Topical nitric oxide application in the treatment of chronic extensor tendinosis at the elbow: a randomized, double-blinded, placebo-controlled clinical trial.
BACKGROUND
Extensor tendinosis ("tennis elbow") is a degenerative overuse tendinopathy of the wrist extensors at their attachment to the lateral humeral epicondyle. No treatment has been universally successful. Topical application of nitric oxide has been used effectively to treat fractures and cutaneous wounds in animal models, presumably by stimulation of collagen synthesis in fibroblasts.


OBJECTIVE
To determine whether topical nitric oxide can improve outcome of patients with extensor tendinosis.


METHODS
Prospective, randomized, double-blinded clinical trial.


METHODS
Eighty-six patients with extensor tendinosis were randomized into two equal groups; both were instructed to perform a standard tendon rehabilitation program. One group received an active glyceryl trinitrate transdermal patch, and the other group received a placebo patch.


RESULTS
Patients in the glyceryl trinitrate group had significantly reduced elbow pain with activity at 2 weeks, reduced epicondylar tenderness at 6 and 12 weeks, and an increase in wrist extensor mean peak force and total work at 24 weeks. At 6 months, 81% of treated patients were asymptomatic during activities of daily living, compared with 60% of patients who had tendon rehabilitation alone.


CONCLUSIONS
Application of topical nitric oxide improved early pain with activity, late functional measures, and outcomes of patients with extensor tendinosis.
Paoloni
Justin A
JA
Orthopaedic Research Institute, St. George Hospital Campus, University of New South Wales, Sydney, New South Wales, Australia.
Appleyard
Richard C
RC
Nelson
Janis
J
Murrell
George A C
GA
D000287:Administration, Topical; D000328:Adult; D002908:Chronic Disease; D004311:Double-Blind Method; D005260:Female; D049671:History, 18th Century; D006801:Humans; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D013716:Tennis Elbow / Q000188:drug therapy* / Q000534:rehabilitation; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*
D014665:Vasodilator Agents; D005996:Nitroglycerin