Heart Medication May Effectively Treat Tennis Elbow; Electrical Delivery of Steroids Also Relieves Elbow Pain 7/21/2003
From: Brian Haefs of the American Orthopaedic Society for Sports Medicine, 847-292-4900 or brian@aossm.org; http://www.sportsmed.org SAN DIEGO, July 21 -- Topical administration of medication to treat angina helps speed recovery from tennis elbow, according to new research released today at the 2003 Annual Meeting of the American Orthopaedic Society for Sports Medicine (AOSSM). "Patients with tennis elbow, who use patches to deliver nitric oxide to the affected area, recover on average about 20 weeks earlier than those not receiving the treatment," says George A.C. Murrell, MBBS, DPhil, associate professor and chairman of the department of orthopaedic surgery and director of the Orthopaedic Research Institute at St. George Hospital, University of New South Wales in Sydney, Australia. Tennis elbow, a common cause of chronic elbow pain and wrist dysfunction, typically affects people between 35 and 54 years of age. No treatment is universally successful in managing tennis elbow. The best practice management involves rest, forearm bracing, and stretching and strengthening exercises. "Tennis elbow and similar tendinopathies from overuse are very common and often debilitating," Dr. Murrell says. "There are few good treatments for tendinopathy other than avoiding aggravating activities and waiting. This study and our ongoing research on nitric oxide suggest there may be safe, simple non-invasive ways to treat these problems. In the study, Justin A. Paoloni, MBBS; Richard C. Appleyard, PhD; Janis Nelson, MClinPharm; and Dr. Murrell conducted a randomized double-blinded, placebo-controlled study of 86 patients with tennis elbow to evaluate the continuous topical nitric oxide effect on patients with chronic tennis elbow. Half of the patients were given nitric oxide patches and tendon rehabilitation exercises; the other half received placebo patches and tendon rehabilitation exercises. "We found that patients who received the nitric oxide patches had less pain at two weeks, less tenderness at six weeks and better strength at six months," commented Dr. Murrell. "They did better on every test we performed." At six months, 81 percent of the patients using the nitric oxide patches were pain free compared to 60 percent of patients using placebo patches. Nitric oxide, which helps dilate blood vessels, has been used for more than 100 years to treat angina (chest pain caused by clogged arteries). Nitric oxide also enhances collagen synthesis, which is crucial to tendon healing. Although further study may be needed to confirm these results, Dr. Murrell concluded, "We hope that someday products based on this research will be available for doctors to prescribe for tennis elbow and other tendinopathies.". Electrical Delivery of Steroids also Relieves Elbow Pain In a second study released today at the AOSSM Annual Meeting, researchers evaluated the safety and effectiveness of using electric current to deliver a steroid to the elbow. This delivery technique is called iontophoresis. "Using iontophoresis for steroid delivery can keep patients comfortable, allowing them to complete physical therapy," said lead author Robert P. Nirschl, MD, director of the Nirschl Orthopedic and Sportsmedicine Clinic at the Virginia Hospital Center Arlington. The researchers note that this is the first controlled study comparing iontophoretic steroid delivery to electrical stimulation alone. Tennis elbow affects as many as seven adults per 1,000 seen in general practice. Dr. Nirschl estimates that as many as 100 million Americans have general tendon overuse syndrome. He says the results of his study can be extended to other superficial tendons with overuse syndrome including the Achilles tendon and the knee. "Physical therapists have been intuitively combining cortisone cream with electrical stimulation. Now we have evidence that iontophoretic delivery of cortisone works to relieve pain with fewer side effects than steroid injections," explained Dr. Nirschl. The researchers completed a randomized, double-blind, placebo-controlled study of 199 patients with tennis elbow. They found that iontophoretic administration of cortisone was well tolerated and effective in reducing tennis elbow symptoms at short-term follow up. Patients completing six treatments in 10 days or less showed better results than those treated over a longer period. Rehabilitation and occasionally surgery are necessary to revitalize tendon tissue. Impact injury can be reduced in racket sports by improving stroke technique, counterforce bracing, and equipment upgrade, according to the researchers. "Resting is not curing. Symptoms may subside if the arm is rested, but the diseased tendon is still present," said coauthor Derek H. Ochiai, MD, a graduating fellow also from the Nirschl clinic. "Rehabilitation must be done to change and strengthen that tissue. The goal is revitalization through nutrition and new collagen production plus strength, endurance, and flexibility." The coauthors of the second study are Dennis M. Rodin, MD; and Craig Maartmann-Moe, MPT. The American Orthopaedic Society for Sports Medicine (AOSSM), a world leader in sports medicine education, research, communication, and fellowship, is a national organization of orthopaedic sports medicine specialists, including national and international sports medicine leaders. The Society works closely with many other sports medicine specialists and clinicians, including family physicians, emergency physicians, pediatricians, athletic trainers, and physical therapists to improve the identification, prevention, treatment, and rehabilitation of sports injuries. All AOSSM press releases are available on the Societys website, http://www.sportsmed.org. |