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Revista de la Sociedad Española del Dolor
Print version ISSN 1134-8046
Abstract
FERNANDEZ CUADROS, ME; ALBALADEJO FLORIN, MJ; ALAVA RABASA, S and PEREZ MORO, OS. Calcific tendinitis of the shoulder: risk factors and effectiveness of iontophoresis with acetic acid 5 % plus ultrasound: prospective quasi-experimental study at 5 years with 138 cases. Rev. Soc. Esp. Dolor [online]. 2020, vol.27, n.6, pp.340-348. Epub Feb 08, 2021. ISSN 1134-8046. https://dx.doi.org/10.20986/resed.2020.3842/2020.
Objective:
To characterize clinically calcifying tendonitis (CT) and to conduct a prospective quasi-experimental before-and-after study in order to demonstrate the effectiveness of 5 % acetic acid iontophoresis and ultrasound in the treatment of CT.
Material and methods:
Prospective, observational, quasi-experimental before-after intervention study to 138 patients who attended to Rehabilitation Department, Santísima Trinidad's General Foundation Hospital, Salamanca, from June-2014 to December-2018.
Outcome Measures: 1) pain: measured by Visual Analogical Scale (VAS); 2) calcification size: in millimetres (mm); 3) functional limitation of shoulder movement (% of patients), all measured at the beginning/end of treatment.
Intervention: iontophoresis with 5 % acetic acid at 4,7mA x 10 minutes and ultrasound 1W/cm2x 5 minutes over calcification.
Results:
Mean age 54.6 years (n = 138). Female (73.1 %; n = 101); female to male ratio 3:1. Supraspinatus tendon (94.6 %; n = 124), subscapularis (5.4 %; n=14); left shoulder (55.1 %; n = 76), right shoulder (44.9 %; n = 62). Bilateral 1.4 % (n = 2). Right handed 96.3 % (n = 133); Personal history: smoking (19.5 %; n = 27), diabetes (7.2 %; n = 10); disease time averaged 6.08 months; acute-subacute pain (less than 3 months) 47.1; (n = 65), chronic pain (greater than 3 months) 52.9 % (n = 73). Radiological type: formative 75.3 % (n = 104); resorptive 24.7 % (n = 34). Average number of sessions: 20.5. Treatment complications 2.8 % (n = 4): intolerance/erythema/burn. Occupation: administrative 39.8 % (n = 55), manual jobs 60.2 % (n = 83).
Average initial pain 7.3 points (VAS scale), significantly decreased (p = 0.0000) post treatment to 2.7. Initial average size of calcifications 10.7 mm and significantly decreased (p = 0.0000) post treatment to 3.8 mm. Change of calcification: success/cure rate 55.7 % (n = 77), improvement rate 20.2 % (n = 28); failure rate 23.9 % (n = 33). Functional limitation decreased from 10.8 % of patients to 2.1 %.
Conclusions:
CT is common in middle-aged working women. It affects supraspinatus tendon. It is associated with smoking and diabetes. Occupational risk factors include awkward positions and lighting weights. Iontophoresis with 5 % acetic acid and ultrasound is a safe, simple and inexpensive technique, capable to reduce pain and calcification, and recover functional limitation, with a recommended degree of scientific evidence (2B).
Keywords : Iontophoresis; calcific tendinitis; pain; shoulder; ultrasound.