n International SportMed Journal - Topical glyceryl trinitrate treatment in chronic tendinopathies : review article
|Article Title||Topical glyceryl trinitrate treatment in chronic tendinopathies : review article|
|© Publisher:||International Federation of Sports Medicine|
|Journal||International SportMed Journal|
|Author||Justin A. Paoloni|
|Publication Date||Jan 2006|
|Pages||238 - 254|
|Keyword(s)||Achilles tendon, Elbow, Glyceryl trinitrate, Nitroglycerin, Shoulder, Tendinopathy and Tendon|
<I>Objective:</I> Literature review of topical glyceryl trinitrate treatment for chronic tendinopathy. <br><I>Data sources:</I> MEDLINE, PubMed, and EMBASE searches were performed in April, 2006 on all studies from 1966 onwards using the terms: nitric oxide, nitroglycerin, glyceryl trinitrate, tendon, tendonitis, tendinosis, tendinopathy, tendonopathy, elbow, tennis elbow, epicondylitis, epicondylosis, Achilles, patella, patellar, supraspinatus, impingement, and rotator cuff. <br><I>Study section:</I> Only randomised controlled trials were included in the analysis. Four studies were identified using topical glyceryl trinitrate treatment in tendinopathy. <br><I>Data extraction:</I> Relevant literature was identified, sourced, and reviewed. <br><I>Data synthesis:</I> Topical glyceryl trinitrate treatment of chronic tendinopathy has recently been investigated with several published clinical trials. Randomised, double-blind, placebo controlled clinical trials investigating topical glyceryl trinitrate treatment (1.25mg/24-hours) for chronic tendinopathies in adults (Achilles tendinopathy, N=84: extensor tendinopathy at the elbow, N=95: and supraspinatus tendinopathy, N=57) have demonstrated improved patient outcomes when compared with rehabilitation alone. Topical glyceryl trinitrate treatment results in significant improvements in patient rated pain, increased tendon force measures, improved functional measures, and improved patient outcomes relative to tendon rehabilitation. Outcomes at 6 months demonstrate that 22-29% more patients were completely asymptomatic when treated with topical glyceryl trinitrate. Effect size estimates ranged from 12-26%. <br><I>Conclusions:</I> Topical glyceryl trinitrate treatment is a well-tested medication with no irreversible side effects and use of this therapy is warranted to treat chronic tendinopathies to improve patient outcomes. Topical glyceryl trinitrate treatment requires further investigation to: define the mechanism of action of glyceryl trinitrate in tendinopathy, and delineate the most effective dosage regime to maximize effect and limit side effects.
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