Hackett-Hemwall Dextrose Prolotherapy for Unresolved Elbow Pain

Authors: Ross A. Hauser, MD, Marion A. Hauser MS, RD, & Patricia Hollan, RN

Chronic elbow pain is a common condition affecting 15% of the population at any one time.¹ Lateral epicondylitis (tennis elbow) is the most common form of elbow pain and the most common reason patients with elbow pain come to a physician’s office.²It is usually an overuse injury. Elbow injuries in sports with overhead or repetitive arm actions are frequent and often severe. Epicondylitis is an acute injury that results in inflammation and is usually the result of
large valgus forces with medial distraction and lateral compression. Epicondylosis develops over a longer period of time from repetitive forces and results in structural changes in the tendon.³ Other diagnoses for elbow pain include olecranon bursitis, biceps tendinitis, ulna and radial collateral ligament sprain, and degenerative arthritis.

The typical treatment for elbow conditions is conservative and includes oral NSAIDs, physical therapy, botulinum injections, pulsed low-intensity ultrasound, repetitive low energy shock wave therapy, corticosteroid injections, bracing, ergonomic modification of work stations, and rest.^{4,5,6,7,8,9,10,11} Although these therapies are prescribed, convincing evidence to support their use is lacking.¹² It appears the longer the condition persists, the moreit becomes resistant to traditional therapies. It has been documented that prolonged symptoms and relapses are frequently observed after having many conservative treatments. In one survey analysis, the elbow complaint resolved in 13% of the patients at three months and in 34% at 12 months.¹³ Because of the limited response to traditional therapies,^14,15 many patients with chronic elbow pain are turning to alternative therapies such as prolotherapy—including platelet rich plasma (PRP) prolotherapy injections.^16,17

George S. Hackett, MDcoined the term prolotherapy.¹⁸ As he described it, “The treatment consists of the injection of a solution within the relaxed ligament and tendon which will stimulate the production of new fibrous tissue and bone cells that will strengthen the ‘weld’ of fibrous
tissue and bone to stabilize the articulation and permanently eliminate the disability.”¹⁹ Animal studies have shown that prolotherapy induces the production of new collagen by stimulating the normal inflammatory reaction.^20,21 In addition, animal studies have shown improvements in ligament and tendon diameter and strength.^22,23

Prolotherapy is becoming a widespread form of pain management in both complementary and allopathic medicine. Prolotherapy is commonly used for unresolved elbow pain.^24,25 In double-blinded human studies, the evidence on the effectiveness of prolotherapy has been considered promising but mixed.^26,27,28 More studies need to be done utilizing larger groups with validated clinical and diagnostic measures to show its effectiveness.

While the normal proliferant used in prolotherapy is dextrose-based, PRP prolotherapy is gaining in popularity. In PRP prolotherapy, aconcentrated amount of one’s own platelets which contain growth factors are injected into the injured tissue to promote and speed up the body’s natural healing process.32 There have been numerous studies and papers written regarding use of platelet rich plasma (PRP) therapy to induce healing of elbow injuries—specifically for epicondylitis.29, 30,31

While prolotherapy has a long history of use with chronic elbow problems, no study to date using dextrose as the proliferant has been documented. This observational pilot study was undertaken to evaluate the effectiveness of Hackett-Hemwall dextrose prolotherapy not just
on unresolved elbow pain but on quality of life measures and its ability to reduce or eliminate the need for pain medications.