Topical Glyceryl Trinitrate for Managing Refractory Tendinopathy In February 2019 the BMJ published a review of topical nitroglycerin or glyceryl trinitrate (TGN) for the treatment of tendinopathies which I think is...
Topical Glyceryl Trinitrate for Managing Refractory Tendinopathy In February 2019 the BMJ published a review of topical nitroglycerin or glyceryl trinitrate (TGN) for the treatment of tendinopathies which I think is worth reviewing. Tendinopathies account for up to 30% of an orthopedic or sports medicine practice. Patients typically present with pain and swelling at the affected tendon with a clear history of overuse from repetitive microtrauma, although acute injuries do occur.
Tendinitis refers to acute injuries where inflammation of the tendon results in micro-tears that happen when the musculotendinous unit is acutely overloaded with a tensile force that is too heavy and/or too sudden. Tendinosis is a degeneration and remodeling of the tendon’s collagen in response to chronic overuse; when overuse is continued without giving the tendon time to heal and rest, such as with repetitive strain injury. Although there is a lack of clear consensus, tendinitis can be thought of as an acute injury lasting up to 6 weeks, at which time histological changes are occuring, the tendon begins to remodel and the transition to tendinosis or tendinopathy begins to occur.
Because of the high incidence of tendinopathies, lets briefly review the current understanding of its pathophysiology. Tendons are designed to withstand considerable loads. At the histological level, changes include reduced numbers and rounding of fibroblasts, increased content of proteoglycans, glycosaminoglycans and water, hypervascularization and disorganized collagen fibrils.
At the molecular level, upregulation of RNA for type I and III collagens, proteoglycans, angiogenic factors, stress and regenerative proteins and proteolytic enzymes occurs. Additionally, tendon microrupture and material fatigue have been suggested as possible injury mechanisms. Inadequate rest likely contributes to collagen loss and vulnerability.
Neovascularization occurs and the entire process can be accelerated by overloading. Despite this information, complete understanding of this pathogenesis remains unclear. Example of topical nitroglycerin (courtesy of goodrx) It is important to understand the distinction between tendinitis and tendinosis because these diseases require different treatment modalities and approaches by the clinician.
If you are experiencing symptoms that may be related to managing refractory tendinopathy: topical glyceryl trinitrate, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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