acetic acid iontophoresis protocol

After the translation and cultural adaptation, it was obtained a reliable version of SPADI-Brazil and to assess its reliability. Following examination, the patient was prescribed rest, isometrics, and pain-free range of motion. The outcome measures were found to be suitable for subjects with plantar fasciitis and the methodology appropriate for the research design chosen and the feasibility of a clinical trial comparing the effects of transverse friction massage and a home exercise programme and a HEP alone was demonstrated. A 16-year-old male soccer player was referred to my clinic by his physician for treatment of his "deep quadriceps contusion." 2007; 177(3):972-975. Radiographic follow-up of ultrasound therapy in calcific bursitis: case report. Additional treatment consisted of mild treatment consisted of mild passive-range-of-motion (PROM) movements within pain-free limits for 5 minutes three times a week. Luz Otilia Casique-Bocanegra [3] Bilateral Calcification of Achilles Tendons, and Acetic Acid Iontophoresis Marcos Edgar Fernandez-Cuadros: Ultrasound was administered directly over the myositis ossificans site in an attempt to decrease skin irritation and to possibly further disperse the acetic acid throughout the injury site. Conservative treatment includes nonsteroidal anti-inflammatory drugs (NSAIDs), physiotherapy, electrotherapy (micro-waves, short-waves, transcutaneous electrical nerve stimulation (TENS), ultrasounds, iontophoresis, interferential, and pulsed electromagnetic therapy). Finally, Mr Tygiel expressed his disappointment that the Journal would publish this Evidence in Practice article as an example of evidence-based practice. The therapist discussed treatment options for myositis ossificans with the physician. Background: The calcific tendinitis of the shoulder is a dysfunction conservatively treated by shock waves, iontophoresis, and phonophoresis, associated or not with the use of acetic acid . CT at the elbow (triceps tendon) and at the wrist showed similar frequencies (n=2; 2%). More importantly, I found no indication that the evidence from the respected authorities actually exists in our peer-reviewed literature. Myositis osiificans in an adolescent following a sports injury. In this case, Dr Ciccone's careful literature searches produced no meta-analyses, no systematic reviews, and no clinical practice guidelines. Kahn 1977 49 PATELLAR TENDINITIS . I disagree. Protocol for Neurophysiological Studies of the Superior and Recurrent Laryngeal Nerves and of the Cricothyroid and Thyroarytenoid Muscles . Setting: General community, private practice. The study focuses on the integrative use of acetic acid iontophoresis in combination with active rehabilitation for her treatment. 57 Results of Surgery in Athletes with Plantar Fasciitis R. Leach, Mitchell S. Seavey, Daniel K. Salter Medicine Cormack [3] Nalley J, Susan Jay M, Durant RH. [10] Antao NA. IontoPatch - On-the-Go Patch Therapy. Traumatic myositis ossificans is a reactive osseous lesion occurring in soft tissues and at times close to bone and periosteum. His pain score went from an 8 to a zero on a 10-point numerical scale. Therapeutic ultrasound. 1966;6:724--738. The information of acetic acid iontophoresis protocol is constantly complemented and updated on echemi.com. If the patient didn't get better, however, the patient might have been denied a beneficial intervention because of Dr Ciccone's failure to recognize and properly use what little evidence there was. Effectiveness of acetic acid iontophoresis and ultrasound on calcifying tendonitis of the shoulder. In an attempt to decrease the size and possible progression of the calcium formation, acetic acid iontophoresis was chosen to supplement the physician's prescription of rest and inactivity. The use of AA will be more beneficial for the patient's needs than any alternative licensed medicine; The surgeon has a sufficient evidence base and experience of using AA to understand its safety and efficacy; The surgeon must take responsibility for prescribing AA and overseeing care of the patient; In his introduction, Ciccone also referred to a case report by Wieder,7 which indicated the possibility of some benefit from the treatment on a similar condition (myositis ossificans). Methods: Measurements of ROM, muscle strength and functionality of the shoulder (SPADI) were made pre and post-physiotherapeutic treatment. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. ).sup.2] + [H.sub.2.O+CO.sub.2] This article reviews plantar fasciitis, presents the most effective treatment options currently available, and proposes nutritional considerations that may be beneficial in the management of this condition. Physical Therapy Feb. 1992: 133+. Iontophoresis with dexamethasone combined with individualized traditional physical therapy may have contributed to decreased plantar foot pain, increased ankle active range of motion, and improved functional mobility in this older adult with chronic PF. A small contusion developed on his anterior superior iliac spine; however, he continued to swim and dive for the rest of the afternoon. In addition, an anti-inflammatory agent may be prescribed. Fernandez Cuadros ME, Perez Moro OS, Nieto Blasco J, Rivera Garcia V, Olazar Pardeiro A, Miron Canelo JA. . Crossref. This study likewise failed to find a difference between the groups in any other dependent variables (pain and range of motion). We really don't know. Calcifying tendonitis of the shoulder, risk factors and effectiveness of acetic acid iontophoresis and ultrasound. He was able to achieve full passive knee extension, but was unable to perform an isometric quadriceps femoris muscle contraction in full extension. The use of acetic acid iontophoresis (with and without ultrasound therapy) has been investigated in other calcific conditions including calcifying shoulder tendonitis [ 7, 8 ]. The treatment area of the electrode was approximately 2.5 cm in diameter. Intervention: Iontophoresis with 5% acetic acid at 4,7mA x 10 minutes and continuous Ultrasound 1W/cm2 /1MHz x 5 minutes over calcification. Wieder, Deborah L. "Treatment of traumatic myositis ossificans with acetic acid iontophoresis." As I stated before, I am unfamiliar with this intervention; therefore, I have no personal opinion one way or the other on whether it works. It was no more than a stab in the dark or, at best, in the dim. The integration of acetic acid iontophoresis, orthotic therapy and physical rehabilitation for chronic plantar fasciitis: a case study. There are several drawbacks with the findings of this study: small sample size (n = 31), no long-term follow-up (patients were only followed for 4 weeks), and Because using no treatment was just as effective as using the intervention, I must interpret these results as providing evidence that the treatment did not work and was therefore ineffective. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited, Marcos Edgar Fernandez-Cuadros, Olga Susana Perez-Moro, Maria Jesus Albaladejo-Florin, Luz Otilia Casique-Bocanegra, Ruben Algarra-Lopez, Rehabilitacion y Medicina Fisica, Hospital Universitario Santa Cristina, Madrid, Spain, Rehabilitacion y Medicina Fisica, Fundacion Hospital de la Santisima Trinidad, Salamanca, Spain, Copyright 2022 Reserved by, Publication Ethics and Publication Malpractice Statement, Middle East Journal of Rehabilitation and Health Studies. [12] Cline PD. Acetic acid iontophoresis has shown promising results and further studies should be considered to. [13] Ziskin MC, Michlovitz SL. [2] Huss CD. Although it is true that their study failed to provide evidence of efficacy for this treatment, it is not true that it also proved the null hypothesis (ie, that evidence was found that the treatment was not effective). Examination by the physical therapist revealed that the patient had pain that restricted passive knee flexion greater than 80 degrees. Further studies are needed to support the use of acetic acid iontophoresis for both treatment and possible use as prevention once initial trauma has occurred. 2016;5:328. doi: 10.4172/2167-0420.1000328. The athlete complained of pain rated a 2-3 out of 10. , 2 The etiology is multifactorial and its pathophysiology is still unclear; degeneration plays and important role in CT. Interventional Musculoskeletal Ultrasound SpringerLink. New York, NY: Churchill Livingstone Inc; 1987;165. Due to failure, she also went through bilateral shock wave therapy, but no alleviation was observed on pain or the calcification. Tygiel Physical Therapy 6606 E Carondelet Dr Tucson, AZ 85710. An ultrasonic coupling gel was used as the transfer medium. the mass was fixed, nonpulsatile, and not warm. M E, Perez-Moro For the best clinical results at 4 weeks, taping combined with acetic acid is the preferred treatment option compared with taping combined with DEX or saline iontophoresis. NSAIDs did not alleviate pain. [14] Thorndike A. Myositis ossificans traumatica. A protective Orthoplast (+) "donut" thigh pad was then placed over the area of previous injury in an attempt to protect against future injury to the thigh musculature during athletic activity. 1988;16:82--83. 1997 73. Iontophoresis is a conservative, non-surgical technique that favors the penetration of transdermal substances/drugs through the skin with the help of electric current, based on physical-chemical properties of attraction and repulsion of charges. Quadriceps contusions in young athletes. Dr Ciccone chose to disregard the Rioja Toro et al study because it lacked a control group. In: Michlovitz SL, ed. At the shoulder, Supraspinatus tendon was the most affected (91.5%; n = 65) followed by Subscapularis (8.5%; n = 9). [4] Ellis M, Frank HG. Radiography showed bilateral insertional formative calcification on both Achilles tendons confirmed by ultrasound scan (Figures 1 and 2); 9.6 mm length in its longer axis, at the insertion of the left Achilles tendon, and 6.6 mm length on the right Achilles tendon. . The problem is how to prepare 5% acetic acid solution. It has been inconclusively argued in the literature as to whether bone reabsorption or formation is enhanced by ultrasound. . Fernandez Cuadros M, Perez Moro O, Diez Ramos F, Albaladejo Florin MJ. The second article, by Rioja Toro et al,3 was a cohort study rather than an RCT. Moreover, Mr Tygiel maintains that there is a big difference between those studies that fail to provide evidence of efficacy and those that provide evidence of ineffectiveness. [3] Heat, continuous ultrasound, massage, stretching, and exercise shouldbe avoided initially so as not to induce further bleeding in the area. bursitis, tenosynovitis) Lidocaine (+): Treatment Rationale. Occup Med Health Aff. HiDoes anyone know where in LA I can get Iontophoresis with acetic acid treatment for myositis ossificans? Password. As we have indicated many times in the past, these articles are intended to illustrate the search process rather than establish best practice or serve as clinical guidelines. Your comment will be reviewed and published at the journal's discretion. radiographs, demonstrated marked resorption of the calcific deposit. In popular (lay) terms it is sometimes called "an injection without the needle". In my opinion, evidence-based practice means that the thinking clinician looks at all possible evidence starting with the basic science evidence at the bottom of the hierarchy and then working up the ladder, through what other clinicians have done, to what the research community has been able to find. CT . , Herbert RD, Khouw W, Lee R. Oxford University Press is a department of the University of Oxford. This statement is actually the opposite of what we know to be true. It is the type of judgment call that sets the clinician apart from the technician. From his search Dr Ciccone was only able to find 2 articles that he felt might provide evidence on the question. 1955;35:84--87. Iontophoresis with 5%Acetic Acid and Ultrasound is a safe, simple and inexpensive technique capable to reduce pain and calcification on the shoulder, elbow, wrist, hip, knee and ankle. References Blood System Drugs. Physicial therapy protocols for this pathology have been argued in the literature. [1] Tyler JL, Derbekyan V, Lisbona R. Early diagnosis of myositis ossificans with To99m diphosphonate imaging. The authors were unable to find any difference between groups for any of the variables measured. The iontophoresis, ultrasound, and passive stretching treatment was administered on alternate days three times per week for 3 weeks. chronic plantar fasciitis. , Malouin F. Rioja Toro This review provides a detailed account of mechanisms, current status and future prospects of ultrasonic cavitation in drug and gene delivery applications. Mr Tygiel also overlooked an important finding from that study that I used to guide my clinical decision. DL Olga Susana Perez-Moro The physician ordered anterior-posterior and lateral radiographs of the right femur, which revealed a maturing myositis ossificans located in the region of the vastus lateralis musculature (Fig. 1963;43:659--660. Fluid, Electrolyte, and Acid-base Balance. I thank Mr Tygiel for his thoughtful comments. 2015;3(220):2. doi: 10.4172/2329-6879.1000220. This scant evidence, the only available evidence on which to make a clinical decision, suggests that acetic acid iontophoresis treatment might be helpful. Ciccone 2003 14 Osborne, 2006 69. Digestive System Drugs. After the fifth treatment, the mass became increasingly compressible, and the patient's pain-free ROM improved to 110 degrees of knee flexion. Case Presentation: A 57-year-old female presented a 12-month experience of bilateral Achilles' tendon pain. During the second week postinjury, pain was increasingly present on descending stairs. Close Log In. He was treated with iontophoresis, utilizing 3% acetic acid, for 3 visits per week for 5 weeks. Treatment Protocols: Iontophoresis 1. The patient regained full knee ROM of 149 degrees and was able to resume playing soccer pain-free. [3] Alternative treatments include surgery; aspiration of the hematoma with subsequent injection of 1% lidocaine hydrochloride, anti-inflammatory steroids, and lysosomal enzymes; cold laser therapy; radiation treatments; and acetic acid iontophoresis. Calcifying Tendonitis of the Ankle, Effectivenness of 5% Acetic Acid Iontophoresis and Ultrasound over Achiles Tendon: A Prospective Case Series International Journal Foot Ankle 2019, 3:023 13 de . Synthetic steroidal anti-inflammatory agent. Subsequently, continuous Ultrasound with an intensity of 1 W/cm2 and 1 MHz frequency was applied for 5 minutes at the insertion of the Achilles tendon on the affected ankle. This article describes a physical therapy intervention that I have not used yet; but I have heard, from several colleagues whom I respect, that this intervention had good results when other interventions had failed. Diagnostic Agents. The patient's 3-week physical therapy program consisted of a 2% acetic acid iontophoresis treatment followed by pulsed ultrasound and mild PROM movements. Treatment of this condition with acetic acid iontophoressis may result in a quicker, safer return to activity and may eliminate the need for surgical removal. If that were the case, our patients would have never benefited when their physical therapists used the works and ideas of other innovative clinicians, from Bobath and Brunnstrom to McKenzie and McConnell. Protocol applied at the Department of Rehabilitation at Santa Cristina's University Hospital (Madrid-Spain), and at Santsima Trinidad's Foundation Hospital (Salamanca-Spain). Perron and Malouin clearly provided evidence that the intervention did not work in the 21 subjects in their study. It reduces sweating and enhances the delivery of drugs and . He suggests the use of such a hierarchy based on some common study designs. At that point, the patient demonstrated 160 of active left shoulder flexion, 2/10 pain, and a SPADI . Therefore, although soccer is one of the most popular team sports in the world, PF is not a common pathology. Again, I am not sure who these authorities are, but it is their professional obligation to publish their opinions via case reports and other studies so that these opinions can be subjected to the scrutiny and critical analysis that constitutes peer review. The Journal of the Canadian Chiropractic Association, A 15-year-old female soccer player presented with chronic plantar fasciitis. 2017 Acetic acid as part of a debridement protocol during revision total knee arthroplasty The Journal of arthroplasty 32 (3) 953-957. , * In the situation described in my article, however, we do not have absence of evidence. Results: Mean age 55.0811.62 years (n = 91).. Little recent literature exists regarding treatment for myositis ossificans. The potential for a therapeutic program of acetic acid iontophoresis and ultrasound in eliminating myositis ossificans is demonstrated and the patient regained full range of motion and was able to return to pain-free activity. A hierarchy such as the one proposed by Mr Tygiel is very useful, but only if we have the confidence to accept evidence from higher levels that might contradict the opinions of clinical experts. The study did not, in any way, provide evidence that this intervention is not effective. The study failed to provide any conclusive evidence of anything. Middle East J Rehabil Health Stud. She reported no significant return of symptoms post follow-up at 2 months. Soft-tissue pain and inflammation (e.g. Ultrasound may have enhanced the resorption of the soluble calcium acetate. . Enter the email address you signed up with and we'll email you a reset link. There was no history of prior injury or illness. 22 One small case report showed that acetic acid iontophoresis in conjunction with . Search for other works by this author on: Does acetic acid iontophoresis accelerate the resorption of calcium deposits in calcific tendinitis of the shoulder, Acetic acid iontophoresis and ultrasound for the treatment of calcifying tendinitis of the shoulder: a randomized control trial, Treatment of calcifying tendinitis of the shoulder by acetic acid iontophoreseis and ultrasound, Evidence-Based Medicine: How to Practice and Teach EBM, Evidence-based practicewhat is it and how do I do it, Evidence-based practice [author's response to letter to the editor], Treatment of traumatic myositis ossificans with acetic acid iontophoresis, Ultrasound therapy for calcific tendinitis of the shoulder, A randomized, controlled clinical trial of a treatment for shoulder pain, 2003 American Physical Therapy Association. Three milliliters of a 2% acetic acid solution using a distilled water dilution medium was introduced into the active drug electrode. Calcification disappeared after treatment (from 6.6 to 0 mm) on the right tendon and decreased from 9.3 to 4.3 mm on the left tendon, after radiographic and ultrasound evaluation. [1] Primitive mesenchymal cells proliferate within the injured connective tissue and give rise to osteoid and chondroid formation at the periphery progressing inward. 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