Lateral epicondylosis (“tennis elbow”) is an important condition of the upper extremity with an incidence of 4–7/1000 patients per year in primary care settings. Its greatest impact is on people with repetitive and high-load upper extremity tasks and on athletes. The most common cause of tennis elbow may repetition activities such as keyboarding, though formal data is lacking The term “lateral epicondylitis” is often used indiscriminately to refer to chronic overuse lateral elbow injury. However, the majority of overuse tendon injuries show no histopathologic evidence of inflammatory cells. Rather, they are chronic degenerative conditions. Therefore, “lateral epicondylosis” is the preferred term. While many non-surgical therapies have been tested for tennis elbow refractory to conservative measures, we provide Prolotherapy/Prolozone treatments to reduce the pain and inflammation that is caused by tennis elbow.
Prolotherapy (PrT) is an injection-based treatment for tennis elbow including tendinopathy. Dextrose (a form of glucose) and sodium morrhuate (an extract of cod liver oil) are two common PrT injectants. Animal model studies suggest PrT using dextrose and sodium morrhuate may enlarge and strengthen ligament and tendon insertions, though the precise mechanism is unclear. (Jensen 2007 Unpublished data) Injection protocols were formalized in the 1950s by George Hackett, MD, a general surgeon in the US. Treatment generally includes injection of a tender tendon and ligament attachments, with small volumes of proliferant solution, in 3 to 5 treatment sessions at monthly intervals. Anecdotal reports indicate PrT is used in Sport Medicine Physicians, Primary Care Providers and Chiropractors for a variety of musculoskeletal conditions and not only for tennis elbow. (Rabago Unpublished data) Several human randomized controlled trials (RCTs) assessing PrT have reported positive outcomes for low back pain compared to baseline status and to control subjects, and for osteoarthritis, though methodological quality has varied. No RCT has assessed PrT for any tendinopathy. We therefore conducted a double-blind RCT to test the hypotheses that PrT decreases elbow pain, improves resting grip strength and improves isometric elbow extension strength in adults with tennis elbow refractory to standard of care therapy.
Dr. Philipose has been treating lateral epicondylitis for over 22 years and has tremendous success using prolotherapy and dry needling. For more information, call Dr. Philipose at 405-848-7246.