EpicondylitisInjection of Botulinum Toxin for Treatment of Chronic Lateral Epicondylitis: Systematic Review and Meta-Analysis
Section snippets
Search Strategy
PubMed, MEDLINE, CINAHL, Google Scholar, EMBASE, PEDro, and ISI web of Science databases were searched from inception until November 2009 for the key words “elbow,” “lateral,” “epicondylitis,” “tennis elbow,” “epicondylalgia,” “treatment,” “injections,” “Botox,” “Dysport,” and “botulinum.” The titles and abstracts of all articles were reviewed. The search was initially run by 1 reviewer (L.K.) and then it was repeated by 2 reviewers (R.B. and W.H.). The last full search was run on November 3,
Trials
Our search yielded 874 articles. An additional newly published study was identified by hand search after the initial submission of this article. After review of the title and abstracts, 19 references considered as potentially relevant were reviewed in full. After full review, 9 articles were excluded since they were not relevant to the study question. Several articles did not include sufficient data for pooling. One author provided additional data not available in the article, but used surgery
Discussion
This systematic review and meta-analysis identified 10 studies evaluating botulinum for treatment of chronic lateral epicondylitis. The highest level evidence (the RCTs) shows a moderate benefit for botulinum toxin A injection for pain at 3 months in patients with chronic lateral epicondylitis that was resistant to other conventional therapies. Generally effect sizes of 0.2 are considered small; 0.5 are considered medium, and ≥0.8 are considered large (30). Given the lack of very effective
Conclusions
Present literature provides support for use of botulinum toxin A injections into the forearm extensor muscles (60 units Disport or equivalent) for the treatment of chronic treatment-resistant lateral epicondylitis.
Acknowledgments
We are grateful to Usha M Sudireddy for her help in translating the German into English and to Chenchen Wang and Ling Li for translating the Chinese into English.
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Cited by (41)
Nonoperative Management of Lateral Epicondyle Tendinopathy: An Umbrella Review
2023, Journal of Chiropractic MedicineEffectiveness of different doses of botulinum neurotoxin in lateral epicondylalgia: A network meta-analysis
2023, Annals of Physical and Rehabilitation MedicineCitation Excerpt :First, we were the first team to conduct a network meta-analysis focusing on BoNT for the treatment of lateral epicondylalgia. This means that our study may provide more information through the additional comparisons, larger data set analyzed, and the bigger picture [32] as compared with simpler pairwise meta-analysis [8,33]. Second, our study revealed a significant dose–response relationship of BoNT in alleviating pain related to lateral epicondylalgia and that a single injection of high-dose BoNT may be as effective as corticosteroid for up to 11 to 14 weeks.
Number of botulinum toxin injections needed to stop requests for treatment for chronic lateral epicondylar tendinopathy. A 1-year follow-up study
2019, Annals of Physical and Rehabilitation MedicineCitation Excerpt :Nevertheless, the superiority of surgery for BoNT-A injections in patients with chronic epicondylar tendinopathy has not been proven [36]. The primary analgesic effect of BoNT-A is suggested to result from easing the tension in the whole enthesis site, including the tendon [36], thereby resulting in immobilisation of the enthesis. This procedure has been shown to improve the healing process of several tendons [40,41].
News in the treatment of the tendinopathy
2017, Journal de Traumatologie du SportComparison Between Steroid and 2 Different Sites of Botulinum Toxin Injection in the Treatment of Lateral Epicondylalgia: A Randomized, Double-Blind, Active Drug-Controlled Pilot Study
2017, Archives of Physical Medicine and RehabilitationCitation Excerpt :The cost of 20U of onabotulinumtoxinA is approximately $140 in the United States. The data of meta-analyses encourage the use of minimally invasive BoNT-A injection to manage patients with chronic lateral epicondylalgia who have failed the conventional therapies.7,8 Long-term cost-effectiveness of BoNT-A injection for patients with lateral epicondylalgia needs to be evaluated in the future.
Conservative treatment of tendinopathies - what helps?
2015, Sports Orthopaedics and Traumatology
The authors have no conflicts of interest to disclose.