Five Year Prospective Comparison Study of Topical Glyceryl Trinitrate Treatment of Chronic Lateral Epicondylosis at the Elbow

Sebastian D A McCallum ¹, Justin A Paoloni ² and George A C Murrell ^2*

¹ University of New South Wales, Australia
² Orthopaedic Research Institute, University of New South Wales, Australia

^* To whom correspondence should be addressed. E-mail: murrell.g{at}ori.org.au.

Accepted 13 May 2009

Abstract

Background: Topical glyceryl trinitrate treatment has previously demonstrated short-term efficacy in the treatment of lateral epicondylosis. No long term follow up has been performed.

Hypothesis: Benefits from topical gylceryl trinitrate persist five years after cessation of therapy.

Study design: Prospective comparative study.

Methods: A follow up study of 58 patients treated with 6 months of topical glyceryl trinitrate or placebo, combined with a tendon rehabilitation program, was performed 5 years after discontinuation of therapy. Assessment included patient rated pain scores, clinically assessed lateral epicondylar and proximal common extensor tendon tenderness, hand-held dynamometer measurement of resisted 3rd finger metacarpophalangeal extension with a fully extended elbow (Maudsley’s test) and wrist extensor tendon mean peak force using a modified chair pick-up test (ORI-TETS).

Results: Patients in both the glyceryl trinitrate group and those in the placebo group had significant improvements in symptoms, clinical signs and provocative functional tests compared with baseline week 0 measures. Glyceryl trinitrate did not offer any additional clinical benefit over a standard tendon rehabilitation program at five years.

Conclusion: While glyceryl trinitrate appears to offer short term benefits up to 6 months in the treatment of lateral epicondylosis, at five years there does not appear to be significant clinical benefits when compared with patients undertaking a standard tendon rehabilitation program alone. This is in contrast to findings of continued benefits at long term follow up described in the literature for patients with Achilles tendinopathy treated with glyceryl trinitrate.