Date of Award


Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant


Physician Assistant Studies

Department Chair

John Cavenagh, MBA, PhD, PA-C


Objective: The objective of this selective EBM review is to determine whether or not treatment with topical glyceryl trinitrate is effective in reducing elbow pain in patients with lateral epicondylitis.

Study Design: Review of two English language randomized controlled trials and one primary study published 2003, 2009, 2011.

Data Sources: Two double blind randomized controlled and one prospective comparison study comparing the effectiveness of gylceryl trinitrate to placebo in the treatment of pain related to lateral epicondylitis, found using PubMed, EBSCOhost, and CINAHL Plus.

Outcome(s) Measured: The outcome studied was patient self-rated elbow pain at rest, pain with activity, pain at night, and local epicondylar and tendon tenderness, measured with Maudsley’s test (newtons) with dynamometer and wrist extension mean peak force, ORI-TESTS.

Results: Paoloni et al (2003) showed pain and tenderness in 81% (35 of 43) patients in the GTN group were asymptomatic with activities of daily living, compared to 60% (26 of 43) in the placebo group. (p=0.005). The 2009 trial by Paoloni et al was inconclusive due to discontinuation at 8 weeks due to insignificant findings. The prospective study by McCallum et al in 2011 was inconclusive, showing no difference between the GTN group and placebo group at 5 years post treatment.