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Management of tennis elbow with topical glyceryl trinitrate

Year 2014, , 175 - 180, 21.04.2014
https://doi.org/10.3944/AOTT.2014.3123

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.

References

  • De Smedt T, de Jong A, Van Leemput W, Lieven D, Van Glabbeek F. Lateral epicondylitis in tennis: update on aetiology, biomechanics and treatment. Br J Sports Med
  • Rayan F, Rao V Sr, Purushothamdas S, Mukundan C, Shafqat SO. Common extensor origin release in recalci- trant lateral epicondylitis - role justified? J Orthop Surg Res 2010;5:31.
  • Haahr JP, Andersen JH. Physical and psychosocial risk factors for lateral epicondylitis: a population based case- referent study. Occup Environ Med 2003;60:322-9.
  • Faro F, Wolf JM. Lateral epicondylitis: review and current concepts. J Hand Surg Am 2007;32:1271-9.
  • Walz DM, Newman JS, Konin GP, Ross G. Epicondyli- tis: pathogenesis, imaging, and treatment. Radiographics 2010;30:167-84.
  • Van Hofwegen C, Baker CL 3rd, Baker CL Jr. Epicondyli- tis in the athlete’s elbow. Clin Sports Med 2010;29:577-97.
  • Murrell GA, Szabo C, Hannafin JA, Jang D, Dolan MM, Deng XH, et al. Modulation of tendon healing by nitric oxide. Inflamm Res 1997;46:19-27.
  • Yuan J, Murrell GA, Wei AQ, Appleyard RC, Del Soldato P, Wang MX. Addition of nitric oxide via nitroflurbipro- fen enhances the material properties of early healing of young rat Achilles tendons. Inflamm Res 2003;52:230-7.
  • Paoloni JA, Appleyard RC, Nelson J, Murrell GA. Topi- cal glyceryl trinitrate treatment of chronic noninsertional achilles tendinopathy. A randomized, double-blind, place- bo-controlled trial. J Bone Joint Surg Am 2004;86-A:916- 22.
  • Paoloni JA, Murrell GA. Three-year followup study of top- ical glyceryl trinitrate treatment of chronic noninsertional Achilles tendinopathy. Foot Ankle Int 2007;28:1064-8.
  • McCallum SD, Paoloni JA, Murrell GA. Five-year pro- spective comparison study of topical glyceryl trinitrate treatment of chronic lateral epicondylosis at the elbow. Br J Sports Med 2011;45:416-20.
  • Paoloni JA, Murrell GA, Burch RM, Ang RY. Ran- domised, double-blind, placebo-controlled clinical trial of a new topical glyceryl trinitrate patch for chronic lateral epicondylosis. Br J Sports Med 2009;43:299-302.
  • Sanford J, Moreland J, Swanson LR, Stratford PW, Gow- land C. Reliability of the Fugl-Meyer assessment for test- ing motor performance in patients following stroke. Phys Ther 1993;73:447-54.
  • Svernlöv B, Adolfsson L. Non-operative treatment regime including eccentric training for lateral humeral epicon- dylalgia. Scand J Med Sci Sports 2001;11:328-34.
  • Friedlander HL, Reid RL, Cape RF. Tennis elbow. Clin Orthop Relat Res 1967;51:109-16.
  • Gardner RC. Tennis elbow: diagnosis, pathology and treatment. Nine severe cases treated by a new reconstruc- tive operation. Clin Orthop Relat Res 1970;72:248-53.
  • Paoloni JA, Appleyard RC, Murrell GA. The Orthopaedic Research Institute-Tennis Elbow Testing System: A mod- ified chair pick-up test-interrater and intrarater reliability testing and validity for monitoring lateral epicondylosis. J Shoulder Elbow Surg 2004;13:72-7.
  • Verhaar J, Walenkamp G, Kester A, van Mameren H, van der Linden T. Lateral extensor release for tennis elbow. A prospective long-term follow-up study. J Bone Joint Surg Am 1993;75:1034-43.
  • Tosti R, Jennings J, Sewards JM. Lateral epicondylitis of the elbow. Am J Med 2013;126:357.e1-6.
  • Coonrad RW, Hooper WR. Tennis elbow: its course, nat- ural history, conservative and surgical management. J Bone Joint Surg Am 1973;55:1177-82.
  • Nirschl RP, Pettrone FA. Tennis elbow. The surgical treatment of lateral epicondylitis. J Bone Joint Surg Am 1979;61:832-9.
  • Paoloni JA, Appleyard RC, Nelson J, Murrell GA. Topi- cal nitric oxide application in the treatment of chronic extensor tendinosis at the elbow: a randomized, double- blinded, placebo-controlled clinical trial. Am J Sports Med 2003;31:915-20.
  • Paoloni JA, Appleyard RC, Nelson J, Murrell GA. Topical glyceryl trinitrate application in the treatment of chronic supraspinatus tendinopathy: a randomized, double-blind- ed, placebo-controlled clinical trial. Am J Sports Med
  • Smidt N, van der Windt DA, Assendelft WJ, Devillé WL, Korthals-de Bos IB, Bouter LM. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lat- eral epicondylitis: a randomised controlled trial. Lancet 2002;359:657-62.
  • Kapetanos G. The effect of the local corticosteroids on the healing and biomechanical properties of the partially in- jured tendon. Clin Orthop Relat Res 1982;163:170-9.
  • Gottlieb NL, Riskin WG. Complications of local cortico- steroid injections. JAMA 1980;243:1547-8.
  • Krogh TP, Fredberg U, Stengaard-Pedersen K, Chris- tensen R, Jensen P, Ellingsen T. Treatment of lateral epi- condylitis with platelet-rich plasma, glucocorticoid, or sa- line: a randomized, double-blind, placebo-controlled trial. Am J Sports Med 2013;41:625-35.
  • Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, cortico- steroid injection, or wait and see for tennis elbow: ran- domised trial. BMJ 2006;333:939.

Topikal gliseril trinitrat ile tenisçi dirseğinin tedavisi

Year 2014, , 175 - 180, 21.04.2014
https://doi.org/10.3944/AOTT.2014.3123

Abstract

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.

References

  • De Smedt T, de Jong A, Van Leemput W, Lieven D, Van Glabbeek F. Lateral epicondylitis in tennis: update on aetiology, biomechanics and treatment. Br J Sports Med
  • Rayan F, Rao V Sr, Purushothamdas S, Mukundan C, Shafqat SO. Common extensor origin release in recalci- trant lateral epicondylitis - role justified? J Orthop Surg Res 2010;5:31.
  • Haahr JP, Andersen JH. Physical and psychosocial risk factors for lateral epicondylitis: a population based case- referent study. Occup Environ Med 2003;60:322-9.
  • Faro F, Wolf JM. Lateral epicondylitis: review and current concepts. J Hand Surg Am 2007;32:1271-9.
  • Walz DM, Newman JS, Konin GP, Ross G. Epicondyli- tis: pathogenesis, imaging, and treatment. Radiographics 2010;30:167-84.
  • Van Hofwegen C, Baker CL 3rd, Baker CL Jr. Epicondyli- tis in the athlete’s elbow. Clin Sports Med 2010;29:577-97.
  • Murrell GA, Szabo C, Hannafin JA, Jang D, Dolan MM, Deng XH, et al. Modulation of tendon healing by nitric oxide. Inflamm Res 1997;46:19-27.
  • Yuan J, Murrell GA, Wei AQ, Appleyard RC, Del Soldato P, Wang MX. Addition of nitric oxide via nitroflurbipro- fen enhances the material properties of early healing of young rat Achilles tendons. Inflamm Res 2003;52:230-7.
  • Paoloni JA, Appleyard RC, Nelson J, Murrell GA. Topi- cal glyceryl trinitrate treatment of chronic noninsertional achilles tendinopathy. A randomized, double-blind, place- bo-controlled trial. J Bone Joint Surg Am 2004;86-A:916- 22.
  • Paoloni JA, Murrell GA. Three-year followup study of top- ical glyceryl trinitrate treatment of chronic noninsertional Achilles tendinopathy. Foot Ankle Int 2007;28:1064-8.
  • McCallum SD, Paoloni JA, Murrell GA. Five-year pro- spective comparison study of topical glyceryl trinitrate treatment of chronic lateral epicondylosis at the elbow. Br J Sports Med 2011;45:416-20.
  • Paoloni JA, Murrell GA, Burch RM, Ang RY. Ran- domised, double-blind, placebo-controlled clinical trial of a new topical glyceryl trinitrate patch for chronic lateral epicondylosis. Br J Sports Med 2009;43:299-302.
  • Sanford J, Moreland J, Swanson LR, Stratford PW, Gow- land C. Reliability of the Fugl-Meyer assessment for test- ing motor performance in patients following stroke. Phys Ther 1993;73:447-54.
  • Svernlöv B, Adolfsson L. Non-operative treatment regime including eccentric training for lateral humeral epicon- dylalgia. Scand J Med Sci Sports 2001;11:328-34.
  • Friedlander HL, Reid RL, Cape RF. Tennis elbow. Clin Orthop Relat Res 1967;51:109-16.
  • Gardner RC. Tennis elbow: diagnosis, pathology and treatment. Nine severe cases treated by a new reconstruc- tive operation. Clin Orthop Relat Res 1970;72:248-53.
  • Paoloni JA, Appleyard RC, Murrell GA. The Orthopaedic Research Institute-Tennis Elbow Testing System: A mod- ified chair pick-up test-interrater and intrarater reliability testing and validity for monitoring lateral epicondylosis. J Shoulder Elbow Surg 2004;13:72-7.
  • Verhaar J, Walenkamp G, Kester A, van Mameren H, van der Linden T. Lateral extensor release for tennis elbow. A prospective long-term follow-up study. J Bone Joint Surg Am 1993;75:1034-43.
  • Tosti R, Jennings J, Sewards JM. Lateral epicondylitis of the elbow. Am J Med 2013;126:357.e1-6.
  • Coonrad RW, Hooper WR. Tennis elbow: its course, nat- ural history, conservative and surgical management. J Bone Joint Surg Am 1973;55:1177-82.
  • Nirschl RP, Pettrone FA. Tennis elbow. The surgical treatment of lateral epicondylitis. J Bone Joint Surg Am 1979;61:832-9.
  • Paoloni JA, Appleyard RC, Nelson J, Murrell GA. Topi- cal nitric oxide application in the treatment of chronic extensor tendinosis at the elbow: a randomized, double- blinded, placebo-controlled clinical trial. Am J Sports Med 2003;31:915-20.
  • Paoloni JA, Appleyard RC, Nelson J, Murrell GA. Topical glyceryl trinitrate application in the treatment of chronic supraspinatus tendinopathy: a randomized, double-blind- ed, placebo-controlled clinical trial. Am J Sports Med
  • Smidt N, van der Windt DA, Assendelft WJ, Devillé WL, Korthals-de Bos IB, Bouter LM. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lat- eral epicondylitis: a randomised controlled trial. Lancet 2002;359:657-62.
  • Kapetanos G. The effect of the local corticosteroids on the healing and biomechanical properties of the partially in- jured tendon. Clin Orthop Relat Res 1982;163:170-9.
  • Gottlieb NL, Riskin WG. Complications of local cortico- steroid injections. JAMA 1980;243:1547-8.
  • Krogh TP, Fredberg U, Stengaard-Pedersen K, Chris- tensen R, Jensen P, Ellingsen T. Treatment of lateral epi- condylitis with platelet-rich plasma, glucocorticoid, or sa- line: a randomized, double-blind, placebo-controlled trial. Am J Sports Med 2013;41:625-35.
  • Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, cortico- steroid injection, or wait and see for tennis elbow: ran- domised trial. BMJ 2006;333:939.
There are 28 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Article
Authors

Raif Ozden This is me

Vedat Uruc This is me

Yunus Dogramaci This is me

Aydiner Kalaci This is me

Erhan Yengil This is me

Publication Date April 21, 2014
Published in Issue Year 2014

Cite

APA Ozden, R., Uruc, V., Dogramaci, Y., Kalaci, A., et al. (2014). Management of tennis elbow with topical glyceryl trinitrate. Acta Orthopaedica Et Traumatologica Turcica, 48(2), 175-180. https://doi.org/10.3944/AOTT.2014.3123
AMA Ozden R, Uruc V, Dogramaci Y, Kalaci A, Yengil E. Management of tennis elbow with topical glyceryl trinitrate. Acta Orthopaedica et Traumatologica Turcica. April 2014;48(2):175-180. doi:10.3944/AOTT.2014.3123
Chicago Ozden, Raif, Vedat Uruc, Yunus Dogramaci, Aydiner Kalaci, and Erhan Yengil. “Management of Tennis Elbow With Topical Glyceryl Trinitrate”. Acta Orthopaedica Et Traumatologica Turcica 48, no. 2 (April 2014): 175-80. https://doi.org/10.3944/AOTT.2014.3123.
EndNote Ozden R, Uruc V, Dogramaci Y, Kalaci A, Yengil E (April 1, 2014) Management of tennis elbow with topical glyceryl trinitrate. Acta Orthopaedica et Traumatologica Turcica 48 2 175–180.
IEEE R. Ozden, V. Uruc, Y. Dogramaci, A. Kalaci, and E. Yengil, “Management of tennis elbow with topical glyceryl trinitrate”, Acta Orthopaedica et Traumatologica Turcica, vol. 48, no. 2, pp. 175–180, 2014, doi: 10.3944/AOTT.2014.3123.
ISNAD Ozden, Raif et al. “Management of Tennis Elbow With Topical Glyceryl Trinitrate”. Acta Orthopaedica et Traumatologica Turcica 48/2 (April 2014), 175-180. https://doi.org/10.3944/AOTT.2014.3123.
JAMA Ozden R, Uruc V, Dogramaci Y, Kalaci A, Yengil E. Management of tennis elbow with topical glyceryl trinitrate. Acta Orthopaedica et Traumatologica Turcica. 2014;48:175–180.
MLA Ozden, Raif et al. “Management of Tennis Elbow With Topical Glyceryl Trinitrate”. Acta Orthopaedica Et Traumatologica Turcica, vol. 48, no. 2, 2014, pp. 175-80, doi:10.3944/AOTT.2014.3123.
Vancouver Ozden R, Uruc V, Dogramaci Y, Kalaci A, Yengil E. Management of tennis elbow with topical glyceryl trinitrate. Acta Orthopaedica et Traumatologica Turcica. 2014;48(2):175-80.