Comparison between Steroid and Two Different Sites of Botulinum Toxin Injection in the Treatment of Lateral Epicondylalgia: A Randomized, Double-blind, Active Drug-controlled Pilot Study

Publication date: Available online 22 September 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Yao-Hong Guo, Ta-Shen Kuan, Kuan-Lin Chen, Wei-Chih Lien, Pei-Chun Hsieh, I-Chieh Hsieh, Szu-Hao Chiu, Yu-Ching Lin
ObjectivesTo compare the effects of two different injection sites of low doses of botulinum toxin type A with steroid in treating lateral epicondylalgia.DesignDouble-blind, randomized, active drug-controlled trial.SettingTertiary medical center.ParticipantsTwenty-six patients with lateral epicondylalgia for more than six months were recruited from hospital-based outpatient population. A total of 66 patients were approached, and 40 were excluded. No participant withdrew due to adverse effects.InterventionsPatients were randomly assigned into three groups: 1. The Botox-Epic group (n=8) received 20 units of Botox injection into the lateral epicondyle; 2. The Botox-Tend group (n=7) had 20 units of Botox injected into tender points of muscles; 3. The Steroid group (n=11) had 40 mg of triamcinolone acetonide injected into the lateral epicondyle.Main Outcome MeasuresA visual analogue scale, dynamometer, and Patient-Rated Tennis Elbow Evaluation were used to evaluate the perception of pain, maximal grip strength, and functional status, respectively. Outcome measures were assessed before intervention and at 4, 8, 12 and 16 weeks after the treatment. The primary outcome measure was a visual analogue scale.ResultsAt 4 weeks after injection, the Steroid group was superior to the Botox-Tend group in improvement on the visual analogue scale (p=0.006), grip strength (p=0.03) and Patient-Rated Tennis Elbow Evaluation (p=0.02). However, these differences were not observed at the 8-, 12-, and 16-week follow-ups. There was no significant difference between the Steroid and Botox-Epic groups.ConclusionsInjections with the Botox and with steroid effectively reduced pain and improved upper limb function in patients with lateral epicondylalgia for at least 16 weeks. The onset of effect was earlier in the Steroid and Botox-Epic groups than in the Botox-Tend group.



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