Table 2

Samples, characteristics of interventions and outcome measures of the included studies

chronic tendinopathy
Tendon affectedAuthorSample, mean/median age, %FInterventionsTreatment duration (follow-up)Outcome measures
AcuteRotator cuffBerrazueta et al 13 n=20; mean 37 years (2062 years); 50%.GTN patch 5 mg/day (n=10) or placebo patch (n=10).3 days (24 hours, 48 hours, 15 days).Pain: (A) VAS score. (B) Pain duration in last 24 hours (five-point scale).
ROM: restriction of joint movement (five-point scale).
Other: sleep hours (three-point scale).
Treatment success: asymptomatic at 15 days.
AcuteRotator cuffPons et al 32 n=48; mean 61 years; 69%.GTN patch 5 mg/day (n=24) or local corticosteroid injection (n=24).3 days; if no complete improvement, intervention was repeated up to 3 times at 15-day intervals (7 days, 22 days and 42 days).Pain: at rest (changes in VAS score; described as three categories: decrease of >5 points=complete improvement, 3–5 points=partial improvement, <3 points= failure).
ChronicPatellarSteunebrink et al 35 n=33; median age 31.9 years in GTN group and 33.8 years in control group; NA.GTN patch 1.25 mg/day+tendon rehab (n=16) or placebo patch+tendon rehab (n=17).12 weeks (6 weeks, 12 weeks and 24 weeks).Pain: VAS score during sports.
Tendon specific: VISA-P questionnaire.
Patient satisfaction.
ChronicRotator cuffGiner-Pascual et al 33 n=45; mean 54.3 years GTN and 42.2 years control; 37.8%.GTN patch 1.25 mg/day (n=33) or placebo patch (n=12).6 months (6 months).Pain: VAS score.
ROM (degrees).
Patient-group specific: (A) functional movement (SCIM).
(B) Functional movement-induced pain (WUSPI).
ChronicRotator cuffPaoloni et al 29 n=53; mean 51 years, median 52 years (25–79 years); 55%.GTN patch 1.25 mg/day+tendon rehab (n=26) or placebo patch+tendon rehab (n=27).24 weeks
(2 weeks, 6 weeks, 12 weeks and 24 weeks).
Pain: at rest, at night and with activity (five-point scale: 0–4).
Subacromial tenderness (four-point scale: 0–3).
ROM: passive (degrees).
Force (N).
Tendon specific: Clinical impingement tests in IR and ER (positive or negative).
ChronicAchillesKane et al 30 n=40; mean 40.5 years (22–68 years); %NA.GTN patch 2.5 mg/day+tendon rehab (n=20) or tendon rehab only (n=20).
Histology and immunohistochemistry of Achilles samples from surgery (control group n=3, GTN group n=4).
6 months
(6 months)
Pain: AOS VAS for pain and disability.
Other: (A) histology (neovascularisation, collagen synthesis and fibroblast activity).
(B) Immunohistochemistry (NOS production).
ChronicAchillesPaoloni et al 28 n=65; median 49 years (24–77 years); 38.5%.GTN patch 1.25 mg/day+tendon rehab (n=32) or placebo patch+tendon rehab (n=33).24 weeks (2 weeks, 6 weeks, 12 weeks and 24 weeks).Pain: (A) at rest, at night, with activity (five-point scale: 0–4). (B) After hop test (11-point scale: 0–10).
Tenderness: four-point scale (0–3).
Force: (A) plantar flexor peak force (N).
(B) plantar flexor work (N).
ChronicWrist extensorsOzden et al 34 n=40; mean 43.2 years (19–74 years), 30%.GTN patch 1.25 mg/day+tendon rehab (n=20) or placebo patch+tendon rehab (n=20).24 weeks (3 weeks and 6 months).Pain: VAS score.
Force: grip strength (N).
Tendon specific: treatment outcomes as per Verhaar et al.
ChronicWrist extensorsPaoloni et al 31 n=154; NA years (NA years), NA%.GTN patch 0.72 mg/day+stretching (n=41) GTN patch 1.44 mg/day+stretching (n=34), GTN patch 3.6 mg/day+stretching (n=44), placebo patch+stretching (n=35).8 weeks (8 weeks)Pain: at rest, with activity (VAS score).
Force: (A) grip strength (kg) and (B) strength test using ORI-TETS (kg; tendon specific).
Tendon specific: PRTEV.
Other: SGAC in overall symptoms.
ChronicWrist extensorsPaoloni et al 27 n=86; median 46 years (30–74 years), 51%.GTN patch 1.25 mg/day+tendon rehab (n=43) or placebo patch+tendon rehab (n=43).24 weeks (2 weeks, 6 weeks, 12 weeks and 24 weeks).Pain: at rest, at night, with activity (five-point scale: 0–4).
Tenderness (four-point scale: none, mild, moderate and severe).
Force: (A) Maudsley’s test (resisted third MCPJ extension force; N), (B) wrist extension peak force (chair pick up test - ORI-TETS; N; tendon specific) and (C) total work using ORI-TETS (N; tendon specific).
  • AOS, Ankle Osteoarthritis Scale; ER, external rotation; GTN, glyceryl trinitrate; IR, internal rotation; MCPJ, metacarpophalangeal joint; NOS, nitric oxide synthase; ns, not stated; ORI-TETS, Orthopaedic Research Institute Tennis Elbow Testing System; PRTEV, Patient-Rated Tennis Elbow Evaluation; ROM, range of movement; SCIM, spinal cord injury measurement; SGAC, Subjective Global Assessment of Change; VAS, visual analogue scale; VISA-P, Victorian Institute of Sports Assessment – Patella; WUSPI, Wheelchair Users Shoulder Pain Index.