Topical Glyceryl Trinitrate for Managing Refractory Tendinopathy
In February 2019 the BMJ published a review of topical nitroglycerin or glyceryl trinitrate (TGN) for the treatment of tendinopathies which I think is worth reviewing [1]. Tendinopathies account for up to 30% of an orthopedic or sports medicine practice. Patients typically present with pain and swelling at the affected tendon with a clear history of overuse from repetitive microtrauma, although acute injuries do occur. Tendinitis refers to acute injuries where inflammation of the tendon results in micro-tears that happen when the musculotendinous unit is acutely overloaded with a tensile force that is too heavy and/or too sudden [3].
Because of the high incidence of tendinopathies, lets briefly review the current understanding of its pathophysiology. Tendons are designed to withstand considerable loads. At the histological level, changes include reduced numbers and rounding of fibroblasts, increased content of proteoglycans, glycosaminoglycans and water, hypervascularization and disorganized collagen fibrils. At the molecular level, upregulation of RNA for type I and III collagens, proteoglycans, angiogenic factors, stress and regenerative proteins and proteolytic enzymes occurs.
Read More: https://wikism.org/Tendinopathies_(Main)
Read More
Managing Refractory Tendinopathy: Topical Glyceryl Trinitrate
Managing Refractory Tendinopathy: Needle Tenotomy (Part 2)
Managing Refractory Tendinopathy (Part 3): Dextrose Prolotherapy
Managing Refractory Tendinopathy (Part 4): Extracorporeal Shock Wave Therapy
Managing Refractory Tendinopathy: What is Ultrasound Guided Galvanic Electrolysis?
References
- Challoumas D, Kirwan PD, Borysov D, et al. Topical glyceryl trinitrate for the treatment of tendinopathies: a systematic review. British Journal of Sports Medicine 2019;53:251-262
- Magnusson SP, Langberg H, Kjaer M. The pathogenesis of tendinopathy: balancing the response to loading. Nat Rev Rheumatol. 2010 May;6(5):262-8. Doi: 10.1038/nrrheum.2010.43. Epub 2010 Mar 23. Review. PubMed PMID: 20308995.
- Bass E. Tendinopathy: why the difference between tendinitis and tendinosis matters. Int J Ther Massage Bodywork. 2012;5(1):14-7. Epub 2012 Mar 31. PubMed PMID: 22553479; PubMed Central PMCID: PMC3312643.
- Khan KM, Cook JL, Taunton JE, Bonar F. Overuse tendinosis, not tendinitis part 1: a new paradigm for a difficult clinical problem. Phys Sportsmed. 2000 May;28(5):38-48. doi: 10.3810/psm.2000.05.890. PubMed PMID: 20086639.
- Berrazueta, José Ramón, et al. “Successful treatment of shoulder pain syndrome due to supraspinatus tendinitis with transdermal nitroglycerin. A double blind study.” Pain 66.1 (1996): 63-67.