1	Overview NSAIDs in other tendinopathy (1 min) GTN patches for other tendinopathy (2 min) NSAIDs limit fracture healing and promote stress fractures (2 min) Exercise for Falls Prevention (3 min) Summary (1 min)
2	"Dr Lloyd-Smith has talked about..." Dr Lloyd-Smith has talked about Achilles tendinopathy What about NSAIDs in other tendinopathies? Meta-analysis reveals questionable ‘weak’ benefit Clinically – leading Olympic/national team doctors generally do not prescribe NSAIDs for tendinopathies
3	While on tendinopathy… Case study: Mr G T Eng Has shoulder, elbow and Achilles tendinopathy!! Is he better off with a nitro patch or with an NSAID?
4	Nitro patches great for tendons! Nitro patches have the best evidence of any treatment! For shoulder, elbow and Achilles tendinopathy!! That’s right J the dose is 1.25mg/day (1/2 of a 0.2 mg Nitrodur patch) applied for 12 hours and then replaced with a fresh one (different to the cardiac approach)
5	0.2 mg nitro patch Likely works by promoting cell repair and regeneration (tendon cells repair and make new collagen) Most common side-effect = headache Easy, evidence-based medical therapy Prescribe in conjunction with a strengthening program
6	Case Study – Mr Rib 46 yr old commuter cyclist falls off and breaks 3 ribs - pneumothorax What do you prescribe for pain relief? NSAIDs?
7	NSAIDs limit fracture healing The same mechanism that makes Cox inhibitors efficient for inhibiting heterotopic ossification in hip surgery makes them ‘strongly and highly associated with delayed union and pseudoarthrosis’ (in Aspenberg, Acta Orthop, 2005, 76: 741-8
8	Mr Rib, outcome Took a total of 6 tablets of 325 mg Acetaminophen for entire episode Back on the bike in 2.5 weeks Full clinical fracture healing in 4 weeks Clear inhibitory effects on bone formation in humans
9	Overview NSAIDs in other tendinopathy GTN patches for other tendinopathy NSAIDs limit fracture healing and promote stress fractures Exercise for Falls Prevention
10	Exercise – key role in falls prevention Case: 80 yr old, sedentary woman, knee OA, CCF, osteoporosis Has an indoor fall On examination – slow gait, seems unsteady Timed up and go test (TUG) = 17 seconds Management?
11	Strength and balance training Level 1 evidence that strength and balance training prevents falls in those aged > 80 years Indoor falls are a major risk factor for further falls One simple contact number to refer fallers in the Lower Mainland (BC Women’s, VGH, St Paul’s) – 827-4191
12	Falls Clinic Service GP referral Quantified risk assessment Comprehensive Geriatric Assessment Home strength and balance program Level 1 evidence for each part 604-827-4191
13	Overview NSAIDs in other tendinopathy GTN patches for other tendinopathy NSAIDs limit fracture healing and promote stress fractures Exercise for Falls Prevention