Botulinum Toxin for Chronic Lateral Epicondylitis (LE).

Area of Science:

• Orthopaedics
• Musculoskeletal Disorders
• Pain Management

Background:

• Lateral epicondylitis, or tennis elbow, is a frequent orthopaedic condition.
• Chronic cases resistant to initial treatments pose significant long-term pain management challenges.
• Off-label botulinum toxin use is explored for orthopaedic indications.

Purpose of the Study:

• To review existing evidence on botulinum toxin for lateral epicondylitis.
• To propose an optimized injection protocol for botulinum toxin in lateral epicondylitis.
• To evaluate the safety and efficacy of this novel injection technique.

Main Methods:

• Literature review of EBM (≥ level 3) studies from 2000-2019 on botulinum toxin for lateral epicondylitis.
• Analysis of studies comparing botulinum toxin with placebo, corticosteroids, and surgery.
• Development of a new injection schedule based on clinical literature and practical experience.

Main Results:

• Eight relevant studies were identified, evaluating botulinum toxin in various contexts (vs. placebo, corticosteroids, surgery).
• Findings suggest botulinum toxin as a potential treatment for refractory chronic lateral epicondylitis before surgery.
• The proposed injection schedule identifies three specific sites for targeted infiltration.

Conclusions:

• Botulinum toxin offers a promising therapeutic option for recalcitrant chronic lateral epicondylitis.
• The novel injection technique aims to improve treatment effectiveness and reduce side effects like muscle weakening.
• This approach allows for dual therapy and individualized infiltration based on muscle status.