The aim of the study is to compare two different injection sites of low dose botulinum toxin type A with steroid in treating lateral epicondylalgia.

Lateral epicondylalgia or tennis elbow is a common painful elbow disorder with a prevalence of 1% to 3% in the general population and has a higher rate up to 14.5% in strenuous jobs. Botulinum toxin type A injection was an emerging option in treating lateral epicondylalgia. In this study, the patients were randomly assigned into three groups:

1. Botox-Epic group received 20 units of Botox injection into lateral epicondyle;
2. Botox-Tend group had 20 units of Botox injected into tender point of muscles;
3. Steroid group had 40mg of triamcinolone injected into lateral epicondyle.

The aim of this randomized controlled study was to compare the effects of injection with corticosteroid and botulinum toxin type A via two different sites in patients with lateral epicondylalgia.

Inclusion Criteria:

• spontaneous local pain over lateral epicondyle of the affected elbow for more than six months and failure to respond to previous physical therapy or oral medications,
• local tenderness around the lateral epicondyle, and
• pain elicited or aggravated by resisted contraction of the wrist or middle finger extensors.

Exclusion Criteria:

• local steroid injection within the past six months,
• coexisting elbow arthritis or arthralgia,
• previous trauma or surgery history over the lateral epicondyle,
• pregnancy or lactation, and
• other systemic, neuromuscular or bleeding disorders that are contraindicated to Botox injection.