Tendinitis calcificante de hombro: Factores de riesgo y efectividad de la Iontoforesis con ácido acético 5% más Ultrasonido: estudio cuasi-experimental prospectivo a 5 años, 138 casos.

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 44 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).