Conservative Management for Calcific Tendonitis of the Rotator Cuff Calcifying tendonitis of the rotator cuff is a common disorder

whose process of development is still unknown. Put simply, this is the process in which the supraspinatus starts degenerating leading to its calcification and eventually to its rupture into the subacromial bursa. The good news is that about 90% of the patients who suffer from this condition can be treated with non-operative treatments. This article seeks to find out if certain modalities like iontophoresis, extracorporeal shock wave therapy, radial shock therapy, therapeutic therapy, and microwave diathermy have any benefits in the management of calcific tendonitis. Iontophoresis is a process that allows increased penetration of the ionized molecule across or into the tissue by application of a low electric current. This mechanism works on the basis of polarity. Because calcification consists mainly of crystals which are insoluble in water and soluble in acidic pH, it expected to see some regression in calcification. Extracorporeal shock wave therapy is a treatment that involves the delivery of low or high energy shock waves via a device to a specific site on the body. The theory is that this modality helps disrupt fibrous tissue, along with revascularization and healing of tissue. It is also hypothesized that the shock waves help in the reduction of signals from noxiceptors. A Radial Shock Wave (RSW) is a low- to medium-energy shock wave that is pneumatically generated through the acceleration of a projectile which is present inside the hand piece of the treatment device and that is then transmitted radially from the tip of the applicator to the target zone. The only difference between this and ESWT is the focal point is on the tip applicator.

Ultrasound is a sound wave that has a frequency which is higher than 20 KHz. Ultrasound stimulates the accumulation of the peripheral-blood mononuclear cells by activating endothelial cells. It may also act indirectly by increasing the intracellular calcium levels. This can stimulate macrophages to remove calcifications by way of phagocytosis. Due to increased tissue temperature, ultrasound may induce hyperaemia and metabolism which can lead to disintegration of calcium deposits. Microwave diathermy works in the same way as ultrasound, producing hyperthermia in the affected area; reducing symptoms and with hopes of reducing calcium deposits. In the end, this article shows that the therapy modalities of iontophoresis, extracorporeal shock wave therapy, radial shock wave therapy, ultrasound, and microwave diathermy are effective in the treatment of calcific tendonitis with patients when diagnosed on time. They are mainly shown to help with relieving pain and discomfort with minimal signs of decreased calcium deposits. This is achieved by disrupting fibrous tissue, increasing heat, and disturbing pain signals. I believe as long as the pain is managed with some evidence of calcium reduction, that it is successful. They are the best alternative treatments to surgery. J Clin Diagn Res. Calcific tendonitis of the rotator cuff: a review. JCDR Research & Publications Private Limited. 2013 July; 7(7): 14821485. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3749672/#b40. Accessed October 11, 2013.