Article

OBJECTIVE: To evaluate evidence on the effectiveness of topical nitroglycerin
(NTG) in treating tendinopathies. DATA SOURCES:
Systematic searches were
conducted on ScienceDirect, Scirus, Highwire Press Stanford University, PubMed
Central, Directory of Open Access Journals, Free Medical Journals, Free Full
Text, Bioline International, Findarticles, BioMed Central, IndMed, OpenMD, QMed,
Geneva Foundation for Medical Education and Research, Scientific Electronic
Library Online, eMedicine/Medscape/Medline, Biomedical E-journals, Current
Contents Connect, Journal of Medical Internet Research, Cochrane, Turning
Research Into Practice, Ovid, and EBSCO databases. There were no restrictions
regarding the language of publication. STUDY SELECTION: All clinical controlled
trials or randomized controlled trials (RCTs) evaluating the effects of NTG for
patients with acute, subacute, or chronic tendinopathies, whether the said
intervention was placebo-controlled or controlled against a comparator
intervention, were considered for inclusion. DATA EXTRACTION: A reviewer
extracted data from included studies using a data extraction form by the Joanna
Briggs Institute. DATA SYNTHESIS: Methodologic quality of studies was assessed by
2 independent reviewers through a critical appraisal form by the Alberta Heritage
Foundation. Qualitative analyses of data were done using a rating system devised
by Van Tulder and colleagues. Where possible, meta-analyses of data were
performed. Seven clinically relevant and high-quality RCTs involving 446 subjects
were identified and included in this review. Meta-analysis showed that NTG has a
positive effect in pain reduction during activities of daily living in chronic
tendinopathies, with an odds ratio of 4.44 (95% confidence interval [CI],
2.34-8.40), and in both acute and chronic phases combined, with an odds ratio of
4.86 (95% CI, 2.62-9.02). There is also qualitative, strong (Level 1) evidence
that NTG is effective in enhancing tendon forces in the chronic phase. There is
limited and/or conflicting evidence (Level 3) for other outcomes in the chronic
phase and all outcomes in the acute phase. There is a significant between-group
difference between NTG and control in the incidence of headache, with an odds
ratio of 1.73 (95% CI, 1.01-2.97). No significant difference was observed in the
occurrence of contact dermatitis, with an odds ratio of 2.12 (95% CI, .89-5.02).
CONCLUSIONS: In chronic tendinopathies, there is strong evidence for NTG in
relieving pain during activities of daily living, and increasing tendon strength.
Further studies are needed to explore the role of this promising intervention in
all phases of tendinopathies.

Langue : ANGLAIS