Comparison of ESWT and Single-Session 5% Dextrose Prolotherapy in Lateral Epicondylitis

Comparison of the Effectiveness of Extracorporeal Shock Wave Therapy and 5% Dextrose Prolotherapy in Patients With Lateral Epicondylitis: A Prospective Randomized Controlled Trial

Lateral epicondylitis is a common musculoskeletal disorder associated with pain and impaired upper extremity function. The aim of this study was to compare the effectiveness of extracorporeal shock wave therapy (ESWT) and single-session 5% dextrose prolotherapy (DPT) in patients with lateral epicondylitis and to evaluate the relative superiority of these treatment approaches during short- and mid-to-long-term follow-up. Ninety-six patients were allocated into three groups: conventional treatment alone, conventional treatment plus ESWT, and conventional treatment plus DPT. Pain, functional status, grip strength, and common extensor tendon thickness were evaluated during follow-up.

Lateral epicondylitis is a common musculoskeletal disorder associated with pain, reduced grip strength, and impaired upper extremity function. This study aimed to compare the effectiveness of extracorporeal shock wave therapy (ESWT) and single-session 5% dextrose prolotherapy (DPT) in patients with lateral epicondylitis and to evaluate their relative effectiveness during short- and mid-to-long-term follow-up.

Ninety-six patients were allocated into three groups: conventional treatment alone, conventional treatment plus ESWT, and conventional treatment plus DPT. Conventional treatment consisted of home exercise and splinting. ESWT was applied in 3 sessions (2000 pulses, 0.15 mJ/mm²), while the DPT group received a single ultrasound-guided 5% dextrose injection.

Primary outcomes included Visual Analog Scale pain scores for rest, night pain, resisted wrist extension, and grip pain. Secondary outcomes included QuickDASH, PRTEE, grip strength measured with a Jamar dynamometer, and ultrasonographic assessment of common extensor tendon thickness. Clinical assessments were performed at baseline, 1, 3, and 6 months.

Inclusion Criteria:

• Adults aged 18-75 years
• Clinical and ultrasonographic diagnosis of lateral epicondylitis
• Symptoms persisting for at least 3 months
• Visual Analog Scale (VAS) score ≥4
• Resistance to previous medical treatment
• Ability to comply with study procedures and complete questionnaires

Exclusion Criteria:

• Injection treatment for lateral epicondylitis within the previous 3 months
• History of trauma within the previous 3 months
• Cervical disc herniation
• Median or ulnar tunnel neuropathy
• Medial epicondylitis
• Anticoagulant therapy use
• Pregnancy or breastfeeding
• Psychiatric disorders or cognitive impairment interfering with questionnaire -completion
• Allergy to the treatment solution
• History of upper extremity surgery or fracture
• Rheumatoid arthritis
• Connective tissue diseases such as dermatomyositis