title: Effectiveness of 1% diclofenac gel in the treatment of wrist extensor tenosynovitis in long distance kayakers.
abstract: Anecdotally many athletes use non-steroidal anti-inflammatory gels during competition to allow continued participation. To determine if this clinical practice is useful a randomised placebo-controlled study was conducted at the 5-day 2004 Red Cross Murray River Marathon. Forty-two kayakers presented with wrist extensor tenosynovitis while competing in the single and double kayak events. All subjects received standard treatment of ice, stretches and massage for wrist tenosynovitis before being randomised into a placebo or 1% diclofenac gel group. Evaluation was done by using a visual analogue scale (0-10) for pain and by clinical grading (0-3). The main outcome measurements were reduction in pain and clinical grading, the requirement for a rescue medication (paracetamol or diclofenac tablets) and effect on performance times. Both groups had similar pain scores and clinical grading on the first and fifth days of pain. On the second to fourth days of pain there was clearly no benefit and possibly a detrimental effect on pain with diclofenac gel relative to placebo. However, diclofenac tablets were possibly beneficial for pain relative to paracetamol tablets. The effects of pain and the various treatments on performance time were either trivial (<0.5%) or small, but none was particularly clear. We conclude that standard treatment appears to be sufficient for the management of wrist extensor tenosynovitis during competition.
authors.affiliation: Sports Medicine ACT, Suite 9 Calvary Clinic, Bruce, ACT 2617, Australia. blair.may@bigpond.com.au
authors.forename: Judith J
authors.initials: JJ
authors.lastname: May
authors.forename: Greg
authors.initials: G
authors.lastname: Lovell
authors.forename: Will G
authors.initials: WG
authors.lastname: Hopkins
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000284:Administration, Oral; D000287:Administration, Topical; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D004008:Diclofenac / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005782:Gels; D006801:Humans; D008297:Male; D010147:Pain Measurement; D013177:Sports / Q000502:physiology*; D013717:Tenosynovitis / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome; D014955:Wrist Joint / Q000503:physiopathology*
chemical_list: D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D005782:Gels; D004008:Diclofenac; D000082:Acetaminophen