Article

OBJECTIVES: To explore the effectiveness of botulinum toxin compared with
non-surgical treatments in patients with lateral epicondylitis. METHODS: Data
sources including PubMed, Scopus, Embase and Airity Library from the earliest
record to February 2017 were searched. Study design, patients' characteristics,
dosage/brand of botulinum toxin, injection techniques, and measurements of pain
and hand grip strength were retrieved. The standardized mean differences (SMDs)
in pain relief and grip strength reduction were calculated at the following time
points: 2-4, 8-12, and 16 weeks or more after injection. RESULTS: Six randomized
controlled trials (321 participants) comparing botulinum toxin with placebo or
corticosteroid injections were included. Compared with placebo, botulinum toxin
injection significantly reduced pain at all three time points (SMD, -0.729, 95%
confidence interval [CI], -1.286 to -0.171; SMD, -0.446, 95% CI, -0.740 to
-0.152; SMD, -0.543, 95% CI, -0.978 to -0.107, respectively). Botulinum toxin was
less effective than corticosteroid at 2-4 weeks (SMD, 1.153; 95% CI, 0.568-1.737)
and both treatments appeared similar in efficacy after 8 weeks. Different
injection sites and dosage/brand did not affect effectiveness. Botulinum toxin
decreased grip strength 2-4 weeks after injection, and high equivalent dose could
extend its paralytic effects to 8-12 weeks. CONCLUSIONS:
When treating lateral
epicondylitis, botulinum toxin was superior to placebo and could last for 16
weeks. Corticosteroid and botulinum toxin injections were largely equivalent,
except the corticosteroid injections were better at pain relief in the early
stages and were associated with less weakness in grip in the first 12 weeks.

Langue : ANGLAIS