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Randomised controlled trial
A single botulinum toxin injection at a precise anatomic point on the forearm reduces pain at rest, compared to placebo injection in patients with chronic refractory lateral epicondylitis
  1. Bill Vicenzino,
  2. Brooke K Coombes
  1. University of Queensland, Queensland, Australia
  1. Correspondence to Bill Vicenzino
    University of Queensland, Therapies building 84A, St Lucia Campus, Queensland, QLD Australia 4072; b.vicenzino{at}uq.edu.au

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Context

Botulinum toxin type A, historically used for neuromuscular conditions, is a new and unproven intervention for tendinopathy.

Methods

A total of 48 patients with recalcitrant lateral epicondylalgia were randomly allocated to receive a single injection of botulinum toxin A (60 units in 1 ml of normal saline) or the same volume of 0.9% saline placed at a standardised injection site. The primary outcome was pain at rest (100 mm visual analogue scale) 4-week postinjection, although follow-up also occurred at eight and 16 weeks. A research assistant assessed adverse effects, including third- and fourth-finger extensor lag. The physician making the injection and recording outcomes was blind to intervention; patients were not.

Findings

Compared to saline, botulinum toxin produced a mean benefit of 14.1 mm (95% CI 5.8 to …

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