Efficacy of Botulinum Toxin in Treating Lateral Epicondylitis—Does Injection Location Matter?

2020 ◽  
Vol 99 (12) ◽  
pp. 1157-1163
Author(s):  
Bo Song ◽  
Derek Day ◽  
Prathap Jayaram
Author(s):  
Stephan Grüner ◽  
Axel Schulz ◽  
Klaus Schlüter-Brust ◽  
Marcela Lippert-Grüner

AbstractLateral epicondylitis is a common disease in orthopaedic practice. Although the majority of cases do not become chronic, patients who do not respond to the initial treatment may suffer from pain in the long term and effective treatment is challenging. The off-label use of botulinum toxin is one of the common potential indications for the substance in orthopaedics and traumatology. In a literature review of 2000 – 2019, eight EBM ≥ level 3 studies evaluating the use of botulinum toxin in lateral epicondylitis were found. Five of these studies evaluated botulinum toxin versus placebo in chronic cases; two other studies compared botulinum toxin with corticosteroids in acute cases and classic Hohmann surgery in chronic cases; the eighth study compared botulinum toxin in two different injection sites and corticosteroids by classic injection. Our findings suggest that the use of this substance may be a treatment option in refractory chronic cases before surgery is indicated. The working group on botulinum toxin in O & T of the International Musculoskeletal Pain Society (IMPS/IGOST) introduced an alternative injection schedule, which combines findings from the recent clinical literature with practical experience in order to reduce the risk of side effects while ensuring treatment effectiveness. Using 2 simple tests of function and, if necessary, sonographic verification, 2 separate injection sites in the extensor carpi radialis or the extensor digitorum can be identified by palpation. The tendon level on the lateral epicondyle acts as the third injection site. With optimal use of the ampoule content, the 3 injection sites can be infiltrated individually, depending on the muscle status. On the one hand, this enables treatment to take place after a dual therapy approach and, on the other hand, the risk of overdose in a muscle with subsequent unnecessary muscle weakening can be reduced.


2012 ◽  
Vol 41 (6) ◽  
pp. e1-e2 ◽  
Author(s):  
Yu-Ching Lin ◽  
Shu-Min Chen ◽  
Ta-Shen Kuan ◽  
Pei-Chun Hsieh ◽  
Yo-Hong Guo ◽  
...  

2011 ◽  
Vol 40 (6) ◽  
pp. 532-538 ◽  
Author(s):  
Leonid Kalichman ◽  
Raveendhara R. Bannuru ◽  
Marianne Severin ◽  
William Harvey

2010 ◽  
Vol 182 (8) ◽  
pp. 749-750 ◽  
Author(s):  
R. Buchbinder ◽  
B. L. Richards

Pain Medicine ◽  
2019 ◽  
Vol 21 (9) ◽  
pp. 1971-1976 ◽  
Author(s):  
Sang Hoon Lee ◽  
Hyun Hee Choi ◽  
Min Cheol Chang

Abstract Background Botulinum toxin (BTX) is widely used for pain control in various musculoskeletal disorders. Objectives We evaluated the analgesic effect of botulinum toxin type A (BTX-A) in chronic lateral epicondylitis and compared the effect between 10 and 50 IU of BTX-A. Methods Sixty subjects with chronic lateral epicondylitis were included and underwent a BTX-A injection in the common extensor tendon. The subjects were randomly allocated into two groups: the small-dose group (SD group; 30 subjects, 10 IU) and large-dose group (LD group; 30 subjects, 50 IU). Treatment outcomes were evaluated by measuring the pain level using the numeric rating scale (NRS) and measuring grip strength before and one, two, three, four, five, and six months after treatment. Results Subjects in both groups showed a significant decrease in NRS scores at all evaluation time points after treatment. The reduction in NRS scores was significantly greater in the LD group at one, two, three, and four months after treatment. Six months after treatment, 19 subjects (63.3%) in the SD group and 21 (70%) in the LD group reported successful pain relief (pain relief ≥50%). The rate of successful pain relief was not significantly different between the two groups. Grip strength was more increased in the LD group at one, two, three, four, and six months after treatment. Conclusions BTX-A injection into the common extensor tendon can be a good treatment option for chronic lateral epicondylitis. The 50-IU BTX-A injection achieved a better outcome than the 10-IU injection.


2019 ◽  
Vol 22 (3) ◽  
pp. 27-28
Author(s):  
Neilson Mathews ◽  
Veronica Brohm ◽  
Elaine Seaton Banerjee

2011 ◽  
Vol 40 (6) ◽  
pp. 585-587 ◽  
Author(s):  
Rose Galvin ◽  
Claire Callaghan ◽  
Wai-Sun Chan ◽  
Borislav D. Dimitrov ◽  
Tom Fahey

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