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, 53 (4), 251-262

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


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

Dimitris Challoumas et al. Br J Sports Med.


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.


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

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