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Joint Bone Spine
Volume 83, n° 2
pages 149-154 (mars 2016)
Doi : 10.1016/j.jbspin.2015.10.001
accepted : 24 June 2015
Usefulness of intra-articular botulinum toxin injections. A systematic review

Hichem Khenioui a, b, c, , Eric Houvenagel b, c, d, Jean François Catanzariti a, b, d, e, Marc Alexandre Guyot a, b, d, Olivier Agnani a, b, d, Cécile Donze a, b, d
a Service de médecine physique et de réadaptation, centre hospitalier Saint-Philibert, groupe hospitalier de l’institut catholique de Lille, 115, rue du Grand-But, BP 249, 59462 Lomme cedex, France 
b Université Nord de France, 1, rue Lefèvre, 59000 Lille, France 
c Université catholique de Lille, 60, boulevard Vauban, 59800 Lille, France 
d Service de rhumatologie, centre hospitalier Saint-Philibert, groupe hospitalier de l’institut catholique de Lille, 115, rue du Grand-But, BP 249, 59462 Lomme cedex, France 
e Service de médecine physique et réadaptation, centre de SSR pédiatrique Marc-Sautelet, 10, rue du Petit-Boulevard, 59650 Villeneuve-d’Ascq, France 

Corresponding author. Service de médecine physique et de réadaptation, centre hospitalier Saint-Philibert, 115, rue du Grand But, BP 249, 59462 Lomme cedex, France.

Botulinum toxin is a proven and widely used treatment for numerous conditions characterized by excessive muscular contractions. Recent studies have assessed the analgesic effect of botulinum toxin in joint pain and started to unravel its mechanisms.


We searched the international literature via the Medline database using the term “intraarticular botulinum toxin injection” combined with any of the following terms: “knee”, “ankle”, “shoulder”, “osteoarthritis”, “adhesive capsulitis of the shoulder”.


Of 16 selected articles about intraarticular botulinum toxin injections, 7 were randomized controlled trials done in patients with osteoarthritis, adhesive capsulitis of the shoulder, or chronic pain after joint replacement surgery. Proof of anti-nociceptive effects was obtained in some of these indications and the safety and tolerance profile was satisfactory. The studies are heterogeneous. The comparator was usually a glucocorticoid or a placebo; a single study used hyaluronic acid. Pain intensity was the primary outcome measure.


The number of randomized trials and sample sizes are too small to provide a satisfactory level of scientific evidence or statistical power. Unanswered issues include the effective dosage and the optimal dilution and injection modalities of botulinum toxin.

The full text of this article is available in PDF format.

Keywords : Botulinum toxin, Intra articular injection, Osteoarthritis, Adhesive capsulitis of shoulder, Rheumatology

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