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Improved intramuscular blood flow and normalized metabolism in lateral epicondylitis after botulinum toxin treatment
Örebro University, Department of Clinical Medicine.
Örebro University, Department of Clinical Medicine.
Orebro University Hospital.
2009 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 19, no 3, p. 323-328Article in journal (Refereed) Published
Abstract [en]

Lateral epicondylitis is a common cause of elbow pain, and decreased microcirculation in extensor carpi radialis brevis (ECRB) has recently been suggested to contribute to the symptoms. The purpose of this pilot study was to investigate the treatment response after injection of botulinum toxin type A. Ten patients with unilateral epicondylitis and decreased intramuscular blood flow in ECRB participated. Handgrip, 2-pinch grip and muscle strength during radial deviation and dorsal extension of the wrist were recorded. Perceived pain during contraction was evaluated with the Visual Analogue Scale (VAS) and function in daily activities was assessed using the Disability of Arm, Shoulder and Hand instrument (DASH) and the Canadian Occupational Performance Measure instrument (COPM). Intramuscular blood flow was recorded by laser Doppler flowmetry, and microdialysis was used to analyze muscle metabolism. The difference in intramuscular blood flow between the control and the affected side had decreased 3 and 12 months after treatment (P=0.03). Lactate concentration at the 12-month follow-up had decreased (P=0.02); perceived pain was reduced and function in daily activities had improved. Injection of botulinum toxin is an alternative treatment for epicondylitis. Symptom relief may be due to enhanced microcirculation causing an aerobic metabolism.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2009. Vol. 19, no 3, p. 323-328
National Category
Medical and Health Sciences Sport and Fitness Sciences
Research subject
Medicine; Sports Science
Identifiers
URN: urn:nbn:se:oru:diva-4607DOI: 10.1111/j.1600-0838.2008.00804.xISI: 000266431300004PubMedID: 18435689Scopus ID: 2-s2.0-66249083500OAI: oai:DiVA.org:oru-4607DiVA, id: diva2:138906
Available from: 2008-09-23 Created: 2008-09-23 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Lateral epicondylitis: intramuscular blood flow, pressure and metabolism in the ECRB muscle
Open this publication in new window or tab >>Lateral epicondylitis: intramuscular blood flow, pressure and metabolism in the ECRB muscle
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Lateral epicondylitis is classified as an overuse injury and the main symptom is pain from the lateral side of the elbow. There is general agreement that the extensor carpi radialis brevis (ECRB) muscle and its proximal tendon play a central role in the development of lateral epicondylitis. However, the pathophysiology is to a large extent unclear. The aim of the thesis was to investigate the intramuscular blood flow, the muscle metabolism as well as the vascular reactivity and the intramuscular pressure (IMP). Patients having chronic unilateral epicondylitis were investigated, with the unaffected arm serving as a control. Measurements were performed during rest, before and 3 and 12 months after an injection of botulinum toxin type A to cause relaxation of the muscle as well as after muscle contraction and occlusion of blood flow.

Initial intramuscular blood flow in the affected ECRB was lower compared with the unaffected muscle and anaerobic metabolism was recorded. The dif­ference in intramuscular blood flow between the affected and the unaffected arm was reduced after injection of botulinum toxin type A and muscle metabolism was aerobic. Perceived pain (VAS-score) was reduced and functional daily activity was improved, evaluated using the instrument Canadian Occupational Performance Measure (COMP) and the Disability of Arm, Shoulder and Hand instrument (DASH). Vascular reactivity during recovery after muscle contraction tended to be faster on the unaffected side than on the affected side. No difference in the post-occlusive reactive hyperaemia response between the affected and the unaffected ECRB was observed. The intramuscular pressure tended to be elevated in affected muscle.

In conclusion, decreased microcirculation and an anaerobic metabolism in ECRB may contribute to the symptoms in chronic lateral epicondylitis, which has not previously been showed. The impaired blood flow in the affected arm does not seem to be caused by impaired vascular reactivity but may partly be due to an elevated IMP probably due to an increased tension in the affected ECRB.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2010. p. 59
Series
Örebro Studies in Sport Sciences, ISSN 1654-7535 ; 7
Keywords
Lateral epicondylitis, ECRB, intramuscular microcirculation, intramuscular pressure, botulinum toxin, muscle metabolism, pain
National Category
Medical and Health Sciences
Research subject
Sports Science
Identifiers
urn:nbn:se:oru:diva-10892 (URN)978-91-7668-731-4 (ISBN)
Public defence
2010-09-03, HSP1, Prismahuset, Örebro universitet, Örebro, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2010-06-07 Created: 2010-06-02 Last updated: 2017-10-18Bibliographically approved

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Oskarsson, EvaPiehl Aulin, Karin

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