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).

Conclusion: The administration of NO directly over an area of tendinopathy through a GTN patch reduces pain and other symptoms in chronic LE.

Keywords

• Lateral epicondylitis
• nitric oxide
• topical glyceryl trinitrate

Topikal gliseril trinitrat ile tenisçi dirseğinin tedavisi

Öz

Amaç: Bu çalışmada, lateral epikondilitin (LE) tedavisinde topikal gliseril trinitrat (GTN) formunda nitrik oksit (NO) uygulaması ile tedavi edilen hastaların tedavi sonuçlarının değerlendirilmesi amaçlanmıştır.

Çalışma planı: Lateral epikondiliti olan 40 hasta rastgele 2 eşit gruba bölündü. Seçim kriterleri ağrı, hassasiyet ve ağrı uyarıcı manevraların pozitifliği olarak kabul edildi. Teadvi grubunda GTN yamaları, kontrol grubunda ise plasebo yamalar günde bir kez olmak üzere en çok hassasiyet olan bölgeye uygulandı. Hastaların görsel analog skala (GAS) ile ağrının ne derece giderildiği bazında değerlendirildi ve sonuçlar Verhaar ve ark.’nın kriterlerine göre sınıflandırıldı. Mükemmel ve iyi sonuçlar başarılı tedavi olarak kabul edildi. Gruplar arası GAS skorundaki farklılık Mann-Whitney U-testi ile hesaplandı. Kategorik değişkenlerin dağılımları (cinsiyet, etkilenen taraf) ve gruplar arası iyi ve mükemmel sonuçların karşılaştırılması için ki-kare testi kullanıldı.

Bulgular: Tedavi başlangıcında, iki grup arasında klinik parametreler açısından istatistiksel olarak anlamlı bir fark yoktu. Hastaların 3. hafta sonundaki GAS değerlendirmesinde iki grup arasında istatiksel olarak anlamlı ölçüde fark bulundu (kontrol ve tedavi gruplarının ortalama GAS skorları, sırasıyla, 6.45 ve 3.15 idi) (p=0.001). Gliseril trinitrat uygulanan hastalar ve kontrol grubundaki hastalarda 3. hafta sonunda anlamlı derecede düşük GAS skoru (GTN grubunda GAS skoru başlangıç değeri 8.05’ten 3.15’e, kontrol grubunda ise başlangıç değeri 8.80’den 6.45’e gerilemişti) ve azalmış dirsek ağrısı saptandı. Kontrol grubunda hiç mükemmel ve iyi sonuç olmamasına rağmen, tedavi grubunda 18 hastada (%90) başarı kaydedildi. Altıncı ay sonunda grupların GAS skorları arasında istatistiksel olarak anlamlı ölçüde fark belirlendi (kontrol ve tedavi gruplarının ortalama GAS skorları, sırasıyla, 4.85 ve 0.70 idi) (p=0.001).

Çıkarımlar: Gliseril trinitrat yaması kullanılarak tendinopatili bölge üzerine uygulanan NO, kronik LE’deki ağrı ve diğer semptomları azaltmaktadır.

Anahtar Kelimeler

• Lateral epikondilit; nitrik oksit; topikal gliseril trinitrat.

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