Hyperthermia Bests Ultrasound, Exercise in Rotator Tendinopathy
Hyperthermia appears safe and effective in the short term for the management of supraspinatus tendinopathy, Dr. Arrigo Giombini of the Italian National Olympic Committee, Rome, and associates reported.
There is currently no consensus about the treatment of choice for rotator cuff tendinopathy, a condition that affects about half of all athletes who impose repeated stress on their shoulders, such as swimmers and volleyball players. A variety of physical therapy modalities have been used to treat the condition, but few well-designed studies have evaluated their effectiveness, the investigators said (Am. J. Sports Med. 2006;34:1247–53).
Hyperthermia is becoming widely used in physical medicine and rehabilitation in central and southern Europe. This approach utilizes a machine that combines a superficial cooling system and a deep-heating source with a microwave power generator at 434 MHz. This frequency raises tissue to therapeutic temperatures to a depth of several centimeters into the skin with no risk of overheating the superficial tissues, Dr. Giombini and associates explained.
This study population, 29 male and 8 female athletes with a mean age of 27 years, all reported a gradual onset of shoulder pain that impaired their sports activities for 3–6 months despite nonoperative management, including nonsteroidal anti-inflammatory drugs and complete or modified rest from their sport.
The participants were randomized to receive treatment with either hyperthermia (14 subjects), ultrasound at 1 MHz (12 subjects), or exercise (11 subjects) for 4 weeks. The hyperthermia was delivered in 30-minute sessions three times a week, whereas the ultrasound treatments lasted 15 minutes each, also three times weekly. The exercise group performed passive shoulder exercises for 5 minutes, twice daily.
At the 6-week follow-up, only the hyperthermia group had significant reductions in pain scores on the visual analog scale, which ranges from 0 (no pain) to 10 (incredibly severe pain). Their mean VAS score dropped from 5.96 at study entry to 1.2 at 6 weeks, compared with insignificant reductions of 6.3 to 5.15 in the ultrasound group and 6.1 to 4.9 with passive exercise.
The hyperthermia group also showed significantly greater improvements on measures of resisted movement, painful arc, and Constant Morley functional assessment, an overall clinical assessment of the power of the subject's shoulder and his or her ability to perform normal tasks of daily living.
By the end of the study, 12 of the hyperthermia patients had returned to their chosen sports, compared with just 4 each of the ultrasound and exercise patients, Dr. Giombini and associates reported.
Four athletes in the study reported transient discomfort from the high temperature reached with hyperthermia, but treatment was not interrupted for that reason. There were no other adverse effects.
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