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Elbow News

Use of Nitric Oxide in Tendon Healing

Tennis elbow isn't life-threatening, but it can keep a person from going to work or enjoying other activities. The average episode of tendonitis lasts between six months and two years. The usual treatment for tendonitis is rest, splinting, and an exercise program.

Researchers in Australia are trying nitric oxide (NO) as another treatment option. NO is present throughout the body as a byproduct of protein metabolism. Scientists think NO increases collagen tissue needed for tendon healing and repair.

In this study, patients with lateral epicondylitis (tennis elbow along the outside of the elbow) were divided into two groups. Both groups followed the same exercise program. All patients received a patch to wear on or around the elbow. Patients in group one received patches with NO. The other group received placebo patches without NO. Patches were worn daily and replaced every 24 hours. Patients were followed for six months.

The NO patches seemed to help. The best results occurred in the first two weeks with decreased elbow pain and increased activity. Patients continued to show improvement through week 24 when the patches were taken off. After six months 80 percent of the patients were still symptom-free. This compares to 60 percent of the patients who didn't get NO patches.

The authors conclude that NO can be used to treat tennis elbow. They don't know why 80 percent got better while the other 20 percent didn't improve. More studies are needed to find out why NO works and who can benefit from its use. How much is needed? How long should it be used? Researchers have more questions than answers. But this is the first step toward using NO therapy for tennis elbow.


Justin A. Paoloni, MBBS, et al. Topical Nitric Oxide Application in the Treatment of Chronic Extensor Tendinosis at the Elbow. In The American Journal of Sports Medicine. November/December 2003. Vol. 31. No. 6. Pp. 915-920.

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