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Tennis elbow (lateral epicondylitis): Effects of Botox (botulinum toxin A) treatment on muscle function and molecular mechanisms related to skeletal muscle growth and reinnervation Methee
Örebro University, School of Health Sciences.
2017 (English)Independent thesis Advanced level (degree of Master (Two Years)), 30 credits / 45 HE creditsStudent thesis
Abstract [en]

Abstract

Background: Lateral epicondylitis (LE) is a condition defined as pain by the lateral humeral epicondyle that affects 4-7 per 1000 patients every year. An effective and standardized treatment has not yet been established. Botulinum toxin A (Botox) injections have shown some promising results; however, little has been done to study the affected extensor carpi radialis brevis (ECRB) muscle and the molecular markers governing muscle recovery. The goals of this study were to evaluate the effects of Botox injections on: (1) functional characteristics of forearm extensors (2) markers of ECRB muscle growth; (3) markers of ECRB muscle reinnervation; (4) responses of muscle-derived neurotrophins, in patients suffering from LE.

Materials and methods: 10 patients (47 ± 4 years) suffering from LE were randomly split into the Botox injection (n=5) or placebo injection (n=5) groups. ECRB biopsies and measurements of forearm strength, pain, wrist mobility, and self-assessed disability were taken at 2 weeks before (baseline), 6 weeks after, and 6-9 months after injection. From ECRB muscle, protein expressions of beta-actin, NT3, GDNF, and proBDNF were quantified using western blot. Gene expressions of beta-actin, IGF1, TRIM63, FOXO32, CHRNA1, MuSK, LRP4, APP, CDK5, NRG1, EGFR, SYP, S100B, BDNF, GDNF, NT3, and NT4/5 were quantified using qPCR.

Results: Botox injections caused no improvements in hand mobility, forearm strength, and self-assessed disability but decreased pain while gripping after 6 weeks. Botox seems to stimulate hypertrophy- and reinnervation-related pathways in ECRB muscle as seen by the increased beta-actin protein expression (58%), decreased change in TRIM62 gene expression (61%), and increased changes in CHRNA1 (561%) and CDK5 (21%) gene expressions. However, based on the lowered changes in BDNF (83%) and NT4/5 (85%) gene expressions, it appears that Botox might also hinder intrinsic repair.

Conclusion: Botox injections promotes ECRB muscle recovery in LE patients more than placebo. Furthermore, the combination of functional characteristics and molecular markers can and should be used to assess the effectiveness of other treatment modalities for LE.

Place, publisher, year, edition, pages
2017.
Keywords [en]
extensor carpi radialis brevis muscle, hypertrophy, neurotrophins, neuromuscular junction
National Category
Sport and Fitness Sciences
Identifiers
URN: urn:nbn:se:oru:diva-66090OAI: oai:DiVA.org:oru-66090DiVA, id: diva2:1193300
Subject / course
Sports Science
Available from: 2018-03-26 Created: 2018-03-26 Last updated: 2018-03-26Bibliographically approved

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