Injection Therapy in Patients With Lateral Epicondylitis
Condition: Lateral Epicondylitis; Tennis Elbow
MeSH terms: Tennis Elbow
Study type: Interventional

Summary: 
      Lateral epicondylitis is a painful enthesopathy of the common extensor tendon at the lateral
      part of the elbow, with a prevalence of 1-3 % in the general population. In the treatment of
      lateral epicondylitis, the role of biological-based therapies has begun to investigate
      regeneration and optimize tendon healing. Prolotherapy (PrT) and hyaluronic acid (HA)
      injections are biological based treatments. Previous studies have shown benefit of PrT in the
      treatment of tendinopathies. Preliminary findings demonstrated that HA could be clinically
      effective in the treatment of enthesopathies. Considering the paucity of HA studies (which
      also lack a control group) and the proposed mechanism of action of both PrT and HA is through
      cell proliferation and the healing process of tendons, this study was conducted to compare
      the effect of PrT and HA in chronic lateral epicondylitis .
    

Detailed description: 
      Lateral epicondylitis and other chronic tendinopathies are now understood to be
      non-inflammatory conditions characterized by collagen degeneration, fibroblast proliferation,
      mucoid degeneration and neovascularization Biological-based treatments can trigger the
      release of cytokines and growth factors from platelets, leukocytes, macrophages and other
      inflammatory cells. These growth factors support neovascularization and the chemotaxis of
      fibroblasts and tenocytes. It stimulates proliferation and collagen remodeling of fibroblasts
      and tenocytes.

      PrT involves multiple injections of a small amount of irritant or sclerosing solution. Common
      irritants include hypertonic dextrose, phenol-glycerin-glucose and sodium morrhuate. PrT
      injection mechanism is as follows; while hypertonic dextrose causes cell rupture through
      osmosis, monosodium morrhuate attracts inflammatory mediators and improves blood flow of the
      diseased tendon.Previous studies have shown benefit of PrT in the treatment of tendinopathies
      HA injection is a treatment method that increases the ability of sliding with its
      viscoelastic properties, reduces tendon surface friction and accelerates regeneration. In
      vitro models suggest that HA can increase collagen I production and accumulation with a
      dose-dependent positive collagen I / collagen III ratio. However, controlled randomised
      studies are still needed.

      Mechanism of action of both PrT and HA is cell proliferation and the healing process of
      tendons, this study was conducted to compare the effect of PrT and HA in chronic lateral
      epicondylitis .
    

Intervention name(s): Hyaluronic Acid; Prolotherapy
Intervention type(s): Drug; Biological
Intervention description(s): Patients were infiltrated with injection single dose 30 mg/2 ml 1500 kilodalton high molecular weight hyaluronic acid at the lateral epicondyle according to the standard technique.; Patients were infiltrated with 5cc of dextrose 15% at the lateral epicondyle according to the standard technique. For solution, 1 cc 2% lidocaine, 5 cc 30% hypertonic dextrose and 4 cc 0.9 % isotonic were used.
Other intervention name(s): Prostrolane
Intervention MeSH terms: Hyaluronic Acid
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Lateral epicondylitis; Prolotherapy; Hyaluronic acid