Botox for Tennis Elbow?

Have you ever suffered from tennis elbow, golfer’s elbow or pitcher’s elbow?

You may suffer from any one or more of these conditions even if you have never touched a golf club or a tennis racket or ever pitched a ball.

Tennis elbow is in overload injury which causes pain on the lateral (outer) aspect of the elbow joint(s) where the common extensor muscles are attached to the bone (lateral epicondyle of the humerus).

Golfer’s elbow, also sometimes called pitcher’s elbow, affects the medial (inner) side of the elbow, is an inflammatory condition of the elbow which in some ways is similar to tennis elbow.

Tennis elbow, also called lateral epicondylitis, is an extremely common injury. About 50 per cent of the tennis players are estimated to suffer from this condition first described by Runge in 1873. Interestingly enough, the condition is prevalent in people who do not play tennis at all. There is much controversy about the real cause of pain due to this condition and its treatment.

An article on this subject in the Canadian Medical Association Journal (CMAJ) calls this condition a costly disorder that affects one to three per cent of the general population and up to 15 per cent of at-risk workers.

Tennis elbow affects men more than women. People of any age can be affected but it most often affects people between the ages of 30 and 50. The condition also affects other athletes and people who participate in leisure or work activities that require repetitive arm, elbow and wrist movement.

People at risk are golfers, baseball players, bowlers, gardeners or landscapers, house or office cleaners (because of vacuuming, sweeping, and scrubbing), carpenters, mechanics and assembly-line workers.

Current treatment of this condition is aimed at reducing inflammation and pain. These involve rest and avoid any activity that causes pain. Apply ice or heat to the affected area. Painkillers like ibuprofen are helpful.

A splint or a brace to reduce strain at the elbow can be tried. See an occupational therapist. If nothing works then see your doctor to try injection of local anaesthtic or cortisone. If this does not work then surgery may be an option.

The CMAJ article says that there is limited evidence for the effectiveness of current approaches to treatment. Although recent studies report that 90 per cent of patients in primary care improve or recover completely after one year, tennis elbow results in substantial disability, use of health care resources, loss of productivity and high costs. New, more effective therapies are needed so people can continue to be productive.

Espandar and colleagues present (in CMAJ) the results of a randomized placebo-controlled trial that investigated the efficacy and safety of botulinum toxin type A (Botox) for the management of tennis elbow in 48 patients. Botox, a neurotoxin, is a poisonous protein complex that acts on the nervous system to paralyse it. Here, the idea is to paralyse the affected muscles temporarily to allow them to rest and heal. Botox is also thought to have some pain killing properties.

Three other similar trials with Botox have had conflicting results.

The trial reported in the CMAJ shows significant reductions in pain at rest at four, eight and 16 weeks. In the treatment group the intensity of pain during maximum pinch decreased at all time points. However, there was no significant difference in pain during maximum grip or in grip strength at any point between the two groups. The limiting factor was the expected paralysis in the muscles of the third and fourth fingers.

So, is Botox injection the treatment of choice for tennis elbow? It depends on your symptoms and how far you want to go. The good news is, 90 per cent of patients in primary care improve or recover completely after one year with non-surgical and non-Botox treatment.

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