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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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Conventional Treatment + ESWT | Active Comparator | Three treatment sessions administered at weekly intervals using 2000 pulses per session at an energy flux density of 0.15 mJ/mm². |
|
| Conventional Treatment + Dextrose Prolotherapy | Active Comparator | Single-session ultrasound-guided injection of 1 mL 5% dextrose. |
|
| Conventional Treatment | Active Comparator | Splinting and home exercise program. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Conventional Treatment group | Behavioral | Splinting and home exercise program |
|
| Measure | Description | Time Frame |
|---|---|---|
| VAS Resisted Wrist Extension Pain | Pain during resisted wrist extension assessed using the Visual Analog Scale (VAS). | Baseline, 1 month, 3 months, and 6 months after treatment |
| VAS Gripping Pain | Pain intensity during gripping assessed using the Visual Analog Scale (VAS). | Baseline, 1 month, 3 months, and 6 months after treatment |
| VAS Resting Pain | Resting pain assessed using the Visual Analog Scale (VAS). | Baseline, 1 month, 3 months, and 6 months after treatment |
| VAS Night Pain | Night pain assessed using the Visual Analog Scale (VAS). | Baseline, 1 month, 3 months, and 6 months after treatment |
| Measure | Description | Time Frame |
|---|---|---|
| Quick-DASH Score | Functional disability assessed using the Quick Disabilities of the Arm, Shoulder and Hand questionnaire. The QuickDASH score ranges from 0 to 100, where 0 indicates no symptoms and normal upper extremity function, while 100 indicates the highest symptom severity and the poorest functional status. | Baseline, 1 month, 3 months, and 6 months after treatment |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| SBU Ankara Physical Medicine and Rehabilitation Training and Research Hospital Ankara, Turkey | Ankara | Cankaya | Turkey (Türkiye) |
Individual participant data will not be publicly shared due to institutional and ethical restrictions regarding patient confidentiality.
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Participants were allocated into three parallel groups: conventional treatment alone, conventional treatment plus extracorporeal shock wave therapy (ESWT), and conventional treatment plus single-session 5% dextrose prolotherapy.
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| Extracorporeal Shock Wave Therapy (ESWT) | Device | 3 sessions, weekly, 4Hz, 2000 pulses/session, 0.15 mJ/mm². |
|
| Dextrose prolotherapy (DPT) | Procedure | Single-session ultrasound-guided 1 mL 5% dextrose injection. |
|
| PRTEE Score | Functional outcome assessed using the Patient-Rated Tennis Elbow Evaluation questionnaire. The PRTEE consists of 15 items divided into two subscales: pain (5 items) and function (10 items). The total score ranges from 0 to 100, with 0 indicating no pain and normal function, and 100 indicating the highest pain severity and the poorest functional status. Higher scores reflect greater pain intensity and functional impairment. | Baseline, 1 month, 3 months, and 6 months after treatment |
| Grip Strength | Grip strength measured using a Jamar dynamometer. | Baseline and 6 months |
| Common Extensor Tendon Thickness | Ultrasonographic measurement of common extensor tendon thickness. | Baseline and 6 months |
| ID | Term |
|---|---|
| D013716 | Tennis Elbow |
| ID | Term |
|---|---|
| D000070639 | Elbow Tendinopathy |
| D052256 | Tendinopathy |
| D009135 | Muscular Diseases |
| D009140 | Musculoskeletal Diseases |
| D000092464 | Elbow Injuries |
| D001134 | Arm Injuries |
| D014947 | Wounds and Injuries |
| D013708 | Tendon Injuries |
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| ID | Term |
|---|---|
| D000074059 | Extracorporeal Shockwave Therapy |
| ID | Term |
|---|---|
| D014464 | Ultrasonic Therapy |
| D003972 | Diathermy |
| D006979 | Hyperthermia, Induced |
| D013812 | Therapeutics |
| D026741 | Physical Therapy Modalities |
| D012046 | Rehabilitation |
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