Are topical nitrates safe and effective for upper extremity tendinopathies?

Abstract

Q. Are topical nitrates safe and effective for upper extremity tendinopathies? A. Topical nitrates provide short-term relief with some side effects, especially headache. Topical nitroglycerin (NTG) patches improve subjective pain scores by about 30% and range of motion over 3 days in patients with acute shoulder tendinopathy (strength of recommendation [SOR]: C, small randomized controlled trial [RCT] with no methodologic flaws). NTG patches, when combined with tendon rehabilitation, improve subjective pain ratings by about 30% and shoulder strength by about 10% in patients with chronic shoulder tendinopathy over 3 to 6 months, but not in the long term (SOR: C, RCTs with methodologic flaws). They improve pain and strength 15% to 50% for chronic extensor tendinosis of the elbow over a 6-month period (SOR: C, small RCT with methodologic flaws). NTG patches used without tendon rehabilitation don't improve pain or strength in chronic lateral epicondylitis over 8 weeks (SOR: C, RCT). Topical NTG patches commonly produce headaches and rashes (SOR: B, multiple RCTs).