Number of botulinum toxin injections needed to stop requests for treatment for chronic lateral epicondylar tendinopathy. A 1-year follow-up study - 24/01/19

Doi : 10.1016/j.rehab.2018.12.003

Mélanie Cogné ^a,^b,^c,^⁎ , Alexandre Creuzé ^a, Hervé Petit ^a, Claire Delleci ^a, Patrick Dehail ^a,^b, Mathieu de Seze ^a,^b
^a Physical and Rehabilitation Medicine Unit (PRM), University Hospital, 33076 Bordeaux, France
^b EA4136 Handicap, Activité, Cognition, Santé, Bordeaux University, 33076 Bordeaux, France
^c University Hospital of Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France

^⁎Corresponding author at: Service de médecine physique et de réadaptation, hôpital Pellegrin, place Amélie Raba-Léon, 33076 Bordeaux, France.Service de médecine physique et de réadaptation, hôpital Pellegrin, place Amélie Raba-LéonBordeaux33076France

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Highlights

•	At 1-year follow-up of the effect of botulinum toxin injections on chronic epicondylar tendinopathy, 1 or 2 botulinum toxin injections seemed enough to obtain pain relief.
•	Quality of life, pain and maximal gripping force improved after botulinum toxin injections during follow-up.
•	Repercussion of pain on daily and professional activities decreased after botulinum toxin injections during follow-up.

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Abstract

Background

Epicondylar tendinopathy (“tennis elbow”) is a serious issue in manual labourers. Symptoms can persist over months or even more than 1 year, even when treated with trinitrine patches, acupuncture, sclerosis of neovessels, shock-wave therapy, autologous blood injections, platelet-rich plasma or hyaluronic acid. Botulinum toxin (BoNT-A) injections showed promising short-term results, but the long-term beneficial effects are not yet known.

Objective

We aimed to assess the long-term effect, side effects and recurrence rate after BoNT-A injections on chronic lateral epicondylar tendinopathy during 1 year.

Methods

This open study followed a 3-month randomized controlled trial. We included 50 patients followed at day 0 (V0), 90 (V1), 180–270 (V2) and 365 (V3). The main judgment criterion was the number of BoNT-A injections required to achieve pain relief with no further request for treatment by the patient.

Results

After one BoNT-A injection, 22/50 (44%) patients did not ask for further treatment during follow-up because of complete pain relief, and 20/50 (40%) asked for a second BoNT-A injection. For 20 patients with a second injection, 18 (90%) did not ask for further treatment during follow-up. Only 1 patient had a recurrence of pain after an initial pain relief of greater than 75%. Quality of life, and painful and maximal gripping force improved significantly at V1, V2 and V3 as compared with V0, and repercussions on daily and professional activities decreased significantly (P<0.05).