Dextrose Prolotherapy Plus Steroid Eases Tennis Elbow Pain Early, Trial Suggests

A retrospective study of patients with lateral epicondylalgia compared two ultrasound-guided injection strategies and reported better short-term pain relief when a corticosteroid injection was added to hypertonic dextrose prolotherapy. A retrospective study from China compared two ultrasound-guided injection strategies for lateral epicondylalgia, the medical name for pain at the outer elbow, and found that combining a corticosteroid injection with hypertonic dextrose prolotherapy produced better short-term pain relief and a greater early reduction in tendon thickness than prolotherapy alone. The advantage, however, faded over time: at 12 and 24 weeks the two groups showed no statistically significant difference in pain scores.

The study, conducted at hospitals in Zhuhai and Dingxi, enrolled 42 patients with lateral epicondylalgia who received treatment between May 2022 and December 2023. Half of them received the combined approach, labeled HDPrT-C, which involved injecting hypertonic dextrose and lidocaine directly into the tendon while also delivering a corticosteroid and lidocaine around the tendon. The other half received only the hypertonic dextrose and lidocaine injections. Because patients were enrolled retrospectively rather than randomized in advance, the findings describe observed differences between groups rather than the results of a controlled trial design.

Researchers tracked three measures at baseline and at 1, 4, 12, and 24 weeks: pain intensity on a visual analogue scale, the thickness of the affected tendon measured by ultrasound, and the grade of blood supply to the tendon. In the first weeks after treatment, the combined group pulled ahead. VAS pain scores and tendon thickness both improved significantly more in patients who received the corticosteroid addition at the 1-week and 4-week assessments, with differences reaching statistical significance at P < 0.05.

The medium-term picture looked different. At 12 weeks, tendon thickness in the combined group was actually higher than in the prolotherapy-only group, with a mean difference of 0.2 millimeters and a 95 percent confidence interval of 0.09 to 0.39. Pain scores at 12 weeks showed no significant difference between the two treatments.

By 24 weeks, the combined group had regained some ground on structural measures. Tendon thickness was reduced and blood supply grade improved compared with the prolotherapy-only group, both reaching statistical significance. Yet pain relief remained equivalent between the groups at that final follow-up. The authors conclude that the combined injection produced superior short-term pain relief and greater early tendon thinning, while noting that definitive medium- and long-term comparative efficacy requires larger trials.

The study’s retrospective design limits how strongly these results can be interpreted. Without randomization, patients in each group may have differed in ways that influenced outcomes, such as symptom duration, activity level, or prior treatments. The sample size of 42 patients, split evenly between groups, is modest, and the authors themselves call for larger trials to confirm the findings.

The findings come from a retrospective comparison of 42 patients, and the authors note that definitive medium- and long-term comparative efficacy requires larger trials. At 12 weeks, tendon thickness was higher in the combined group, and pain scores showed no significant difference between the treatments at 12 or 24 weeks.

Subject of Research: Comparing combined corticosteroid and hypertonic dextrose prolotherapy against prolotherapy alone for lateral epicondylalgia.

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

Article References: Li, X., Huang, B., Huang, G., & Ou, Z. (2026). Hypertonic dextrose prolotherapy and combined corticosteroid injection for lateral epicondylalgia: a comparative study. Frontiers in Pain Research, 7, Article 1976214. https://doi.org/10.3389/fpain.2026.1976214

Image Credits: AI Generated

DOI: 10.3389/fpain.2026.1976214

Keywords: lateral epicondylalgia, tennis elbow, prolotherapy, corticosteroid injection, hypertonic dextrose, ultrasound-guided injection, tendon thickness, pain relief, retrospective study, tendon blood supply, Hypertonic, dextrose