Extensor tendinitis: (See extensor tendinosis)
Tennis Elbow: (See extensor tendinosis)
Extensor tendinosis: Dex and Sodium morrhuate: Scarpone et al 2008
Injection of combination of sodium morrhuate (.72%) and dextrose (10.7%) on 3 occasions in patients with tennis elbow (lateral epicondylosis) resulted in marked improvement in pain, wrist extension and grip strenth in comparision to injection of saline. Scarpone M, Rabago DP, Zgierska A, Arbogast G, Snell E. The efficacy of prolotherapy for lateral epicondylosis: a pilot study [In Process Citation] Clin J Sport Med (United States), May 2008, 18(3) p248-54
Dr Scarpone et al reported this year in a randomized and controlled study that 12 adults with lateral epicondylosis injected at 0, 1 and 3 months with 0.72% sodium morrhuate, 10.7% dextrose, .29% lidocaine and .04% sensorcaine improved far more in pain levels (91% versus 33%; P < .001) and extension strength (P < .01) and grip strength (P < .05) than 12 subjects given saline injection with the same number of needle punctures and volume. Note this is despite the fact that saline injection is not a placebo, suggesting that saline injection is indeed not equivalent to injection of a combination of sodium morrhuate and dextrose. Although a small study, these results and this design are excellent. Here is that abstract. From the Department of Family Medicine, University of Wisconsin-Madison, Madison, Wisconsin.
ABSTRACT: OBJECTIVES:: To assess whether prolotherapy, an injection-based therapy, improves elbow pain, grip strength, and extension strength in patients with lateral epicondylosis. SETTING:: Outpatient Sport Medicine clinic. STUDY DESIGN:: Double-blind randomized controlled trial. PARTICIPANTS:: Twenty-four adults with at least 6 months of refractory lateral epicondylosis. INTERVENTION:: Prolotherapy participants received injections of a solution made from 1 part 5% sodium morrhuate, 1.5 parts 50% dextrose, 0.5 parts 4% lidocaine, 0.5 parts 0.5% sensorcaine and 3.5 parts normal saline. Controls received injections of 0.9% saline. Three 0.5-ml injections were made at the supracondylar ridge, lateral epicondyle, and annular ligament at baseline and at 4 and 8 weeks. OUTCOME MEASURES:: The primary outcome was resting elbow pain (0 to 10 Likert scale). Secondary outcomes were extension and grip strength. Each was performed at baseline and at 8 and 16 weeks. One-year follow-up included pain assessment and effect of pain on activities of daily living. RESULTS:: The groups were similar at baseline. Compared to Controls, Prolotherapy subjects reported improved pain scores (4.5 +/- 1.7, 3.6 +/- 1.2, and 3.5 +/- 1.5 versus 5.1 +/- 0.8, 3.3 +/- 0.9, and 0.5 +/- 0.4 at baseline and at 8 and 16 weeks, respectively). At 16 weeks, these differences were significant compared to baseline scores within and among groups (P < 0.001). Prolotherapy subjects also reported improved extension strength compared to Controls (P < 0.01) and improved grip strength compared to baseline (P < 0.05). Clinical improvement in Prolotherapy group subjects was maintained at 52 weeks. There were no adverse events. CONCLUSIONS:: Prolotherapy with dextrose and sodium morrhuate was well tolerated, effectively decreased elbow pain, and improved strength testing in subjects with refractory lateral epicondylosis compared to Control group injections.
Extensor Tendinosis: PRP: Mishra et al 2006. Treatment of tennis elbow.
141 consecutive patients with elbow epicondylar pain. All failed a standardized physical therapy protocol and a variety of other nonoperative treatments. Either PRP injection of bupivicaine with 15 in the active group and 5 in the control group. Only 8 week followup with 60% improvement versus 16% in control. (Non blinded control). At 6 months 81% improvement. (All patients included) and at 12 months minimum 93% improvement. Blinding did not occur at IRB request, accounting in part of the very small control group. All had pain over medial or lateral epicondyle (14/15 lateral) and pain at the elbow with resistance of either resisted flexion or extension respectively. The number of patients that were able to be contacted was not mentioned. Nevertheless results were impressive. Noted is that a blinded clinical trial was approved and status of this is not clear. MIshra A, Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. American Journal of Sports Medicine Dec 2006 Volume 34: 1774-1778