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Treatment of Lateral Epicondylitis with Botulinum Toxin: A Randomized, Double-Blind, Placebo-Controlled Trial

Shiu Man Wong, MB BCh; Andrew C.F. Hui, MBBS; Po-Yee Tong, BSc; Dawn W.F. Poon, BSc; Evelyn Yu, BSc; and Lawrence K.S. Wong, MD
[+] Article, Author, and Disclosure Information

From North District Hospital, The Chinese University of Hong Kong, and Prince of Wales Hospital, Hong Kong, China.

ClinicalTrials.gov Identifier: NCT00119704

Grant Support: By a donation from New World Development Ltd.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Shiu Man Wong, MB BCh, PacifiCare, 12th Floor, Oterprise Square, 26 Nathan Road, Tsim Sha Tsui, Hong Kong, China; e-mail, jsmwong@hkstar.com.

Current Author Addresses: Dr. S.M. Wong: Department of Medicine, North District Hospital, 9 Po Kin Road, Sheung Shui, Hong Kong, China.

Drs. Hui and L.K.S. Wong, Ms. Tong, and Ms. Yu: Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.

Ms. Poon: Department of Occupational Therapy, Prince of Wales Hospital, Shatin, Hong Kong, China.

Author Contributions: Conception and design: S.M. Wong, A.C.F. Hui, L.K.S. Wong.

Analysis and interpretation of the data: S.M. Wong, A.C.F. Hui, L.K.S. Wong.

Drafting of the article: S.M. Wong, A.C.F. Hui.

Critical revision of the article for important intellectual content: S.M. Wong, A.C.F. Hui, L.K.S. Wong.

Final approval of the article: S.M. Wong.

Provision of study materials or patients: S.M. Wong, P.-Y. Tong, D.W.F. Poon.

Statistical expertise: S.M. Wong, P.-Y. Tong, E. Yu.

Obtaining of funding: S.M. Wong.

Administrative, technical, or logistic support: S.M. Wong, P.-Y. Tong, D.W.F. Poon.

Collection and assembly of data: S.M. Wong, P.-Y. Tong, D.W.F. Poon.

Ann Intern Med. 2005;143(11):793-797. doi:10.7326/0003-4819-143-11-200512060-00007
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Of 100 patients with lateral epicondylitis who were referred to the clinics, 88 met eligibility criteria and 60 agreed to participate in the trial (Figure). Most participants were middle-aged women whose symptoms had persisted for several months (Table 1). Most baseline characteristics for the 2 groups appeared to be similar. Table 2 shows mean scores for the VAS at baseline and at each follow-up assessment. At 4 weeks, the botulinum group showed a statistically significant improvement in VAS pain assessments over the placebo group (P < 0.001), which was maintained at 12 weeks (P = 0.006). The mean VAS scores were 65.5 mm and 25.3 mm at baseline and at 4 weeks for the botulinum group and 66.2 mm and 50.5 mm for the placebo group, respectively (between-group difference of changes, 24.4 mm [95% CI, 13.0 to 35.8 mm]). At week 12, the mean VAS scores were 23.5 mm for the botulinum group and 43.5 mm for the placebo group (between-group difference of changes, 19.3 mm [CI, 5.6 to 32.9 mm]). Grip strength was not statistically significantly different between groups at any time.

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Submit a Comment/Letter
corticosteroids vs botulinum toxin
Posted on December 28, 2005
James R Korb
Southern California permanete Medical group
Conflict of Interest: None Declared

Wong et.al did a placebo controlled trial of botulinum toxin for lateral epicondylitis. I have often treated tennis elbow with an injection of lidocaine and steroids. In his editorial Pullman asserts that BTx injections are "less harmful" than corticosteroids. Since corticosteroids are a standard treatment for this condition, the study would have been more useful if they had compared corticosteroids with BTx. rather than placebo.

Conflict of Interest:

None declared

Submit a Comment/Letter

Summary for Patients

Botulinum Toxin as a Treatment for Tennis Elbow

The summary below is from the full report titled “Treatment of Lateral Epicondylitis with Botulinum Toxin. A Randomized, Double-Blind, Placebo-Controlled Trial.” It is in the 6 December 2005 issue of Annals of Internal Medicine (volume 143, pages 793-797). The authors are S.M. Wong, A.C.F. Hui, P.-Y. Tong, D.W.F. Poon, E. Yu, and L.K.S. Wong.


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