Abstract
Lateral epicondylitis is a common disease in orthopaedic practice. Although the majority
of cases do not become chronic, patients who do not respond to the initial treatment
may suffer from pain in the long term and effective treatment is challenging. The
off-label use of botulinum toxin is one of the common potential indications for the
substance in orthopaedics and traumatology. In a literature review of 2000 – 2019,
eight EBM ≥ level 3 studies evaluating the use of botulinum toxin in lateral epicondylitis
were found. Five of these studies evaluated botulinum toxin versus placebo in chronic
cases; two other studies compared botulinum toxin with corticosteroids in acute cases
and classic Hohmann surgery in chronic cases; the eighth study compared botulinum
toxin in two different injection sites and corticosteroids by classic injection. Our
findings suggest that the use of this substance may be a treatment option in refractory
chronic cases before surgery is indicated.
The working group on botulinum toxin in O & T of the International Musculoskeletal
Pain Society (IMPS/IGOST) introduced an alternative injection schedule, which combines
findings from the recent clinical literature with practical experience in order to
reduce the risk of side effects while ensuring treatment effectiveness. Using 2 simple
tests of function and, if necessary, sonographic verification, 2 separate injection
sites in the extensor carpi radialis or the extensor digitorum can be identified by
palpation. The tendon level on the lateral epicondyle acts as the third injection
site. With optimal use of the ampoule content, the 3 injection sites can be infiltrated
individually, depending on the muscle status. On the one hand, this enables treatment
to take place after a dual therapy approach and, on the other hand, the risk of overdose
in a muscle with subsequent unnecessary muscle weakening can be reduced.
Key words
lateral epicondylitis - botulinum toxin - literature review - injection scheme
