Calcifying Tendonitis: effect of Physical Therapy and Iontophoresis

Calcifying tendonitis (CT) is the deposit of hydroxyapatite within tendons. CT is multifactorial and it can affect the rotator cuff, Achilles, Patella, forearm extensors, biceps brachi and tibialis posterior tendons. The etiology is unclear, playing degeneration an important role. Three stages with clinical/histological/radiological correlation are described: 1) pre-calcification: tenocyte metaplasia/chondrocyte transformation; 2) calcification: a) formative, b) resorptive (spontaneous resorption/phagocytosis); 3) post-calcification: collagen remodeling/tendon repair. The diagnosis is clinical and radiological. Conservative treatment includes NSAIDs, physiotherapy, electrotherapy (micro-waves, short-waves, TENS, ultrasounds, iontophoresis, interferential and pulsed electromagnetic therapy). Advanced treatment includes shock-waves, ecoguided aspiration and arthroscopy. The 1st Chapter defines the main risk factors associated with shoulder CT, and the effectiveness of Physical Therapy on pain. The 2nd and 3rd Chapter shows the effectiveness of Iontophoresis on pain and calcification (for the first time) in different tendons. 4th chapter presents Iontophoresis effect on shoulder CT.