Short-Term Effect of Low-Dose, Electromyography-Guided Botulinum Toxin A Injection in the Treatment of Chronic Lateral Epicondylar Tendinopathy

Creuzé, A.; Petit, H; Seze, M. De

doi:10.2106/jbjs.17.00777

Cited by 27 publications

(24 citation statements)

References 55 publications

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“…Often called the “tennis elbow,” lateral epicondylosis is a common painful condition that affects the tendons joining the forearm muscles on the outside of the elbow [ 146 ]. Common non-surgical treatment of lateral epicondylosis includes, but not is limited to, physiotherapy [ 147 ], injections of corticosteroid [ 148 ], extracorporeal shock wave therapy [ 149 ], acupuncture [ 150 ], topical glyceryl trinitrate [ 151 ], botulinum toxin [ 152 ], and platelet-rich plasma [ 153 ]. Regarding the cell therapy for lateral epicondylosis, it was surprising that only a handful of studies had been conducted to date.…”

Section: Type Of Msds Targetedmentioning

confidence: 99%

ADSC-Based Cell Therapies for Musculoskeletal Disorders: A Review of Recent Clinical Trials

Lee

Chae

Song

et al. 2021

IJMS

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Recently published clinical trials involving the use of adipose-derived stem cells (ADSCs) indicated that approximately one-third of the studies were conducted on musculoskeletal disorders (MSD). MSD refers to a wide range of degenerative conditions of joints, bones, and muscles, and these conditions are the most common causes of chronic disability worldwide, being a major burden to the society. Conventional treatment modalities for MSD are not sufficient to correct the underlying structural abnormalities. Hence, ADSC-based cell therapies are being tested as a form of alternative, yet more effective, therapies in the management of MSDs. Therefore, in this review, MSDs subjected to the ADSC-based therapy were further categorized as arthritis, craniomaxillofacial defects, tendon/ligament related disorders, and spine disorders, and their brief characterization as well as the corresponding conventional therapeutic approaches with possible mechanisms with which ADSCs produce regenerative effects in disease-specific microenvironments were discussed to provide an overview of under which circumstances and on what bases the ADSC-based cell therapy was implemented. Providing an overview of the current status of ADSC-based cell therapy on MSDs can help to develop better and optimized strategies of ADSC-based therapeutics for MSDs as well as help to find novel clinical applications of ADSCs in the near future.

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Section: Type Of Msds Targetedmentioning

confidence: 99%

ADSC-Based Cell Therapies for Musculoskeletal Disorders: A Review of Recent Clinical Trials

Lee

Chae

Song

et al. 2021

IJMS

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“…Injektion verweisen wir auf eine weitere neue Studie von Cogné et al [32]. In dieser Arbeit wurde die Studie der Arbeitsgruppe aus dem Jahr 2018 [17] fortgeführt: Die 29 Probanden der Therapiegruppe mit primär erfolgter Botu-linumtoxininjektion und die 21 Probanden der Kontrollgruppe mit nachträglicher Infiltration mit Botulinumtoxin in der beschriebenen Technik nach 90 Tagen (n = 48), 180-270 Tagen (n = 48) und nach einem Jahr (n = 24) wurden weiterverfolgt. Bei 22 der 50 Probanden stellte sich nach einer Injektion und bei weiteren 18 der 50 Probanden stellte sich nach einer 2.…”

Section: Schlussbetrachtungunclassified

“…In der Studie von Lin et al [15] mit 50 Einheiten Onabotulinumtoxin und einem Injektionsort relativ nah am Epicondylus humeroradialis zeigte sich wiederum bei allen Probanden der Botulinumtoxingruppe eine Abschwächung der Handextension und der Fingerextension bei den Kontrollen nach 4-8 Wochen. In der Studie von Creuzé et al [17]…”

Section: Dosisunclassified

“…Hierbei wäre natürlich auch zu diskutieren, ob dieser Effekt nicht auf das unterschiedliche Präparat zurückzuführen ist, gängige klinische Erfahrung und auch die publizierten Studien der einzelnen Präparate bei unterschiedlichen Indikationen zeigen jedoch einen Wirkstärkeneffekt abhängig von der Dosis und nicht vom Präparat. Daher scheint unserer Erfahrung nach eine Injektion mit i. d. R. 15 Einheiten pro Muskel an Ona-oder Incobotulinumtoxin ausreichend (analog zur Arbeit von Creuzé et al[17]), um den gewünschten therapeutischen Effekt zu erzielen und die unerwünschte Wirkung der Parese zu minimieren oder zu vermeiden. Gleichwertig kann auch in analog höherer Dosierung Abobotulinumtoxin mit einem Umrechnungsfaktor von ca.…”

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Botulinum Toxin for Chronic Lateral Epicondylitis (LE)

Grüner¹,

Schulz²,

Schlüter-Brust

et al. 2020

Z Orthop Unfall

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Lateral 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.

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“…Among the numerous injection modalities available, corticosteroid injection remains the mainstream of intra-articular treatment in lateral epicondylitis, and its effect can be augmented in a mix with lidocaine injection [ 3 ]. A recent study on botulinum toxin on ECRB under electromyographic (EMG) guidance revealed analgesic effect due to inhibited pain neurotransmission, and improved healing outcomes in tendon injury by a decrease in tension at the site of enthesis and an increase in muscular blood flow [ 14 ]. A recent meta-analysis concluded that autologous blood products (such as autologous blood and platelet-rich plasma) have an intermediate-term effect on pain relief and elbow function, as compared to corticosteroid injection that exerts a short term effect [ 15 ].…”

Section: Treatment Optionsmentioning

confidence: 99%

Current Trends for Treating Lateral Epicondylitis

Kim

Yoo

Choi

et al. 2019

Clin Shoulder Elbow

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Lateral epicondylitis, also known as ‘tennis elbow’, is a degenerative rather than inflammatory tendinopathy, causing chronic recalcitrant pain in elbow joints. Although most patients with lateral epicondylitis resolve spontaneously or with standard conservative management, few refractory lateral epicondylitis are candidates for alternative non-operative and operative modalities. Other than standard conservative treatments including rest, analgesics, non-steroidal anti-inflammatory medications, orthosis and physical therapies, nonoperative treatments encompass interventional therapies include different types of injections, such as corticosteroid, lidocaine, autologous blood, platelet-rich plasma, and botulinum toxin, which are available for both short-term and long-term outcomes in pain resolution and functional improvement. In addition, newly emerging biologic enhancement products such as bone marrow aspirate concentrate and autologous tenocyte injectates are also under clinical use and investigations. Despite all non-operative therapeutic trials, persistent debilitating pain in patients with lateral epicondylitis for more than 6 months are candidates for surgical treatment, which include open, percutaneous, and arthroscopic approaches. This review addresses the current updates on emerging non-operative injection therapies as well as arthroscopic intervention in lateral epicondylitis.

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Short-Term Effect of Low-Dose, Electromyography-Guided Botulinum Toxin A Injection in the Treatment of Chronic Lateral Epicondylar Tendinopathy

Abstract: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Cited by 27 publications

References 55 publications

ADSC-Based Cell Therapies for Musculoskeletal Disorders: A Review of Recent Clinical Trials

ADSC-Based Cell Therapies for Musculoskeletal Disorders: A Review of Recent Clinical Trials

Botulinum Toxin for Chronic Lateral Epicondylitis (LE)

Current Trends for Treating Lateral Epicondylitis

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