Botulinum Toxin Injection Versus Surgical Treatment for Tennis Elbow

Botulinum toxin and its orthopaedic applications

“…This prompted a randomised, controlled trial by the same group, comparing injection of BTX-A and surgical release with 20 patients in each group. 75 Similar results were found between surgery and injection with respect to subjective (e.g. visual analogue scores of pain) and objective (e.g.…”

Use of anatomic measurement to guide injection of botulinum toxin for the management of chronic lateral epicondylitis: a randomized controlled trial

“…1 Recently, this drug has been used in the management of chronic lateral epicondylitis (tennis el bow). [2][3][4][5] The extensor muscles of the wrist are paralyzed with the aim of releasing tension on the common extensor tendon and causing gradual healing of the epicondylitis. This approach is based on the same rationale as surgical release of the extensor carpi radialis brevis tendon.…”

“…This approach is based on the same rationale as surgical release of the extensor carpi radialis brevis tendon. 3 The most important factor in successfully paralyzing any muscle is the site of injection of the botulinum toxin. 1 Injection at a fixed distance from anatomic landmarks, as was performed in previous clinical trials of botulinum toxin for the management of lateral epicondylitis, [2][3][4][5] would result in inadequate paralysis of the intended muscle.…”

“…3 The most important factor in successfully paralyzing any muscle is the site of injection of the botulinum toxin. 1 Injection at a fixed distance from anatomic landmarks, as was performed in previous clinical trials of botulinum toxin for the management of lateral epicondylitis, [2][3][4][5] would result in inadequate paralysis of the intended muscle. It has been suggested that the extensor digitorum muscle, which is innervated by deep branches of the radial nerve, plays an important role in the development of lateral epicondylitis.…”

Is Posterior Synovial Plica Excision Necessary for Refractory Lateral Epicondylitis of the Elbow?

“…Regardless of surgical treatment option, the reported failure rates range from 5% to 17% [2-6, 8, 11, 20, 25, 26]. New treatment modalities for refractory lateral epicondylitis such as platelet-rich plasma [12], Botox 1 (Allergan Inc, Irvine, CA, USA) [15], or extracorporeal shock wave therapy [17] reportedly are associated with 61% improvement at 6 weeks, 65% good to excellent results at 1 year, and 73% good to excellent results at 6 months after treatment, respectively; however, none of these treatments have shown superiority over surgical débridement. Furthermore, the pathologic features of epicondylitis and etiology of the condition are not completely understood [10,18,29].…”