Botulinum Toxin Injection in the Treatment of Tennis Elbow

Hayton, Michael J.; Santini, Alasdair; Hughes, PJ; Frostick, Simon P.; Trail, IA; Stanley, John

doi:10.2106/jbjs.d.01896

Cited by 88 publications

(20 citation statements)

References 9 publications

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“…The unaffected arm served as a control. We used a dynamometer to measure grip strength in kilograms with the upper limb in a standardized position as recommended in a studies of elbow position and grip strength ( 17 , 18 ). The upper limb was positioned in a supine lying position; the palm of the hand was placed flat on the treatment table and adjacent to the subject’s side.…”

Section: Methodsmentioning

confidence: 99%

Effects of Taping on Pain, Grip Strength and Wrist Extension Force in Patients with Tennis Elbow

Shamsoddini¹,

Hollisaz²

2013

Trauma Mon

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BackgroundTennis elbow (TE) is a common musculotendinous degenerative disorder of the extensor origin at the lateral humeral epicondyle. Different modes of treatment are used for management of tennis elbow.ObjectivesThis study investigated the effect of the taping technique (TT) on pain, grip strength and wrist extension force in treatment of tennis elbow.Patients and MethodsThirty patients (16 men /14 women with a mean age of 32.2 years) with tennis elbow of their dominant arm participated in this study. Outcome measures were assessment of pain at the lateral aspect of the elbow, grip strength and wrist extension force before and five to ten minutes after application of elbow tape on the affected and unaffected arms. A Visual Analog Scale was used to assess pain. A dynamometer and a hand-held dynamometer were used for evaluation of grip strength and wrist extension force, respectively.ResultsAmong the variables, significant differences were found in wrist extension forces between effected and unaffected arms (P = 0.02). Changes in grip strength showed statically significant improvements in the affected arm compared to the unaffected arm (P = 0.03). Also, in assessment of pain at the lateral epicondyle, the mean change between affected and unaffected arms was significant, with P = 0.001.ConclusionsThe taping technique, as applied in this study demonstrates an impressive effect on wrist extension force and grip strength of patients with TE. Elbow taping also reduces pain at the lateral aspect of the elbow in these patients.

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Section: Methodsmentioning

confidence: 99%

Effects of Taping on Pain, Grip Strength and Wrist Extension Force in Patients with Tennis Elbow

Shamsoddini¹,

Hollisaz²

2013

Trauma Mon

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“…Complete return of function occurs by 6 months. 4 Botulinum toxin A is considered safe and effective for the treatment of movement disorders and spasticity, and it has been widely used in both pediatric and adult orthopaedics for spasticity in cerebral palsy, 1,5,6,9,19,22,27 in idiopathic clubfoot, 2,26 in the pectoralis major muscle in irreducible shoulder dislocations, 29 in tennis elbow, 16,20,35 and in flexor tendon repairs in children. 33 Tuzuner et al 33 used botulinum toxin A during surgery to induce forearm flexor relaxation in children aged under 6 years with zone 2 flexor tendon repairs.…”

mentioning

confidence: 99%

The effect of muscle paralysis using Botox on the healing of tendon to bone in a rat model

Hettrich

Rodeo

Hannafin

et al. 2011

Journal of Shoulder and Elbow Surgery

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“…Hayton et al studied 40 patients with refractory tennis elbow pain with a duration of over 6 months, who had experienced no pain relief from ≥1 corticosteroid injections and a full course of physiotherapy 77 ( Table 2). Patients were randomized to either 50 units of botulinum toxin type A (Allergan; n=19) or normal saline placebo (2 ml; n=21) injected 5cm distal to the area of maximal tenderness at the lateral epicondyle 77 ( Table 2).…”

Section: Tennis Elbowmentioning

confidence: 99%

“…Patients were randomized to either 50 units of botulinum toxin type A (Allergan; n=19) or normal saline placebo (2 ml; n=21) injected 5cm distal to the area of maximal tenderness at the lateral epicondyle 77 ( Table 2). There were no statistically significant differences in pain between the botulinum toxin and placebo groups at 3 months after the injection (difference of 1.1 between groups, p = 0.54), grip strength (difference of 0.57 kg between groups, p = 0.90), or quality of life measured by the Short Form-12 physical (difference of 6.24 points between groups, p = 0.16) and mental (difference of 4.26 points between groups, p = 0.42) component summary scores.…”

Section: Tennis Elbowmentioning

confidence: 99%

Use of botulinum toxin in musculoskeletal pain

Singh

2013

F1000Res

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Chronic musculoskeletal pain is a common cause of chronic pain, which is associated with a total cost of $635 billion per year in the U.S. Emerging evidence suggests an anti-nociceptive action of botulinum toxin, independent of its muscle paralyzing action. This review provides a summary of data from both non-randomized and randomized clinical studies of botulinum toxin in back pain and various osteoarticular conditions, including osteoarthritis, tennis elbow, low back pain and hand pain. Three randomized controlled trials (RCTs) of small sizes provide evidence of short-term efficacy of a single intra-articular injection of 100 units of botulinum toxin A (BoNT/A) for the relief of pain and the improvement of both function and quality of life in patients with chronic joint pain due to arthritis. Three RCTs studied intramuscular BoNT/A for tennis elbow with one showing a significant improvement in pain relief compared with placebo, another one showing no difference from placebo, and the third finding that pain and function improvement with BoNT/A injection were similar to those obtained with surgical release. One RCT of intramuscular BoNT/A for low back pain found improvement in pain and function compared to placebo. Single RCTs using local injections of BoNT in patients with either temporomandibular joint (TMJ) pain or plantar fasciitis found superior efficacy compared to placebo. One RCT of intramuscular BoNT/B in patients with hand pain and carpal tunnel syndrome found improvement in pain in both BoNT/B and placebo groups, but no significant difference between groups. Most evidence is based on small studies, but the use of BoNT is supported by a single, and sometimes up to three, RCTs for several chronic musculoskeletal pain conditions. This indicates that botulinum toxin may be a promising potential new treatment for chronic refractory musculoskeletal pain. Well-designed large clinical trials are needed.

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Botulinum Toxin Injection in the Treatment of Tennis Elbow

Abstract: With the numbers studied, we failed to find a significant difference between the two groups; thus, we have no evidence of a benefit from botulinum toxin injection in the treatment of chronic tennis elbow.

Cited by 88 publications

References 9 publications

Effects of Taping on Pain, Grip Strength and Wrist Extension Force in Patients with Tennis Elbow

Effects of Taping on Pain, Grip Strength and Wrist Extension Force in Patients with Tennis Elbow

The effect of muscle paralysis using Botox on the healing of tendon to bone in a rat model

Use of botulinum toxin in musculoskeletal pain

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