Publication: Evaluación y tratamiento de terapia con ondas de choque piezoeléctricas en tendinopatías crónicas resistentes a tratamiento rehabilitador convencional
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2017-10-03
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Universidad Complutense de Madrid
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Abstract
El manejo de las tendinopatías crónicas refractarias a otros tratamientos conservadores convencionales puede incluir la terapia con ondas de choque como una alternativa de tratamiento que mejora el dolor y la funcionalidad mediante un tratamiento eficaz no invasivo y con escasos efectos secundarios. Tras dos años de experiencia en el tratamiento de tendinopatías mediante ondas de choque con un generador de ondas piezoeléctricas en el Hospital del Henares, se propone un estudio prospectivo para evaluar los resultados del tratamiento mediante ondas de choque en tendinopatías y fascitis plantar en función del dolor, de la calidad de vida y de la evolución de la calcificación si la hubiere de las tendinopatías calcificantes tratadas. Asimismo se analizan los factores que tienen un valor predictivo en los resultados finales del tratamiento con ondas de choque. Material y métodos: Se diseña un estudio prospectivo de pacientes remitidos a la consulta de Medicina Física y Rehabilitación que sufran cualquiera de estas cinco patologías (tendinopatía del manguito rotador, fascitis plantar, trocanteritis, epicondilitis, tendinopatía aquílea), que presenten un dolor de más de seis meses de evolución y que hayan realizado ejercicios de fisioterapia sin mejoría. Se recogen datos epidemiológicos como la edad, sexo, tipo de patología, lado afectado, realización de tratamiento rehabilitador previo, infiltración previa, dolor de más de seis meses de evolución, existencia de calcificación y tamaño de la calcificación si la hubiere, tipo de calcificación según la escala de Gartner en tendinopatía del manguito rotador, nivel del dolor según la escala visual analógica (EVA) y SF 12 inicial separado en sus componentes sumatorios físico y mental.Se utiliza un protocolo de 3 sesiones de tratamiento mediante ondas de choque piezoeléctricas a razón de una sesión semanal de 2000 pulsos a una frecuencia de 8 Hz y una intensidad calificada de alta energía (de 0.351 mJ/mm2 de mediana para patología no calcificante y de 0.581mJ/mm2 de mediana para patología calcificante). La valoración posterior se realiza a los tres meses de la última sesión, evaluando los resultados en función de los valores de la EVA y de la necesidad de tratamiento posterior. Como variables secundarias se evalúa la calidad de vida de los pacientes mediante la escala SF 12 y la evolución del tamaño de la calcificación medido en diámetro máximo en radiografía convencional. Todos los pacientes fueron incluidos en el tratamiento previa firma de consentimiento informado y con intención de tratar. Se recogieron datos de un total de 80 pacientes que completaron el estudio. La muestra se compone de 22 hombres (27.5%) y 58 mujeres (72.5%) de una edad media de 51.33 años (DE 9.9). La muestra se compone de 42 pacientes con patología del manguito rotador, 19 fascitis plantares, 8 trocanteritis, 4 epicondilitis y 7 tendinosis aquílea. Se realiza el estudio descriptivo global y por patologías de las cinco tendinopatías y se realiza el estudio analítico inferencial en los grupos de tendinopatía del manguito rotador y de fascitis plantar...
The management of chronic refractory tendinopathies with conventional conservative treatment may include extracorporeal shock wave therapy as an alternative treatment that improves pain and function through an effective, non-invasive treatment with minor complications. After a two year experience treating tendinopathies with extracorporeal shock wave therapy using a piezoelectric device at Hospital del Henares, we perform a prospective study to measure treatment outcomes after extracorporeal shock wave therapy applied to tendinopathies and plantar fasciitis evaluating pain, quality of life and calcification size if any. We also try to determine prognostic factors that may influence the outcome of extracorporeal shock wave treatment. Materials and methods: A prospective study is designed for patients submitted to a Physical Medicine and rehabilitation consultant which suffer from any of these five pathologies (rotator cuff tendinopathy, plantar fasciitis, trochanteritis, epicondylitis, Achilles tendinopathy), with pain for at least six months before treatment and who have carried out physiotherapy without improvement. Epidemiological data such as age, sex, type of tendinopathy, affected side, previous rehabilitation treatment, previous infiltration, pain for at least six months before treatment, calcification and calcification size, type of calcification according to Gartneŕs scale in rotator cuff tendinopathy ,pain using visual analog scale (VAS) and initial SF 12 physical and mental component score are collected. Patients underwent a 3 session treatment at weekly intervals using a piezoelectric device, receiving 2000 pulses per session at 8 Hz frequency and a high energy intensity (0.351 mJ/mm2 median for not calcifying tendinopathy and 0. 581mJ/mm2 median for calcifying tendinopathy).The outcome measures are evaluated three months after the last session, based on the EVA and patients that don’t need to undergo any further treatment, considering the patient discharged from treatment. Secondary measures include quality of life measured by SF 12 scale and calcification size measured in mm at maximum diameter in conventional radiography. All patients were included after signing the informed consent and with intention to treat. Data from a total of 80 patients who completed the study were collected. The sample consists of 22 men (27.5%) and 58 women (72.5%) mean age of 51.33 years (SD 9.9). There were 42 patients with rotator cuff tendinopathy, 19 plantar fasciitis, 8 trochanteritis, 4 epicondylitis and 7 Achilles tendinopathies. Descriptive study was carried out for all patients and all pathologies whereas the inferential analytical study was carried out in rotator cuff tendinopathy and plantar fasciitis patients...
The management of chronic refractory tendinopathies with conventional conservative treatment may include extracorporeal shock wave therapy as an alternative treatment that improves pain and function through an effective, non-invasive treatment with minor complications. After a two year experience treating tendinopathies with extracorporeal shock wave therapy using a piezoelectric device at Hospital del Henares, we perform a prospective study to measure treatment outcomes after extracorporeal shock wave therapy applied to tendinopathies and plantar fasciitis evaluating pain, quality of life and calcification size if any. We also try to determine prognostic factors that may influence the outcome of extracorporeal shock wave treatment. Materials and methods: A prospective study is designed for patients submitted to a Physical Medicine and rehabilitation consultant which suffer from any of these five pathologies (rotator cuff tendinopathy, plantar fasciitis, trochanteritis, epicondylitis, Achilles tendinopathy), with pain for at least six months before treatment and who have carried out physiotherapy without improvement. Epidemiological data such as age, sex, type of tendinopathy, affected side, previous rehabilitation treatment, previous infiltration, pain for at least six months before treatment, calcification and calcification size, type of calcification according to Gartneŕs scale in rotator cuff tendinopathy ,pain using visual analog scale (VAS) and initial SF 12 physical and mental component score are collected. Patients underwent a 3 session treatment at weekly intervals using a piezoelectric device, receiving 2000 pulses per session at 8 Hz frequency and a high energy intensity (0.351 mJ/mm2 median for not calcifying tendinopathy and 0. 581mJ/mm2 median for calcifying tendinopathy).The outcome measures are evaluated three months after the last session, based on the EVA and patients that don’t need to undergo any further treatment, considering the patient discharged from treatment. Secondary measures include quality of life measured by SF 12 scale and calcification size measured in mm at maximum diameter in conventional radiography. All patients were included after signing the informed consent and with intention to treat. Data from a total of 80 patients who completed the study were collected. The sample consists of 22 men (27.5%) and 58 women (72.5%) mean age of 51.33 years (SD 9.9). There were 42 patients with rotator cuff tendinopathy, 19 plantar fasciitis, 8 trochanteritis, 4 epicondylitis and 7 Achilles tendinopathies. Descriptive study was carried out for all patients and all pathologies whereas the inferential analytical study was carried out in rotator cuff tendinopathy and plantar fasciitis patients...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina Física y Rehabilitación. Hidrología Médica, leída el 20-01-2016