evaluation of three types of injection for the treatment of lateral epicondylalgia

Conditions: Epicondylitis, Lateral Humeral; Tennis Elbow

Summary: the primary objective of this study is to compare the evolution of pain profiles among patients suffering from lateral epicondyalgia (tennis elbow) following three types of treatment: prp-l injection versus type a botulinum toxin injection versus corticoid injection.

the secondary objectives are to compare the following among the three groups: a- the global efficacy of each treatment defined by a minimum reduction of 25% in average pain over the last 24 hours between 0 and 6 months. b- the evolution of average pain over the last 24 hours between 0 and each different time frame (3 weeks, 6 weeks, 3 months and 6 months). c- the evolution of maximum pain scores using nocturnal post-effort (jamar grip test) visual analog scales (vas) between day 0, 3 weeks, 6 weeks, 3 months and 6 months. d- the perception of change on the patient's global impression of change score (pgic) at 3 and 6 months e- the evolution of prtee scores at 0, 3 and 6 months f- adverse events at 3 weeks, 6 weeks, 3 months and 6 months. g - quality of life and utility via the sf-12 at 3 and 6 months. h- the consumption of analgesics.

Eligibility criteria:
general inclusion criteria: * the patient must have given free and informed consent and signed the consent * the patient must be affiliated or beneficiary to a health insurance plan * the patient is available for 6 months of follow-up * woman of childbearing age using contraception inclusion criteria for the target population: the patient has a side epicondylalgia objectified by: * clinical criteria: symptoms lasting for more than 6 weeks and less than 12 months. the list of symptoms to be present are: pain on palpation of the lateral epicondyle, pain in the lateral epicondyle during blocked contraction * therapeutic: less than two injections of corticosteroids performed, and the last such injection was performed at least 3 months before inclusion general non-inclusion criteria: * the patient is participating in another study * the patient is exclusion period determined by a previous study * the patient is under judicial protection * the patient is under guardianship or curatorship * the patient refuses to sign the consent * woman of childbearing age not using contraception * impossible to correction inform the patient about the study non-inclusion criteria for investigational and auxiliary medicinal products: * the patient has at least one of the contra-indications listed in the spc for xeomin and altim: * hypersensitivity to botulinum neurotoxin type a or cortivazol * hypersensitivity to any of the excipients used in the composition of xeomin (human albumin, sucrose) and / or altim (benzyl alcohol, carmellose sodium, sodium chloride, cetylpyridinium chloride, polysorbate 80) * generalized disorders of muscle activity (eg myasthenia gravis, lambert-eaton syndrome). * severe coagulation disorders, anticoagulation in progress (ticlopidine, clopidogrel, other antiplatelet or antithrombotic agents) * presence of a local or general infection, suspected infection, infection at the proposed injection site. non-inclusion criteria for the medical device used for the prp samples (smartprep2 sampling system): * clinical or laboratory evidence for sepsis * taking aspirin or other drugs altering platelet function in the previous 3 days * patient with the platelet dysfunction disorders non-inclusion criteria for interfering diseases or conditions: * the patient is pregnant, parturient or she is breastfeeding * the patient has an allergy to botulinum toxin type a and / or glucocorticoids * the patient has medial epicondylalgia * the patient has a history of elbow surgery * the patient has any of the following conditions: immunodeficiency, rheumatic disease, hepatitis, diabetes, another disease of the ipsilateral limb, neurological disorder (radiculopathy, compression of the radial nerve), any myopathy (all etiologies) * the patient received treatment with corticosteroids in the last 3 months * the patient is being treated with long-term anti-platelet medication