Here is a leading authority in the rheumatology/clinical epidemiology world, talking about a commentary she did on tennis elbow for the Canadian Medical Journal….
Lateral epicondylitis or ‘tennis elbow’ is a prevalent and costly disorder that affects 1-3% of the general population and up to 15% of workers in at risk industries. While it is generally self-limiting with most people completely recovered by a year, in the short-term it can cause significant disability. Therefore treatment that can shorten the duration of symptoms has the potential to be of significant value. Botulinum toxin type A injection is a promising new treatment, proposed for this condition on the basis that temporary paralysis of the proximal extensor muscles of the forearm might aid recovery. Three of four randomised placebo-controlled trials that have evaluated its efficacy have reported that it significantly reduces pain in comparison to placebo, although it has not been shown to reduce pain during maximum grip or improve maximum grip strength and its effect on function, quality of life and pain-free grip strength is unknown. Temporary partial or complete paresis of the third and fourth finger extensors occurs in 20 to 96% of patients and may last up to 16 weeks. This may be unacceptable for many individuals who rely on normal hand function for their work. It is also unclear whether any therapeutic effects remain or diminish once the muscle paralysis has abated. At the present time doubt remains about the true efficacy and safety of Botulinum toxin A injection for lateral epicondylitis and further studies are required before it can be introduced into clinical practice.
Rachelle Buchbinder is an NHMRC Practitioner Fellow, rheumatologist and clinical epidemiologist. She is currently Director of the Monash Department of Clinical Epidemiology at Cabrini Hospital and Professor in the School of Public Health and Preventive Medicine, Monash University in Melbourne, Australia. She combines rheumatology practice with clinical research in a wide range of multidisciplinary projects relating to arthritis and other musculoskeletal conditions. She is a principle investigator of the Australian Rheumatology Association Database (ARAD) that is evaluating the long-term outcomes of biological therapy for inflammatory arthritis and she is also one of the Coordinating Editors of the Cochrane Musculoskeletal Group. Other research interests include health literacy and improving the quality of written information for patients.
In case you haven’t worked it out, Prof Buchbinder is a what we would call a dead-set superstar. One of her early projects in back-pain stuff involved a multi-media ad campaign that remains, in my view, the most innovative and effective education strategy I have seen in this area. We are thrilled, absolutely chuffed, that Rachelle has contributed to our blog.
Buchbinder R, & Richards BL (2010). Is lateral epicondylitis a new indication for botulinum toxin? CMAJ : Canadian Medical Association journal, 182 (8), 749-50 PMID: 20421352
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