Topical Glyceryl Trinitrate Application in the Treatment of Chronic Supraspinatus Tendinopathy

Paoloni, Justin; Appleyard, Richard; Nelson, Janis; Murrell, George A. C.

doi:10.1177/0363546504270998

Cited by 104 publications

(107 citation statements)

References 25 publications

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“…Nitric oxide, applied using topical nitroglycerin patches, has been shown to improve outcomes in randomized, double-blind, placebo-controlled trials, possibly by enhancing collagen synthesis. [60][61][62] Sclerosant injections have been shown to give at least shortterm benefit, 63 and might provide a rational basis for targeting neovascularization in painful tendinopathy, which might be triggered initially by hypoxia and regulated by levels of endostatin and vascular endothelial growth factor. 64,65 Aging might reduce the ability of tenocytes to remodel and repair lesions, supporting the use of stem-cell therapies that involve the injection of bone-marrow-derived cells into injured or degenerate tendon; this approach is currently being used to treat equine tendinopathy.…”

Section: New Treatments For Tendinopathy and Future Research Directionsmentioning

confidence: 99%

Tendinopathy—from basic science to treatment

2008

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Section: New Treatments For Tendinopathy and Future Research Directionsmentioning

confidence: 99%

Tendinopathy—from basic science to treatment

2008

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“…Paoloni et al 11 found a significant pain relief, an increase in ROM of internal shoulder abduction and rotation, and an increase in strength of the external and internal rotator muscles due to a NT treatment. In a double-blind study with 65 patients diagnosed with Achilles tendinitis, NT treatment was used and stretch exercises were carried out, resulting in effective pain relief.…”

Section: Discussionmentioning

confidence: 99%

“…The positions taken during the ROM measurement of each movement are shown in Figure 1. Abduction was assessed with the shoulder in external rotation, 11 whereas antepulsion and retropulsion were examined with the shoulder in neutral rotation position. 14 External and internal rotations were assessed with the elbow fixed at 901 and the shoulder at 901 of abduction.…”

Section: Wuspi and Scim Scoresmentioning

confidence: 99%

“…The treated patients reported significant pain relief, although 10% of them complained of headaches in the first 24 h of treatment. 10 In a separate double-blind study of supraspinatus tendinitis, Paoloni et al 11 demonstrated the efficacy of a dose involving a 1.25 mg NT patch/day over a 6-month period. On the other hand, Kane et al 12 recently published a work, in which they report results that do not support the assumed effect of NT on collagen regeneration of damaged tendons.…”

Section: Introductionmentioning

confidence: 99%

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Transdermal nitroglycerine treatment of shoulder tendinopathies in patients with spinal cord injuries

et al. 2011

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Study design: A clinical blind study was conducted to determine the efficacy of transdermal nitroglycerine treatment on the awareness of shoulder pain. Objective: This study aims to determine the effects of transdermal nitroglycerine on shoulder pain and on functional shoulder movement in patients with spinal cord injuries and shoulder tendinopathies. A second aim is to establish the side effects of the treatment. Setting: Hospital ''La Fe'' in Valencia, Spain. Methods: A total of 45 spinal cord injury patients, all of whom are wheelchair users with shoulder tendinopathy, were randomly divided into two groups: placebo (n ¼ 12) and experimental (n ¼ 33). The experimental group (EG) received transdermal treatment for 6 months in the form of a 1.25 mg nitroglycerine (NT) patch on the greater tubercle. A placebo patch was used with the placebo subjects. Functional shoulder movements were assessed by articular range of motion and pain, using a visual analogical scale. Results: NT treatment reduced the awareness of shoulder pain and increased the functional movement and range of articular motion in the shoulders of the EG members (Po0.05). Conclusions: We conclude that transdermal NT is an efficient method for treating shoulder tendinopathies in wheelchair users with spinal cord injuries.

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“…Within a tendon, vascularity decreases at the point of the tear as compared to its interface on bone [4]. Although no studies have directly proven a causal relationship between increased vascularity and improved rotator cuff healing, a recent randomized prospective clinical trial has demonstrated a topically applied angiogenic factor, glyceryl trinitrate, reduced shoulder pain and stiffness in patients with chronic supraspinatus tendinopathy [29,42].…”

Section: Biology Of Bone-to-tendon Healingmentioning

confidence: 99%

Strategies in Biologic Augmentation of Rotator Cuff Repair: A Review

Cheung

Silverio

Sperling

2010

Clinical Orthopaedics &Amp; Related Research

146

103

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Background Degenerative rotator cuff tears are increasing with the aging population, and healing is not uniform after surgery. Rotator cuffs may show improved healing when biologic factors are added during surgery. Questions/purposes We asked: (1) What cellular processes are involved in normal bone-to-tendon healing? (2) What approaches are being developed in tendon augmentation? (3) What approaches are being developed with the addition of growth factors? Methods We reviewed research in relating to biologic augmentation and cellular processes involved in rotator cuff repair, focusing on animal models of rotator cuff repair and nonrandomized human trials. Results Regular bone-to-tendon healing forms a fibrous junction between tendon and bone that is distinct from the original bone-to-tendon junction. Tendon augmentation with cellular components serves as scaffolding for fibroblastic cells and a possible source of growth factors and fibroblastic cells. Extracellular matrices provide a scaffold for incoming fibroblastic cells, although current research does not conclusively confirm which if any of these scaffolds enhance repair owing in part to intermanufacturer variations and the limited human research. Growth factors and platelet-rich-plasma are established in other fields of research and may enhance repair but have not been rigorously tested. Conclusions There is potential application of biologic augmentation to improve healing after rotator cuff repair. However, research in this field is still inconclusive and has not been sufficiently demonstrated to merit regular clinical use. Future human trials can elucidate the use of biologic augmentation in rotator cuff repairs.

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Topical Glyceryl Trinitrate Application in the Treatment of Chronic Supraspinatus Tendinopathy

Cited by 104 publications

References 25 publications

Tendinopathy—from basic science to treatment

Tendinopathy—from basic science to treatment

Transdermal nitroglycerine treatment of shoulder tendinopathies in patients with spinal cord injuries

Strategies in Biologic Augmentation of Rotator Cuff Repair: A Review

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