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Topical glyceryl trinitrate for the treatment of tendinopathies: a systematic review
  1. Dimitris Challoumas1,
  2. Paul D Kirwan2,3,
  3. Dmytro Borysov1,
  4. Christopher Clifford4,
  5. Michael McLean1,
  6. Neal L Millar1
  1. 1 Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
  2. 2 School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
  3. 3 Physiotherapy Department, Connolly Hospital, Dublin, Ireland
  4. 4 Physiotherapy Department, West Glasgow Acute Care Hospital, Glasgow, UK
  1. Correspondence to Mr Neal L Millar, Institute of Infection, Immunity and Inflammation College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8TA, UK; neal.millar{at}


Objective To produce a best evidence synthesis of the clinical effects of topical glyceryl trinitrate (GTN) in the treatment of tendinopathies.

Design A systematic review of published randomised controlled trials (RCTs) of the use of GTN in patients with tendinopathy.

Data sources MEDLINE, Embase, Scopus and CINAHL from database inception to January 2018.

Methods We examined RCTs comparing the effects of topical GTN with either placebo or other treatments on tendinopathy. Overall quality of each eligible study was determined based on a combined assessment of internal validity, external validity and precision. The level of evidence for each assessed parameter was rated based on the system by van Tulder et al.

Results A total of 10 eligible RCTs were identified including patients with tendinopathy of the rotator cuff (n=4), wrist extensors (n=3), Achilles (n=2) and patellar (n=1) tendons. 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.

  • tendinopathy
  • tendinosis
  • tendon
  • treatment
  • overuse injury

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  • Contributors NLM and DC conceived and designed the study. DC and, NLM and PDK performed analysis. DB and CC provided expert advice. All authors analysed the data. DC, NLM and PDK wrote the paper.

  • Funding This work was funded by grants from the Medical Research Council UK (MR/R020515/1) and Arthritis Research UK (21346).

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement DC and NLM have access to all the data, and data are available upon request.

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