TITLE

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

AUTHOR(S)
Espandar, Ramin; Heidari, Pedram; Rasouli, Mohammad Reza; Saadat, Soheil; Farzan, Mahmood; Rostami, Mohsen; Yazdanian, Shideh; Mortazavi, Javad
PUB. DATE
May 2010
SOURCE
CMAJ: Canadian Medical Association Journal;5/18/2010, Vol. 182 Issue 8, p768
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: When using botulinum toxin for the management of lateral epicondylitis, injection at a fixed distance from an anatomic landmark could result in inadequate paralysis of the intended muscle. We assessed the effectiveness of injection of botulinum toxin using precise anatomic measurement in individual patients. Methods: In this randomized placebo-controlled trial, 48 patients with chronic refractory lateral epicondylitis were randomly assigned to receive a single injection of either botulinum toxin (60 units) or placebo (normal saline). The site of injection was chosen as a distance one-third the length of the forearm from the tip of the lateral epicondyle on the course of the posterior interosseus nerve. The primary outcome measure was intensity of pain at rest, measured with the use of a 100-mm visual analogue scale, at baseline and at 4, 8 and 16 weeks after injection. Results: Compared with the placebo group, the group given botulinum toxin had significant reductions in pain at rest during follow-up (decrease at 4 weeks 14.1 mm, 95% confidence interval [CI] 5.8-22.3; at 8 weeks 11.5 mm, 95% CI 2.0-21.0; at 16 weeks 12.6 mm, 95% CI 7.7-17.8; p = 0.01). As for the secondary outcomes, the intensity of pain during maximum pinch decreased in the botulinum toxin group; there was no difference in pain during maximum grip or in grip strength between the two groups. All but one of the patients in the intervention group experienced weakness in the extension of the third and fourth fingers at week 4 that resolved by week 16. No serious adverse events were reported. Interpretation: The use of precise anatomic measurement to guide injection of botulinum toxin significantly reduced pain at rest in patients with chronic refractory lateral epicondylitis. However, the transient extensor lag makes this method inappropriate for patients whose job requires finger extension. (ClinicalTrials.gov trial register no. NCT00497913.)
ACCESSION #
50630881

 

Related Articles

  • Patient: Heal Thyself!  // Current Science;1/19/2007, Vol. 92 Issue 10, p14 

    The article presents information about a new treatment for tennis elbow developed by doctor Allan Mishra and physiotherapist Terri Pavelko.

  • Review: medical therapies are less effective than surgery for anal fissure. Nelson, R. // Evidence Based Medicine;Jul/Aug2004, Vol. 9 Issue 4, p112 

    The article presents a study which found that medical therapies are less effective than surgery for anal fissure. Glyceryl trinitrate (GTN) had higher healing rates than placebo. However, sensitivity analysis excluding 2 controlled trials with low placebo rates found no difference between...

  • Botulinum neurotoxin versus tizanidine in upper limb spasticity: a placebo-controlled study. Simpson, M.; Gracies, J. M.; Yablon, S. A.; Barbano, R.; Brashear, A. // Journal of Neurology, Neurosurgery & Psychiatry;Apr2009, Vol. 80 Issue 4, p380 

    Background: While spasticity is commonly treated with oral agents or botulinum neurotoxin (BoNT) injection, these treatments have not been systematically compared. Methods: This study performed a randomised, double-blind, placebo-controlled trial to compare injection of BoNT-Type A into spastic...

  • Treatment of Lateral Epicondylitis with Botulinum Toxin: A Randomized, Double-Blind, Placebo-Controlled Trial. Shiu Man Wong; Andrew C. F. Hui; Po-Yee Tong; Dawn W. F. Poon; Evelyn Yu; Lawrence K. S. Wong // Annals of Internal Medicine;12/6/2005, Vol. 143 Issue 11, p793 

    Background: Lateral epicondylitis is a common condition for which botulinum toxin has been reported to have a therapeutic role in uncontrolled studies. Objective: To determine if an injection of botulinum toxin is more effective than placebo for reducing pain in adults with lateral...

  • The Myriad Uses of Botulinum Toxin. Pullman, Seth L. // Annals of Internal Medicine;12/6/2005, Vol. 143 Issue 11, p838 

    The article presents information about the uses of Botulinum Toxin (BTx). BTx is an important therapeutic agent with widespread applications in neurologic and non-neurologic disease. Double-blind, placebo-controlled clinical trials have shown that BTx safely and effectively resolves excessive...

  • No need for needles. Kapes, Beth // Cosmetic Surgery Times;Aug2009, Vol. 12 Issue 7, p20 

    The article presents a clinical trial that shows the ability of botulinum toxin to effectively treat crow's feet. The four study sites treated 75 patients with placebo or novel topical toxin to the area of crow's feet. According to doctor Michael Kane, principal investigator in the trial, an...

  • Botulinum toxin in hemifacial spasm: the challenge to assess the effect of treatment. Wabbels, Bettina; Roggenkämper, Peter // Journal of Neural Transmission;Aug2012, Vol. 119 Issue 8, p963 

    Hemifacial spasm is characterized by intermittent tonic or clonic contractions of the muscles supplied by the facial nerve. Although vision is less impaired than in patients with blepharospasm, the disease can impose significant psychosocial burden on patient's life. Botulinum toxin (BoNT) is...

  • Neck pain in chronic whiplash syndrome treated with botulinum toxin. A double-blind, placebo-controlled clinical trial. Padberg, M.; Bruijn, S. F. T. M.; Tavy, D. L. J. // Journal of Neurology;Mar2007, Vol. 254 Issue 3, p290 

    Neck pain in chronic whiplash syndrome is a major burden for patients, healthcare providers and insurance companies. Randomized data on treatment of botulinum toxin in chronic whiplash syndrome are scarce. We conducted a randomized, placebo-controlled clinical trial to prove efficacy of...

  • Für kurze Zeit haben Steroid-injektionen bei Tendinopathien einen schmerzlindernden Effekt. Steurer, Johann // Praxis (16618157);3/16/2011, Vol. 100 Issue 6, p375 

    No abstract available.

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics