Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 53 (4), 251-262

Topical Glyceryl Trinitrate for the Treatment of Tendinopathies: A Systematic Review

Affiliations

Topical Glyceryl Trinitrate for the Treatment of Tendinopathies: A Systematic Review

Dimitris Challoumas et al. Br J Sports Med.

Abstract

Objective: To produce a best evidence synthesis of the clinical effects of topical glyceryl trinitrate (GTN) in the treatment of tendinopathies.

Design: A systematic review of published randomised controlled trials (RCTs) of the use of GTN in patients with tendinopathy.

Data sources: MEDLINE, Embase, Scopus and CINAHL from database inception to January 2018.

Methods: We examined RCTs comparing the effects of topical GTN with either placebo or other treatments on tendinopathy. Overall quality of each eligible study was determined based on a combined assessment of internal validity, external validity and precision. The level of evidence for each assessed parameter was rated based on the system by van Tulder et al.

Results: A total of 10 eligible RCTs were identified including patients with tendinopathy of the rotator cuff (n=4), wrist extensors (n=3), Achilles (n=2) and patellar (n=1) tendons. For all tendinopathies, improvements in pain were significant when comparing GTN versus placebo in the short term (<8 weeks; poor evidence). Significant improvements in midterm outcomes for treatment with GTN versus placebo included the following: patient satisfaction (strong evidence); chances of being asymptomatic with activities of daily living (strong evidence); range of movement (moderate evidence); strength (moderate evidence); pain (at night and with activity; poor evidence) and local tenderness (poor evidence). Patients treated with topical GTN reported a higher incidence of headaches than those who received placebo (moderate evidence).

Conclusions and relevance: Treatment of tendinopathies with topical GTN for up to 6 months appears to be superior to placebo and may therefore be a useful adjunct to the treating healthcare professions.

Keywords: overuse injury; tendinopathy; tendinosis; tendon; treatment.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram of included studies.

Similar articles

See all similar articles

Cited by 2 articles

References

    1. McGonagle D, Marzo-Ortega H, Benjamin M, et al. Report on the Second international Enthesitis Workshop. Arthritis Rheum 2003;48:896–905. 10.1002/art.10841 - DOI - PubMed
    1. Fu SC, Rolf C, Cheuk YC, et al. Deciphering the pathogenesis of tendinopathy: a three-stages process. Sports Med Arthrosc Rehabil Ther Technol 2010;2:30 10.1186/1758-2555-2-30 - DOI - PMC - PubMed
    1. Leadbetter WB. Cell-matrix response in tendon injury. Clin Sports Med 1992;11:533–78. - PubMed
    1. Andres BM, Murrell GA. Treatment of tendinopathy: what works, what does not, and what is on the horizon. Clin Orthop Relat Res 2008;466:1539–54. 10.1007/s11999-008-0260-1 - DOI - PMC - PubMed
    1. Millar NL, Murrell GA, McInnes IB. Inflammatory mechanisms in tendinopathy - towards translation. Nat Rev Rheumatol 2017;13:110–22. 10.1038/nrrheum.2016.213 - DOI - PubMed

Publication types

MeSH terms

Feedback