For all tendinopathies , improvements in pain were significant when comparing GTN versus placebo in the short term ( < 8 weeks ; poor evidence ) .
Significant improvements in midterm outcomes for treatment with GTN versus placebo included the following : patient satisfaction ( strong evidence ) ; chances of being asymptomatic with activities of daily living ( strong evidence ) ; range of movement ( moderate evidence ) ; strength ( moderate evidence ) ; pain ( at night and with activity ; poor evidence ) and local tenderness ( poor evidence ) .
Patients treated with topical GTN reported a higher incidence of headaches than those who received placebo ( moderate evidence ) .
Conclusions and relevance Treatment of tendinopathies with topical GTN for up to 6 months appears to be superior to placebo and may therefore be a useful adjunct to the treating healthcare professions
Objective To produce a best evidence synthesis of the clinical effects of topical glyceryl trinitrate ( GTN ) in the treatment of tendinopathies .
Topical Glyceryl Trinitrate and Noninsertional Achilles Tendinopathy
Background Topical glyceryl trinitrate ( GTN ) therapy has been advocated in the treatment of Achilles tendinopathy . The mechanism of action is unknown but may be related to modulation of local nitric oxide levels . Hypothesis Topical GTN therapy for noninsertional Achilles tendinopathy will significantly enhance clinical improvement and will be associated with increased collagen synthesis within the tendon . Study Design R and omized controlled clinical trial ; Level of evidence , 1 . Methods Forty patients were recruited . Twenty underwent  st and ard nonoperative physical therapy  , and 20 underwent physical therapy and topical GTN daily . Clinical outcome was assessed using the Ankle Osteoarthritis Scale ( AOS ) visual analog score . Patients who failed to improve with conservative measures and who underwent surgical decompression had histological and immunohistochemical examination of sample s from the Achilles tendon . Results Glyceryl trinitrate did not offer any additional clinical benefit over st and ard nonoperative treatment for noninsertional Achilles tendinopathy . After 6 months of treatment , there was no significant difference in scores between the groups for pain ( 3.0 vs 3.1 , P = .42 ) or disability ( 2.15 vs 2.25 , P = .38 ) . Histological examination did not show any difference in neovascularization , collagen synthesis , or stimulated fibroblasts between the 2 groups . There was no evidence of modulation of nitric oxide synthase , a marker of nitric oxide production , in those tendons treated with GTN . Conclusion and Clinical Relevance This study has failed to support the clinical benefit of GTN patches previously described in the literature . In the available tissue sample s , there did not appear to be any histological or immunohistochemical change in Achilles tendinopathy treated with GTN compared with those undergoing st and ard nonoperative therapy
For all tendinopathies , improvements in pain were significant when comparing GTN versus placebo in the short term ( < 8 weeks ; poor evidence ) .
Significant improvements in midterm outcomes for treatment with GTN versus placebo included the following : patient satisfaction ( strong evidence ) ; chances of being asymptomatic with activities of daily living ( strong evidence ) ; range of movement ( moderate evidence ) ; strength ( moderate evidence ) ; pain ( at night and with activity ; poor evidence ) and local tenderness ( poor evidence ) .
Patients treated with topical GTN reported a higher incidence of headaches than those who received placebo ( moderate evidence ) .
Conclusions and relevance Treatment of tendinopathies with topical GTN for up to 6 months appears to be superior to placebo and may therefore be a useful adjunct to the treating healthcare professions
Objective To produce a best evidence synthesis of the clinical effects of topical glyceryl trinitrate ( GTN ) in the treatment of tendinopathies .