Table 4 Comparison of the Strength of Evidence Taxonomy (SORT) recommendation42 and methodological considerations for each injection therapy when used to treat lateral epicondylosis, as practised in assessed papers
InjectantSORT recommendationAnatomical evaluationInjectant preparationAdded injectantsInjection techniqueVolume injectedInjection schedule
Polidocanol2BPalpatory exam, U/S and Colour Doppler exam; elbow structures are examined while seated, with arm resting on a table in 70–80 degrees of elbow flexion and wrist pronationNone; stock polidocanol 10 mg/ml solution usedNoneU/S and Colour Doppler-guided injections at the common extensor origin at the lateral epicondyle. The aim is to inject polidocanol intravascularly; however, due to the small size of neovessels, the solution may be delivered perivascularly.0.4–1.1 ml; one injection, using three to five needle sticks to ensure coverage of neovesselsOne to two injection sessions, approximately 3 months apart
Autologous Whole Blood3CPalpatory exam ± U/S exam2 ml autologous whole blood collected at the time of injectionTopical anaestheticInjection to undersurface of extensor carpi radialis brevis46 47 or area of maximal tendon disruption on U/S exam332 mlStudy-dependent; one to three injection sessions, approximately 1 month apart
Platelet-Rich Plasma2BPalpatory examPreparation of syringes with anticoagulant, then 20–60 ml of whole blood is drawn from peripheral veinProprietary, kit-dependent; anticoagulantU/S-guided single injection, using five to seven needle sticks, 1 cm distal to the origin of the common extensor tendon1 ml per cm2 of involved tissue, up to total of 2–3 mlSingle injection session
Blood is centrifuged
Preparation of the injection site with local anaesthetic
Prolotherapy1BPalpatory examNone; injectant prepared from stock solution of 50% dextrose and 5% morrhuate sodiumSaline and topical anaesthetics: lidocaine and sensorcaineInjection at tender entheses of ligament and tendon structures at the lateral epicondyle and supracondylar ridge; precise location and number of injections per session as well as the number of sessions per treatment course are patient-specific, determined by exam0.5 ml per injection, three to five injections per session3 monthly sessions
  • U/S, ultrasound