title: Management of tennis elbow with topical glyceryl trinitrate.
abstract: OBJECTIVE
  The aim of this study was to evaluate the treatment results of the application of nitric oxide (NO) in the form of topical glyceryl trinitrate (GTN) for the treatment of lateral epicondylitis (LE).
  
  
  METHODS
  The study included 40 patients with LE randomized into 2 equal groups. Selection criteria included the presence of pain, tenderness, and positive pain stimulating maneuvers. Glyceryl trinitrate patches were applied to the area of maximal tenderness once a day in the treatment group and placebo patches in the control group. Outcomes in terms of pain relief was assessed using the visual analog scale (VAS) and were evaluated according to the criteria of Verhaar et al. Excellent or good results were considered successful. Differences in VAS scores between the two groups were calculated using the Mann-Whitney U-test and the chi-square test was used to investigate distributions of categorical variables (sex, affected side) and good and excellent results among groups.
  
  
  RESULTS
  There were no significant differences in any of the baseline clinical parameters between groups. At the 3rd week follow-up, there were statistically significant differences in the pain measured using VAS between groups (mean VAS score of the control and treatment groups were 6.45 and 3.15, respectively) (p=0.001). Patients in the GTN group and control group had lower VAS pain scores and reduced elbow pain at 3 weeks (3.15 vs 8.05 in the GTN and 6.45 vs 8.80 in the control group). In the control group, no patient had excellent or good results while 18 (90%) patients in treatment group reported successful treatment. There was statistically significant difference in the VAS measured at 6 months between groups (mean VAS score of the control and treatment groups were 4.85 and 0.70, respectively) (p=0.001).
  
  
  CONCLUSIONS
  The administration of NO directly over an area of tendinopathy through a GTN patch reduces pain and other symptoms in chronic LE.
authors.affiliation: Department of Orthopedics and Traumatology, Mustafa Kemal University, Faculty of Medicine, Hatay, Turkey. raifozden@gmail.com.
authors.forename: Raif
authors.initials: R
authors.lastname: Ozden
authors.affiliation: Department of Orthopedics and Traumatology, Mustafa Kemal University, Faculty of Medicine, Hatay, Turkey.
authors.forename: Vedat
authors.initials: V
authors.lastname: Uruç
authors.affiliation: Department of Orthopedics and Traumatology, Mustafa Kemal University, Faculty of Medicine, Hatay, Turkey.
authors.forename: Yunus
authors.initials: Y
authors.lastname: Doğramaci
authors.affiliation: Department of Orthopedics and Traumatology, Mustafa Kemal University, Faculty of Medicine, Hatay, Turkey.
authors.forename: Aydiner
authors.initials: A
authors.lastname: Kalaci
authors.affiliation: Department of Orthopedics and Traumatology, Mustafa Kemal University, Faculty of Medicine, Hatay, Turkey.
authors.forename: Erhan
authors.initials: E
authors.lastname: Yengil
mesh_terms: D000287:Administration, Topical; D000328:Adult; D018771:Arthralgia / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D018737:Hand Strength; D006801:Humans; D008297:Male; D005996:Nitroglycerin / Q000008:administration & dosage / Q000009:adverse effects; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement / Q000379:methods; D013716:Tennis Elbow / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D057968:Transdermal Patch; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D014665:Vasodilator Agents; D005996:Nitroglycerin