre- and post-treatment Visual Analogue Scale (VAS) or Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH). All included studies contained follow up data up to 12 weeks post-injection. 2 dextrose prolotherapy studies contained 1 year VAS follow-up data and were excluded as there were no HA comparison group with 1 year data. The remaining studies consisted of 4 double-blinded, 3 single-blinded randomized controlled trials (RCTs) and 1 prospective clinical trial with a total of 427 for final analysis. Statistical analyses were performed using SPSS.
Results: Following treatment of the dextrose prolotherapy injections, there was a strong clinically significant decrease in VAS at 12 weeks compared to the hyaluronic acid injection (Cohen’s d = 3.31). Within the HA subgroup, there was slight improvement in VAS scores between 4 and 12 weeks (Difference of Cohen’s d = 0.86). Within the dextrose prolotherapy subgroup, there was significant improvement in VAS scores between 4 and 12 weeks (Cohen’s d = 4.15). No significant difference was identified for QuickDash scores between the two treatment modalities at 12 weeks.
Conclusion: While HA had a slight increase in VAS scores between 4 and 12 weeks, dextrose prolotherapy showed a significant improvement in VAS scores over the same time period. Throughout the studies analyzed, both injection therapies produced similar results at 4 weeks, with clinically significant improvements VAS scores seen at 12 weeks following dextrose prolotherapy.
