ACETIC-ACID IONTOPHORESIS AND ULTRASOUND FOR THE TREATMENT OF CALCIFYING TENDINITIS OF THE SHOULDER - A RANDOMIZED CONTROL TRIAL

Objective: To assess the effects of acetic acid iontophoresis (AAT) an d ultrasound on calcifying tendinitis of the shoulder, and to determin e the relation between changes in the radiological measures of calcium deposit (CD) and shoulder function. Design: Randomized control trial. Setting: General community, private practice. Patients: Twenty-two ad ults (7 men, 15 women) with a calcifying tendinitis of the shoulder, w ithout associated conditions, stratified according to the type of lesi ons (X-ray: type I, fleecy appearance; type II, homogeneous), were ran domly allocated to an experimental (EXP, n = 11) or to a control (CTL, n = 10) group. Interventions: CTL group, no treatment; EXP group, nin e treatments including AAI (5% acetic acid solution via the negative e lectrode, 5mA galvanic current, 20 minutes) followed by continuous ult rasound (0.8w/cm(2), 1MHz, 5 minutes). Main Outcome Measures: Area and density of the CD, passive shoulder abduction (range of motion [ROM]) , pain intensity. Results: Significant reduction in the area and densi ty of CD (ANCOVA, p = .01 and .03) over time in the EXP and CTL groups , but no significant difference between groups for any of the variable s measured. The decrease in the area of CD in type I lesions (n = 5) w as larger (Mann-Whitney U test, p < .01) than in type II (n = 16) lesi ons. The relation was stronger (r(s) = .90) between changes in area an d density of CD than between ROM and pain (r(s) = -.67). Correlations were weak (r(s) = .21 to .41) between radiological and functional chan ges.Conclusion: The reduction in CD area and density likely results fr om a natural process rather than treatment (AAI and ultrasound); type I lesions (resorptive phase) are more likely to display resorption of the CD than type II lesions (formative phase). Reduction of the CD are a does not necessary result in a functional improvement. (C) 1997 by t he American Congress of Rehabilitation Medicine and the American Acade my of Physical Medicine and Rehabilitation.