Hypertonic dextrose prolotherapy and combined corticosteroid injection for lateral epicondylalgia: a comparative study

Background Corticosteroid injection offered short-term efficacy for lateral epicondylalgia (LE) but limited long-term benefit, whereas hypertonic dextrose prolotherapy (HDPrT) yields superior medium-to-long-term outcomes. This study aimed to compare the efficacy of hypertonic dextrose prolotherapy combined with corticosteroid injection (HDPrT-C) versus HDPrT in the treatment of LE. Methods Patients receiving ultrasound-guided HDPRT-C or HDPrT from May 2022 to December 2023 were retrospectively enrolled. HDPrT-C group received intratendinous injections of hypertonic dextrose and lidocaine, combined with peritendinous injections of corticosteroid and lidocaine. HDPrT group received only hypertonic dextrose and lidocaine. Patient assessments, including visual analogue scale (VAS) scores, tendon thickness, and tendon blood supply grade, were conducted at baseline, 1, 4, 12, and 24 weeks. Results 42 patients with LE were included, of whom 50% received HDPrT-C. HDPrT-C group significantly reduced the VAS scores and tendon thickness at short-term (1 and 4 weeks) follow-up compared to HDPrT ( P < 0.05), while no statistically significant intergroup difference was observed in the improvement of tendon blood supply grade. At medium-term (12 weeks) follow-up, the tendon thickness in the HDPrT-C group was higher than that in the HDPrT group (mean difference, 0.2 mm; 95%CI: 0.09–0.39, P < 0.05). At long-term (24 weeks) follow-up, HDPrT-C group showed reductions in tendon thickness and improvements in tendon blood supply grade compared to HDPrT group ( P < 0.05). No statistically significant intergroup difference was observed in the improvements of VAS scores at 12 weeks and 24 weeks. Conclusion Compared with HDPrT, HDPrT C produced superior short term pain relief and greater reduction of tendon thickness in LE patients. Definitive medium- and long-term comparative efficacy warrant further investigation in larger trials.