The Journal of Bone and Joint Surgery (American). 2005;87:503-507.
doi:10.2106/JBJS.D.01896
© 2005 The Journal of Bone and Joint Surgery, Inc.
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Botulinum Toxin Injection in the Treatment of Tennis Elbow

A Double-Blind, Randomized, Controlled, Pilot Study

M.J. Hayton, FRCS(Tr and Orth)1, A.J.A. Santini, FRCS(Tr and Orth)2, P.J. Hughes, FRCS(Tr and Orth)3, S.P. Frostick, MA, FRCS, DM2, I.A. Trail, MD, FRCS1 and J.K. Stanley, MCh(Orth), FRCS1

1 Wrightington Hospital, Hall Lane, Appley Bridge, Wigan WN6 9EP, United Kingdom. E-mail address for M.J. Hayton: mjhayton{at}aol.com
2 Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, United Kingdom
3 Royal Preston Hospital, Sharoe Green Lane, Preston PR2 9HT, United Kingdom

Investigation performed at Wrightington Hospital, Wigan, and Royal Liverpool University Hospital, Liverpool, United Kingdom

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. One or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (the botulinum toxin was supplied by Allergan). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: A recent report has suggested that local injection of botulinum toxin type A is an effective method of treatment for chronic tennis elbow. The toxin is thought to provide temporary paralysis of the painful common extensor origin, thereby allowing a healing response to occur. To test this theory, we performed a double-blind, randomized, controlled, pilot trial comparing injections of botulinum toxin type A with those of a placebo (normal saline solution) in the treatment of chronic tennis elbow.

Methods: Forty patients with a history of chronic tennis elbow for which all conservative treatment measures, including steroid injection, had failed were randomized into two groups. Half the patients received 50 units of botulinum toxin type A, and the remainder received normal saline solution. The intramuscular injections were performed 5 cm distal to the maximum point of tenderness at the lateral epicondyle, in line with the middle of the wrist. The two solutions used for the injections were identical in appearance and temperature. The results of a quality-of-life assessment with the Short Form-12 (SF-12), the pain score on a visual analogue scale, and the grip strength measured with a validated Jamar dynamometer were recorded before and three months after the injection.

Results: Three months following the injections, there was no significant difference between the two groups with regard to grip strength, pain, or quality of life.

Conclusions: With the numbers studied, we failed to find a significant difference between the two groups; thus, we have no evidence of a benefit from botulinum toxin injection in the treatment of chronic tennis elbow.

Level of Evidence: Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.


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Letters to the Editor:

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Is Botulinum Toxin effective for treating Tennis Elbow?
George Ampat, FRCS(Tr & Orth)
JBJS Online, 26 May 2005 [Full text]
MJ Hayton and colleagues respond to Mr. Ampat
M.J. Hayton, FRCS(Tr and Orth), et al.
JBJS Online, 26 May 2005 [Full text]