Evaluation of the Efficacy of Prolotherapy in Patients With Lateral Epicondylitis Using Shear-Wave Elastography

BACKGROUND This study aimed to evaluate the effectiveness of prolotherapy in patients diagnosed with lateral epicondylitis and to objectively assess changes in tendon elasticity using shear-wave elastography (SWE). MATERIAL AND METHODS This was a prospective, single-center, observational clinical study. Thirty-six patients diagnosed with lateral epicondylitis were included. Each received 3 prolotherapy sessions at 3-week intervals. The elasticity and thickness of the common extensor tendon (CET) were evaluated using SWE both before and after treatment. Pain intensity was measured using the Visual Analog Scale (VAS). The same orthopedic surgeon performed all prolotherapy injections, and the same radiologist performed all SWE evaluations. Data normality was assessed with the Shapiro-Wilk test. Normally distributed variables were analyzed using the t-test or Paired Sample t-test, while the Mann-Whitney U or Wilcoxon Signed-Rank tests were used for non-normal data. Correlations were evaluated using Pearson's or Spearman's correlation coefficient, and P<0.05 was considered statistically significant. RESULTS Prolotherapy resulted in a significant increase in CET elasticity (kPa) and tendon thickness (P<0.01). Male patients exhibited greater tendon thickness and stiffness than female patients. Overall, SWE proved to be a reliable quantitative tool for tracking treatment response. CONCLUSIONS Prolotherapy is an effective treatment for lateral epicondylitis, contributing to pain reduction and structural improvement of the tendon. SWE offers a non-invasive, reliable imaging technique for objectively tracking changes in tendon elasticity. The combination of these methods provides valuable clinical and structural insights into the management of lateral epicondylitis.