Background: Lateral epicondylitis has many analogous terms, including tennis elbow and lateral elbow pain. In 80 % of the cases, the patient will recover spontaneously within 1 year. Although lateral epicondylitis is generally self- limiting, in a minority of people symptoms persist for 18 month to 2 years, and the condition becomes chronic. Patients with chronic lateral epicondylitis are candidates for surgery. One study finds no differences between groups when they study the effect of botulinum toxin injections versus surgery (4). This rewiev investigates what we know about the effect of botulinum toxin injection as treatment for lateral epicondylitis.
Methods: The following databases were used to identify studies for this review: Medline, Pubmed, Embase, Amed, Cinahl, Clinical Evidence and NEL. Following words were used during the search: (lateral epicondylitis OR tennis elbow OR radial epicondylitis) AND (botulinum toxin OR botulinum toxin A). Only randomized trials were included in the study. The trials included were analysed using a check list designed for RCT’s created by kunnskapssenteret 2008.
Results: 4 studies were included in the rewiev (1-4). 3 double-blinded, randomized, placebo-controlled trials (1- 3) and 1 randomized study investigating botulinum toxin versus surgery (4). 2 studies finds significant improved pain score in the botulinum group on a VAS (1, 3). 1 study doesn’t find this significant difference (2).
Conclusions: Those studies finding significant improvement of pain excluded patients earlier treated with corticosteroid injections. The study not finding significant improvement of pain included patients earlier treated with corticosteroid injections. If we suggest that botulinum toxin is an effective treatment, this finding could help us select those patients that would improve their pain score by being treated with botulinum toxin. More investigation is needed.