n International SportMed Journal - The use of topically applied nitric oxide as a treatment for lateral epicondylosis in athletes : review article




&lt;I&gt;Objective:&lt;/I&gt; Literature review of topical nitric oxide as treatment for lateral epicondylosis in athletes. <br><I>Data sources:&lt;/I&gt; MEDLINE and EMBASE database searches were performed in July, 2004 on all studies from 1966 onwards using the terms: nitric oxide, nitroglycerin, glyceryl trinitrate, elbow, tendon, tendonitis, tendinosis, tendinopathy, tennis elbow, epicondylitis, epicondylosis, sport, athlete. <br><I>Study section:&lt;/I&gt; Randomised controlled trials were included in the analysis. Four studies were identified using topical nitric oxide treatment in tendinopathy. <br><I>Data extraction:&lt;/I&gt; Relevant literature was identified, sourced, and reviewed. <br><I>Data synthesis:&lt;/I&gt; Topical nitric oxide treatment of lateral epicondylosis has not been intensively investigated, and there are no studies on athletes. One randomised controlled trial demonstrates that with continuous dosing of 1.25 mg/ 24 glyceryl trinitrate (a nitric oxide donor) there are significant improvements in: elbow pain with activity at 2 weeks (p = 0.01), epicondylar tenderness at 6 and 12 weeks (p = 0.02), wrist extensor mean peak force and total work at 24 weeks (p = 0.03), and patient outcomes (p = 0.005) when compared to tendon rehabilitation. Mean effect size for all outcome measures was 0.12. &lt;br&gt;&lt;I&gt;Conclusions:&lt;/I&gt; Topical nitric oxide treatment requires further investigation to: define the mechanism of action of nitric oxide in tendinopathy, confirm the validity of the current literature, and delineate the most effective dosage regime to maximise effect and limit side effects. Topical nitric oxide treatment is a well tested medication with no irreversible side effects and the use of this therapy is warranted, combined with a tendon rehabilitation programme, to improve patient outcomes in lateral epicondylosis.


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