Soft-tissue injuries are injuries to skin, fascia, ligament, muscle, and tendon. Currently, many therapeutic medications are commonly used in the management of soft-tissue injuries, including: analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, prolotherapy sclerosant agents, aprotinin, glyceryl trinitrate, botulinum toxin, and glucosamine. Despite their regular use for soft-tissue injury, few medications have strong evidence of a consistent therapeutic effect. In this article, we review the proposed mechanisms of action, side effects, and the evidence base (based on National Health and Medical Research Council levels of evidence1) for common soft-tissue injury treatments. We also suggest appropriate circumstances for using therapeutic medications, with emphasis on the Hippocratic principle of primum non nocere (first do no harm).
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- 1. National Health and Medical Research Council. A guide to the development, implementation and evaluation of clinical practice guidelines. Canberra: NHMRC, 1998.
- 2. Hippisley-Cox J, Coupland C. Risk of myocardial infarction in patients taking cyclo-oxygenase-2 inhibitors or conventional non-steroidal anti-inflammatory drugs: population based nested case-control analysis. BMJ 2005; 330: 1366.
- 3. Galer B, Rowbotham M, Perander J, et al. Topical diclofenac patch relieves minor sports injury pain: results of a multicenter controlled clinical trial. J Pain Symptom Manage 2000; 19: 287-294.
- 4. Vaile J, Davis P. Topical NSAIDs for musculoskeletal conditions: a review of the literature. Drugs 1998; 56: 783-799.
- 5. Van der Windt D, Van der Heijden GJ, Scholten RJ, et al. The efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) for shoulder complaints: a systematic review. J Clin Epidemiol 1995; 48: 691-704.
- 6. Gunter P, Schwellnus MP. Local corticosteroid injection in iliotibial band friction syndrome in runners: a randomised controlled trial. Br J Sports Med 2004; 38: 269-272.
- 7. Thomson CE, Gibson JNA, Martin D. Interventions for the treatment of Morton's neuroma. Cochrane Database Syst Rev 2004; (3): CD003118.
- 8. Ly-Pen D, Andreu J-L, De Blas G, et al. Surgical decompression versus local steroid injection in carpal tunnel syndrome: a one-year, prospective, randomized, open, controlled clinical trial. Arthritis Rheum 2005; 52: 612-619.
- 9. Labelle H, Guibert R. Efficacy of diclofenac in lateral epicondylitis of the elbow also treated with immobilisation. Arch Fam Med 1997; 6: 257-262.
- 10. Green S, Buchbinder R, Glazier R, et al. Systematic review of randomised controlled trials of interventions for painful shoulder: selection criteria, outcome assessment, and efficacy. BMJ 1998; 316: 354-360.
- 11. McLauchlan G, Handoll HHG. Interventions for treating acute and chronic Achilles tendinitis. Cochrane Database Syst Rev 2001; (2): CD000232.
- 12. DeGara C, Taylor M, Hedges A. Assessment of analgesic drugs in soft tissue injuries presenting to an accident and emergency department: a comparison of antrafenine, paracetamol, and placebo. Postgrad Med J 1982; 58: 489-492.
- 13. Assendelft W, Hay EM, Adshead R, et al. Corticosteroid injections for lateral epicondylitis: a systematic review. Br J General Practice 1996; 46: 209-216.
- 14. Buchbinder R, Green S, Youd J. Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev 2003; (1): CD004016.
- 15. Murphy D, Failla JM, Konuich MP. Steroid versus placebo injection for trigger finger. J Hand Surg 1995; 20A: 628-631.
- 16. DaCruz D, Geeson M, Allen MJ, et al. Achilles’ paratendonitis: an evaluation of steroid injection. Am J Sports Med 1988; 22: 64-65.
- 17. Korthals-de Bos I, Smidt N, van Tulder M, et al. Cost effectiveness of interventions for lateral epicondylitis: results from a randomised controlled trial in primary care. Pharmacoeconomics 2004; 22: 185-95.
- 18. Tallon C, Maffulli N, Ewen SW. Ruptured Achilles tendons are significantly more degenerated than tendinopathic tendons. Med Sci Sports Exerc 2001; 33: 1983-1990.
- 19. Kim S, Stitik T, Foye P, et al. Critical review of prolotherapy for osteoarthritis, low back pain, and other musculoskeletal conditions: a physiatric perspective. Am J Phys Med Rehabil 2004; 83: 379-389.
- 20. Capasso G, Testa V, Maffulli N, et al. Aprotinin, corticosteroids and normosaline in the management of patellar tendinopathy in athletes: a prospective randomized study. Sports Exerc Injury 1997; 3: 111-115.
- 21. Capasso G, Maffulli N, Testa V, et al. Preliminary results with peritendinous protease inhibitor injections in the management of Achilles tendinitis. J Sports Traumatol Rel Res 1993; 15: 37-40.
- 22. Dietrich W, Spath P, Zuhlsdorf M, et al. Anaphylactic reactions to aprotinin reexposure in cardiac surgery. Anesthesiology 2001; 95: 64-71.
- 23. Freund B, Schwartz MB. Use of botulinum toxin in chronic whiplash associated disorder. Clin J Pain 2002; 18(6 Suppl): S163-S168.
- 24. Keizer S, Rutten HP, Pilot P, et al. Botulinum toxin injection versus surgical treatment for tennis elbow: a randomized pilot study. Clin Orthop Rel Res 2003; 401: 125-131.
- 25. Hayton M, Santini AJ, Hughes PJ, et al. Botulinum toxin injection in the treatment of tennis elbow. A double-blind, randomized, controlled, pilot study. J Bone Joint Surg Am 2005; 87-A: 503-507.
- 26. Schaffer M, Efron PA, Thornton K, Klingel SS. Nitric oxide, an autocrine regulator of wound fibroblast synthetic function. J Immunol 1997; 158: 2382-2389.
- 27. Barrazueta J, Losada A, Poveda J, et al. Successful treatment of shoulder pain syndrome due to supraspinatus tendinitis with transdermal nitroglycerin. A double blind study. Pain 1996; 66: 63-67.
- 28. Pons S, Gallardo C, Caballero J, et al. Topical nitroglycerin versus corticosteroid infiltration for rotator cuff tendinitis. Atencion Primera 2001; 28: 452-455.
- 29. Paoloni J, Appleyard RA, Nelson J, et al. Topical glyceryl trinitrate application in the treatment of noninsertional Achilles tendinopathy. A randomized, double-blind, placebo controlled trial. J Bone Joint Surg Am 2004; 86-A: 916-922.
- 30. Paoloni J, Appleyard RA, Nelson J, et al. A randomized, double-blind, placebo-controlled clinical trial investigating the use of topical nitric oxide application in the treatment of chronic extensor tendinosis at the elbow. Am J Sports Med 2003; 31: 915-920.
- 31. Paoloni J, Nelson J, Murrell GAC. Topical glyceryl trinitrate application in the treatment of chronic supraspinatus tendinopathy. A randomized, double-blind, placebo controlled clinical trial. Am J Sports Med 2005; 33: 8-16.
- 32. McCarty M Glucosamine for wound healing. Med Hypotheses 1996; 47: 273-275.
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