1.
Wireless Versus Wired Iontophoresis for Treating Patellar Tendinopathy: A Randomized Clinical Trial.
Rigby, JH, Mortensen, BB, Draper, DO
Journal of athletic training. 2015;(11):1165-73
Abstract
CONTEXT The efficacy of the relatively new wireless iontophoresis patch compared with the traditional wired dose controller is unknown. OBJECTIVE To determine the differences among 2 iontophoresis drug-delivery systems (wireless patch versus wired dose controller) and a sham treatment in treating patellar tendinopathy. DESIGN Randomized controlled clinical trial. SETTING Physical therapy clinic. PATIENTS OR OTHER PARTICIPANTS Thirty-one participants diagnosed with patellar tendinopathy (men = 22, women = 9, age = 24.5 ± 5.9 years). INTERVENTION(S): Participants were randomly assigned into 1 of 3 treatment groups: wireless patch, wired dose controller, or sham treatment. Participants in the active treatment groups received six 80 mA/min iontophoresis treatments using 2 mL of 4% dexamethasone sodium phosphate. During each visit, clinical outcome measures were assessed and then the assigned treatment was applied. MAIN OUTCOME MEASURE(S): Clinical outcome measures were Kujala Anterior Knee Pain Scale, pressure sensitivity, knee-extension force, and sit-to-stand pain assessment using a numeric rating scale. For each clinical outcome measure, we used a repeated-measures analysis of covariance to determine differences among the treatment groups over the treatment period. RESULTS Participants reported a clinically important improvement on the Kujala Anterior Knee Pain Scale across all treatment groups, with no differences among groups (P = .571). A placebo effect was observed with pressure sensitivity (P = .0152); however, the active treatment decreased participants' pain during the sit-to-stand test (P = .042). CONCLUSIONS A placebo effect occurred with the sham treatment group. Generally, improvement was noted in all groups regardless of treatment type, but greater pain reduction during a functional task was evident within the active treatment groups during the sit-to-stand test. The wireless patch and wired dose controller treatments were equivalent across all variables.
2.
Which method is more effective in treatment of calcific tendinitis in the shoulder? Prospective randomized comparison between ultrasound-guided needling and extracorporeal shock wave therapy.
Kim, YS, Lee, HJ, Kim, YV, Kong, CG
Journal of shoulder and elbow surgery. 2014;(11):1640-6
Abstract
HYPOTHESIS Ultrasound (US)-guided needling with subacromial corticosteroid injection is more effective than extracorporeal shock wave therapy (ESWT) for function restoration and pain relief in patients with calcific tendinitis of the shoulder. METHODS Fifty-four patients diagnosed with unilateral painful calcific tendinitis were randomly allocated to a US needling or ESWT group. The US needling group underwent US-guided needling and received a subacromial corticosteroid injection. The ESWT group received ESWT 3 times a week. All patients were prospectively evaluated; American Shoulder and Elbow Surgeons, Simple Shoulder Test, and visual analog scale for pain scores were recorded before the procedure and at 6 weeks, 12 weeks, 6 months, 12 months, and the last follow-up. The size and morphology of the deposits were evaluated by radiography. RESULTS The average follow-up period was 23.0 months. At last follow-up, the mean size of the deposits was significantly different between the 2 groups (P = .001); it decreased to 0.5 mm from 14.8 mm in the US needling group and to 5.6 mm from 11.0 mm in the ESWT group. There were also significant improvements in clinical outcomes in both groups after treatment (P < .05). At 1-year follow-up, the US needling group had significantly better scores than the ESWT group with regard to the American Shoulder and Elbow Surgeons assessment (90.3 and 74.6, respectively; P = .001), Simple Shoulder Test (83.3 and 70.8, respectively; P = .015), and visual analog scale for pain (1.4 and 3.3, respectively; P = .003).The initial calcium deposit sizes and clinical outcomes were weakly correlated in both groups (P > .05). CONCLUSION Both treatment modalities for calcific tendinitis improved clinical outcomes and eliminated calcium deposits. US-guided needling treatment, however, was more effective in function restoration and pain relief in the short term.
3.
Extracorporeal shock-wave therapy for supraspinatus calcifying tendinitis: a randomized clinical trial comparing two different energy levels.
Ioppolo, F, Tattoli, M, Di Sante, L, Attanasi, C, Venditto, T, Servidio, M, Cacchio, A, Santilli, V
Physical therapy. 2012;(11):1376-85
Abstract
BACKGROUND Extracorporeal shock-wave therapy (ESWT) represents a valid intervention in the treatment of people with supraspinatus calcifying tendinitis (SCT), but there is limited evidence for the useful range of ESWT doses. OBJECTIVE The aim of this study was to compare 2 different ranges of energy flux density in treatment of SCT with ESWT. DESIGN This study was designed as a single-blind randomized clinical trial. SETTING This study was performed in a university hospital. PATIENTS Forty-six patients with SCT were randomly assigned to 2 groups that received different therapeutic energy doses of ESWT (1) group A received ESWT at an energy level of 0.20 mJ/mm², and (2) group B received ESWT at an energy level of 0.10 mJ/mm². INTERVENTION The treatment protocol consisted of 4 sessions performed once a week. MEASUREMENTS The change in mean Constant Murley Scale (CMS) scores at 3 and 6 months was the primary endpoint. The change in the mean visual analog scale (VAS) scores from baseline to 3 and 6 months after the intervention and radiographic change in size of calcium deposits were evaluated as secondary endpoints. At 12 months, pain relief was assessed using a numeric rating scale. RESULTS Significant clinical improvement based on mean CMS scores was observed after 6 months in group A (X=79.43, SD=10.33) compared with group B (X=57.91, SD=6.53). Likewise, after 6 months, a significant decrease in VAS scores was found in group A (X=2.09, SD=1.54) compared with group B (X=5.36, SD=0.78). Calcific deposits disappeared in the same percentage of patients in both groups. LIMITATIONS The small sample size and lack of a control group were limitations of the study. CONCLUSIONS In ESWT for SCT, an energy level of 0.20 mJ/mm² appears to be more effective than an energy level of 0.10 mJ/mm² in pain relief and functional improvement.