Calcific Tendinopathy of the Rotator Cuff Treated With Acetic Acid Iontophoresis

MARYCRIS MEDINA-GANDIONCO, PT, DPT, Physical Therapy Service, Brigadier General Crawford F. Sams US Army
Health Clinic/Medical Department Activity-Japan, Camp Zama, Japan.
ROBERT A. BRIGGS, PT, DPT, PhD, OCS, Army-Baylor University/US Army Medical Center of Excellence, Fort Sam Houston, TX.

A 62-year-old right hand–dominant man with a 20-year history
of left shoulder pain and 6-month insidious, progressively worsening symptoms was referred to physical therapy with clinical and radiographic evidence of left supraspinatus tendon calcification. The patient enjoyed tennis, push-ups, and resistance training but had discontinued these activities because of his increasing shoulder symptom severity.

At evaluation, the patient reported pain ranging from 7/10 to 9/10 on the visual analog scale, and scored 54% on the Shoulder Pain and Disability Index (SPADI). Left shoulder active range of motion was limited to 60° of flexion and abduction, with empty end feel due to muscle guarding. Passively, the patient tolerated 90° of shoulder flexion with increasing pain.
Due to severity and irritability of pain, the patient was prescribed rest, isometrics, and pain-free range of motion. He was treated with iontophoresis, utilizing 3% acetic acid, for 3 visits per week for 5 weeks. Radiographs, repeated 1 week post treatment and 9 weeks since his initial
radiographs, demonstrated marked resorption of the calcific deposit. At that point, the patient demonstrated 160° of active left shoulder flexion, 2/10 pain, and a SPADI score of 28% disability. A progressive resistive exercise
program was initiated.

At 16 weeks post evaluation, the patient demonstrated full active range of
motion of the left shoulder, 4+/5 shoulder girdle strength, a SPADI score of 5% disability, and reported a pain-free return to prior activities.

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