Year 2020 / Volume 27 / Number 6

Original

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. 2020; 27(6): 340-348 / DOI: 10.20986/resed.2020.3842/2020

Marcos Edgar Fernández, María Jesús Albaladejo, Sandra Álava, Olga Susana Pérez


ABSTRACT

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).



RESUMEN

Objetivo: Caracterizar clínicamente la tendinitis calcificante (TC) y demostrar la efectividad de la iontoforesis del ácido acético al 5 % y el ultrasonido en el tratamiento de la TC.
Material y métodos: Estudio prospectivo, observacional, cuasiexperimental, tipo antes y después de la intervención, a 138 pacientes que asistieron al Departamento de Rehabilitación, del Hospital de la Fundación General Santísima Trinidad, Salamanca, de junio de 2014 a diciembre del 2018.
Medidas de resultado: 1) dolor: medido por la escala analógica visual (EVA); 2) tamaño de la calcificación: en milímetros (mm), ambos medidos al inicio/final del tratamiento; 3) limitación funcional (en porcentaje de pacientes) pre/post intervención.
Intervención: iontoforesis con ácido acético al 5 % a 4,7 mA x 10 minutos y ultrasonido 1W/cm2/1Hz/5 minutos sobre calcificación.
Resultados: Edad media: 54,6 años (n = 138); mujer (73,1 %; n = 101); proporción mujer/hombre 3: 1; tendón supraespinoso (94,6 %; n = 124); subescapular (5,4 %; n = 14); hombro izquierdo (55,1 %; n = 76), hombro derecho (44,9 %; n = 62); bilateral 1,4 % (n = 2); diestros 96,3 % (n = 133); antecedentes personales: tabaquismo (19,5 %; n = 27), diabetes (7,2 %; n = 10). El tiempo de enfermedad promedio fue de 6,08 meses. Dolor agudo-subagudo (menos de 3 meses) 47,1 %; (n = 65), dolor crónico (más de 3 meses) 52,9 % (n = 73). Tipo radiológico: formativo 75,3 % (n = 104), resortivo 24,7 % (n = 34). Número promedio de sesiones: 20. Complicaciones del tratamiento 2,8 % (n = 4): intolerancia/eritema/quemadura. Ocupación: administrativo 39,8 % (n = 55), trabajos manuales 60,2 % (n = 83). El dolor inicial EVA de 7,3 puntos disminuyó significativamente (p = 0,0000) después del tratamiento a 2,7. El tamaño promedio inicial de las calcificaciones fue de 10,7 mm y disminuyó significativamente (p = 0,0000) después del tratamiento a 3,8 mm. Cambio de calcificación: tasa de éxito/curación 55,7 % (n = 77), tasa de mejora 20,2 % (n = 28); tasa de fracaso del 23,9 % (n = 33). La limitación funcional disminuyó de un 10,8 % a un 2,1 %.
Conclusiones: La TC es común en mujeres trabajadoras de mediana edad. Afecta el tendón supraespinoso. Se asocia con el tabaquismo y la diabetes. Factores de riesgo ocupacional son las posiciones mantenidas y manipulación de cargas.
La iontoforesis con ácido acético al 5 % más ultrasonido es una técnica segura, simple y económica, capaz de reducir el dolor y la calcificación, y mejorar la limitación funcional, con un grado de evidencia científica recomendado (2B).





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Fernández M, Albaladejo M, Álava S, Pérez O. 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 2020; 27(6): 340-348 / DOI: 1020986/resed20203842/2020


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Recibido: 31/08/2020

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