DOI: 10.32098/mltj_2026_7236

One or two ultrasonography-guided botulinum toxin A injections in the treatment of refractory lateral epicondylalgia? A retrospective study

Authors

  • Pierre-Loup Tabary Univ Brest, CHU Brest, INSERM UMR 1101 LaTIM, Brest, France
  • Jérémy Picard Univ Brest, CHU Brest, INSERM UMR 1078 GGB, Brest, France
  • Olivier Rémy-Néris Univ Brest, CHU Brest, INSERM UMR 1101 LaTIM, Brest, France
  • Gwenaël Cornec Univ Brest, CHU Brest, INSERM UMR 1101 LaTIM, Brest, France 0000-0002-3194-2987

gwenael.cornec@chu-brest.fr

Keywords

Botulinum toxin, chronic pain, lateral epicondylalgia

Abstract

Design: Retrospective cohort study evaluating the outcomes and safety of botulinum toxin A injections in refractory lateral epicondylalgia.
Participants: Seventy-nine patients (81 elbows) with refractory lateral epicondylalgia (persistent pain despite ≥6 months conservative treatment) treated between August 2022 and December 2023.
Interventions: All patients received an initial ultrasound-guided injection of 40 units of botulinum toxin A into the extensor carpi radialis brevis (ECRB). A second injection was offered in case of persistent symptoms, targeting the ECRB, extensor digitorum communis and/or supinator depending on standard provocative tests.
Main measures: Clinical outcome was categorised as ‘poor’, ‘temporary’, ‘partial’ or ‘good’ based on self-reported pain evolution. Patients no longer requesting care were classified in the ‘good’ category. Adverse events were systematically recorded.
Results: After the first injection, 20% (16/81) had a ‘good’ outcome. Among 51 elbows receiving a second injection, 47% (24/51) reached this category, yielding an overall rate of 49% (40/81). Favourable outcome was not significantly associated with sex, age, or number of muscles injected in univariable analyses. Transient motor weakness occurred in 34% (27/79) of patients; one patient experienced a persistent deficit lasting six months with functional impairment.
Conclusions: A second ultrasound-guided botulinum toxin A injection with individually tailored muscle targeting was associated with a favourable outcome in about half of patients insufficiently relieved after the first one. Randomised controlled trials are needed to evaluate the added benefit of a tailored muscle targeting strategy and ultrasound guidance in the management of refractory lateral epicondylalgia.

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Published

2026-11-03

Issue

2026: LATEST ONLINE

How to Cite

1.
Tabary P-L, Picard J, Rémy-Néris O, Cornec G. One or two ultrasonography-guided botulinum toxin A injections in the treatment of refractory lateral epicondylalgia? A retrospective study. MLTJ [Internet]. 2026 Nov. 3 [cited 2026 Nov. 3];16. Available from: https://mltj.online/index.php/mltj/article/view/7236