Comparative Effectiveness of Dextrose Prolotherapy versus Methylprednisolone Acetate Injection in Chronic Lateral Epicondylitis: A Randomised Clinical Trial

Abstract Objective: The objective of this study was to compare the clinical effectiveness of dextrose prolotherapy injection (DPI) versus methylprednisolone acetate injection (MPI) in patients with chronic lateral epicondylitis (CLE). Methods: In this single-blind, randomised, parallel-group trial, 70 adults with CLE were allocated equally to receive either DPI (16% dextrose solution prepared from 25% stock dextrose + lidocaine) or MPI (80 mg methylprednisolone + lidocaine) through peritendinous injection at the extensor carpi radialis brevis origin. Injections were administered under aseptic conditions, with ultrasound guidance selectively applied. Pain intensity (Visual Analogue Scale [VAS]) and upper limb disability (Quick Disabilities of the Arm, Shoulder and Hand [QuickDASH]) were assessed at baseline, 1 month and 3 months. Patient satisfaction and adverse effects were recorded. Results: Both groups showed significant within-group improvements in VAS and QuickDASH scores over 3 months ( P < 0.001). Between-group analysis revealed significantly greater reductions in VAS for DPI compared with MPI at all intervals (baseline–1 month: −1.60 vs. −0.49; 1–3 months: −1.91 vs. −0.97; total: −3.51 vs. −1.46; all P < 0.001). Functional recovery was also superior with DPI (baseline–3 months QuickDASH change: −26.80 vs. −14.91; P < 0.001). High satisfaction (score 3) was reported by 51.4% in both groups. Adverse effects were minimal, with fewer events in the DPI group (8.6% vs. 22.8%). Conclusion: Dextrose prolotherapy produced superior and sustained improvements in pain and function compared with methylprednisolone injection in CLE, with a favourable safety profile. Prolotherapy represents an effective regenerative alternative to corticosteroids in chronic tendinopathy, particularly for high-demand patients.