Study/Type | Subjects | Intervention | Injectant/control | Ancillary treatment | Follow-up/outcome measures | Results | Effect size of pain score (Cohen’s d and % improvement) | Comments | Delphi score, x/9 |
Zeisig et al 200825 Polidocanol RCT | 36 (16 female); mean age 46 (27–66) years; LE pain for mean 21 months; failed ⩾1 of: PT, eccentric PT, NSAIDs, steroid injections, orthotics, acupuncture, ultrasound, botox injections | Pdl: at 0 weeks, and optional at 12 weeks; U/S-guided, to “neovessels”; after their 1st injection session (in Pdl or comparison group), all subjects were offered Pdl injections at 12 weeks if unsatisfied with effects of first injection; 0.5–1 ml total |
| None |
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| Compared with baseline: | At 12 weeks, unsatisfied control subjects were crossed-over to Pdl injections, if desired | 9 |
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Cohen’s d: N/A | |||||||||
Pdl improved: 23%, adrenaline improved: 13% | |||||||||
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Cohen’s d: N/A; Pdl improved: 51% (p<0.05), | |||||||||
adrenaline/Pdl improved: 47% | |||||||||
Zeisig et al 200643 Polidocanol prospective case series | 11 (7 female); mean age 46 (33–63) years; LE pain for mean 23 months; failed ⩾1 of: PT (7), NSAIDs (11), steroid injection (7), orthotics (5), acupuncture (2), ultrasound (2) | Pdl: at 0 weeks; | None |
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| Compared with baseline: | Prospective case series | N/A | |
0.4–1.1 ml total |
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| Cohen’s d: 1.4 | ||||||||
Improved: 55% (p<0.05) | |||||||||
Scarpone et al 200831 Prolotherapy RCT | 24 (13 female); mean age 45.7 (19–62) years; LE pain for mean 1.9 years; failed NSAIDs, relative rest, PT, two steroid injections | PrT: at 0, 4, 8 weeks, to tender points at supracondylar ridge, lateral epicondyle and annular ligament; |
| None |
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| Compared with baseline: | Lack of consistent, long-term follow-up; unconventional assessment of grip strength | 8 |
1.5 ml total |
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| PrT improved: 35% (p<0.05); control improved 20% | ||||||||
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Compared with controls: | |||||||||
PrT improved 68%; | |||||||||
Cohen’s d: 6.68: | |||||||||
Glick et al 2008 Prolotherapy RCT | 8 (2 female), mean age 50 years; LE pain for longer than 3 months | PrT: at 0, 3 and 6 weeks to the lateral epicondyle and tender extensor tendon origin; 5 ml total |
| All subjects used at-home stretching |
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| Compared with baseline: | Lack of disease-specific outcome measure, short follow-up period | 7 |
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Cohen’s d statistic calculated to be 1.57 and 1.78 for the McGill and MOS measures respectively | PrT improved: 66% (p<0.05); control improved 11.5% | ||||||||
Compared with controls: | |||||||||
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Cohen’s d = 1.6 | |||||||||
Improved: 54.5% (p<0.09) | |||||||||
Lyftogt 200745 Prolotherapy Prospective case series | 20 (9 female), mean age 39 (24–64) years; LE pain for mean 6 months | PrT: weekly sessions for mean 8 weeks; to tender points at common extensor tendon; 0.5–1.0 ml total |
| Modified daily activity |
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| Compared with baseline: | Unconventional subcutaneous prolotherapy technique with 10–15 injections per session | N/A |
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Cohen’s d: N/A | |||||||||
Improved: 94% (p<0.05) | |||||||||
Edwards et al 200347 Autologous Whole Blood Prospective case series | 28 (14 female); LE pain for at least 3 months; failed two or more conservative therapies | AWB: at 0, 6 weeks, and optional at 12 weeks; to extensor carpi radialis brevis; 2 ml total |
| 400 splint; 3 weeks of motion restriction, then 3 weeks of stretching exercises |
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| Compared with baseline: | Prospective case series; no statistical comparisons reported | N/A |
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Cohen’s d: 1.7 | |||||||||
Improved: 40% (p<0.05); | |||||||||
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Cohen’s d: 3.0 | |||||||||
Improved: 88% (p<0.05) | |||||||||
Connell et al 200633 Autologous Whole Blood Prospective case series | 35 (12 female); mean age 40.9 (26–62) years; LE pain for mean 13.8 months; failed each of: rest, PT, steroid injection | AWB: 0, 4 weeks, and optional at 8 weeks; U/S-guided, to area of maximal structural discontinuity; 2 ml total |
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| *Compared with baseline: | Prospective case series; raw data, mean scores and statistical comparisons for some of the outcomes not provided | N/A | |
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| Cohen’s d: 0.68; | ||||||||
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Cohen’s d: 0.72 | |||||||||
Gani et al 200746 Autologous Whole Blood Prospective case series | 26 (16 female); mean age 34 (21–54) years; LE pain for mean 2.1 years; failed rest, NSAIDs, activity modification, steroid injection | AWB: at 0 weeks, and optional at 6 weeks |
| Sling for 1 week, then rest and stretching exercises; no heavy lifting for 3 weeks |
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| Compared with baseline: | Prospective case series; | N/A |
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| unconventional Likert scale as primary outcome | ||||||
Cohen’s d: N/A | |||||||||
Improved: 64% (p<0.05) | |||||||||
Mishra et al 200636 Platelet-Rich Plasma non-randomised controlled trial | 20 adults; 15 PRP subjects: mean age 48.1 years, LE pain for mean 15.3 months; five control subjects: mean age 42 years, LE pain for mean 11.8 months; failed one or more of: NSAIDs, PT, bracing, steroid injection | PRP: single injection at 0 weeks |
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| Compared with baseline: | Non-randomised design; three of five control subjects left study at 8 weeks; injected local anaesthesia used in both groups; 108 -week Mayo score not reported | 5 |
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| Cohen’s d: N/A | ||||||||
Improved: 60% (p<0.05); | |||||||||
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Cohen’s d: ; N/A | |||||||||
Improved: 81% (p<0.05) | |||||||||
Compared with controls: | |||||||||
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AWB, autologous whole blood; LE, lateral epicondylosis; N/A, not applicable; NSAIDs, non-steroidal anti-inflammatory drugs; Pdl, polidocanol; PRP, platelet-rich plasma; PrT, prolotherapy; PT, physical therapy; U/S, ultrasound; VAS, visual analogue scale
*Median scores reported, per cent change therefore not calculated; Cohen’s d calculated using reported Z statistic.
Results reported for a final follow-up unless stated otherwise.