{"id":41430,"date":"2021-12-30T10:22:10","date_gmt":"2021-12-30T10:22:10","guid":{"rendered":"https:\/\/biomedpharmajournal.org\/?p=41430"},"modified":"2022-01-04T08:15:46","modified_gmt":"2022-01-04T08:15:46","slug":"effectiveness-of-cryokinetics-in-comparison-with-effectiveness-of-ultrasound-therapy-in-treatment-of-acute-supraspinatus-tendonitis","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol14no4\/effectiveness-of-cryokinetics-in-comparison-with-effectiveness-of-ultrasound-therapy-in-treatment-of-acute-supraspinatus-tendonitis\/","title":{"rendered":"Effectiveness of Cryokinetics in Comparison with Effectiveness of Ultrasound Therapy in Treatment of Acute Supraspinatus Tendonitis"},"content":{"rendered":"

Introduction<\/strong><\/p>\n

Supraspinatus tendinitis was proposed by NEER in 1972 as a clinical entity in which the rotator cuff was pathologically compressed against, anterior structure of coraco- acrominal arch, anterior third of the acromion, the coraco arcrominal ligament and a acromino clavicular joint. Supraspinatus can be affected by trauma but also undergoeschronic degenerative changes leading to tendinopathies and rupture1<\/sup>, it is a painful lesion of the supraspinatus tendon, here the pain is located over the lateral aspect of arm with\u00a0well defined trigger points on the muscle bellyover the supraspinatus notch and at the insertion. A narrowing of the subacrominal outlet by spur formation in coraco acrominal ligament and the under surface of the anterior third of acromion define the relative progression of the impingement syndrome2<\/sup>.<\/p>\n

Rotator cuff muscles blend with and reinforce the glenohumaral capsule, most importantly all these have action lines that significantly contribute to the dynamic stability of glenohumaral joint3<\/sup>. The SST canal forms a rigid and inextensible ring, if the muscle increases in size as a result of scar or an inflammatory process, it cannot glide through the canal without sticking, which causes pain4<\/sup>.Shoulder pain is the 3rd<\/sup> most common cause of musculoskeletal disorder after low back pain and cervical pain.\u00a0The annual incidence is estimated at 10 cases per 1000 population, peaking at 25 cases per 1000 population in a age category of 42-46 years5-7<\/sup>.Medical interventions like Non steroidal anti inflammatory drugs (NSAIDS), Subacromial corticosteroids and Bupivacaine suprascapular nerve block are done. .Many physiotherapy\u00a0 treatments are in use for \u00a0treatment of Supraspinatus tendinitis. Some of them are: Hot\/Cold\u00a0 pack application, ultra sound therapy, Iontophoresis \/ phonophoresis, deep friction\u00a0massage, low level laser therapy, short wave diathermy. Cryokinetics is a systematic combination of cold application to numb the injured body part and graded progressive active exercises8<\/sup>. Using cold application during rehabilitation of acute sprains, strains, contusions and muscle injuries appear to have begun at Brooke Army Hospital in early 1960\u2019s. In 1964 Grant and Hayden described their treatment for\u00a0some musculoskeletal injuries with a new method that they termed Cryokinetics referring to a combination of cold and exercise. Ice was used to anesthetize the injured body part, this took from 3 to 20 minutes and was ceased when patient reported numbness. Once numbed the body part was exercised with active movements, if discomforts recurred the ice was reapplied. In 1967 Moore et al,9<\/sup> presented\u00a0case studies involving athletic rehabilitation with Cryokinetics and discussed possible mechanics to account for quicker rehabilitation and concluded that the success of Cryokinetics was due to early exercise\u2019s and that the role of cold was only to decrease pain and thereby allow earlier and more intense normal active exercise. Cryotherapy is thought to decrease edema formation via induced\u00a0vasoconstriction, reduce secondary hypoxic damage by lowering the metabolic demand of the injured tissue10-11<\/sup>. Cooling skin surface temperature to below approximately 15o <\/sup>C from normal body temperature is also thought to exert a localized analgesic effect by inhibiting the nerve conduction velocity12-13<\/sup>. Thus facilitating earlier and more aggressive therapeutic exercise after muscle injury.14-<\/sup>15\u00a0<\/sup>Cold application diminishes pain so that active exercise is possible16<\/sup>. Exercise increases blood flow to the injured area vital in healing. Exercise re-establishes neuromuscular function. With this technique exercise is possible much earlier than normal. Muscle atrophy is not allowed to set in. Swelling is reduced dramatically through the combination of cooling and exercise. If the exercise during Cryokinetics becomes so vigorous that further damage may result, the body responds with a pain sensation. Thus Cryokinetics has a built in safety value. Cryokinetics allows rehabilitation to begin much sooner than traditional thermo therapy and can reduce rehabilitation time by days or even weeks17,19<\/sup>.<\/p>\n

In ultrasound treatment a stream of sonic waves is transmitted to a small volume of the tissue, which causes the muscles of the tissue to vibrate. The mechanical pressure waves of ultrasound is applied to the tissues at a level of intensity that is too low and at a frequency that is too rapid that the person receiving it cannot detect the pressure18,20<\/sup>.<\/p>\n

This therapy has been found effective in reliving the muscular pain by resolving, inflammation, removal of waste products,19<\/sup> altered permeability of cell membrane to sodium , which may alter the electrical activity or pain threshold, increased blood supply, increased WBC count21<\/sup>. Ultrasound therapy is used as a standard treatment for supraspinatus tendinitis. There is lack literature comparing crokinetics and ultrasound. hence in this study Cryokinetics and ultrasound therapy is used and comparison between the effectiveness of both the interventions is done.<\/p>\n

Aims and objective<\/strong><\/p>\n

To evaluate the effect of cryokinetics as compared to ultrasound therapy in treatment of acute supraspinatus tendonitis.<\/p>\n

Methodology<\/strong><\/p>\n

Design and Study Setting<\/strong><\/p>\n

This study was randomized clinical trial with Random sampling method. Ethical clearance for the study was obtained by Institutional Ethical Review Committee of Kempegowda Institute of\u00a0 Medical Science \u00a0and research center, \u00a0following which participants were screened according to inclusion and exclusion criteria.. The study was conducted in Physiotherapy department of tertiary care center of Bangalore city, India.<\/p>\n

Participants<\/strong><\/p>\n

Participants were assessed for eligibility for inclusion and exclusion criteria. Inclusion criteria were(1) Subjects with supraspinatus tendinitis who are under analgesics (2)Age group: 30-50 yrs.<\/p>\n

Participants were excluded if they had(1)Adhesive capsulitis, (2) Cervical disorders,(3) Fibromyalgia, (4)Rheumatoid Arthritis, (5) Hemiplegia, (6) Thoracic outlet syndrome, (7) Cold hyper-sensitivity, (8)haemoglobineuria, (9) Anesthetic skin, (10) Cardiac conditions, (11) Cold utricaria.<\/p>\n

Randomization<\/strong><\/p>\n

Samples are selected through random sampling by using chit method.<\/strong><\/p>\n

Intervention<\/strong><\/p>\n

Group A<\/em> received Cryokinetics. In this group, pre-application precautions were given to all the patients. Patients were asked not to consciously attempt to overcome the pain. The patients were given explanation of the three types of pain that they would be experiencing during the treatment.<\/p>\n

\u00a0<\/strong>1:Residual pain- which is caused by injury (damaged tissue or swelling). This will be neutralized by the numbness from the ice pack.<\/p>\n

2:<\/strong>Cold pain- caused by the ice, until the patient adapts to it.<\/p>\n

3:<\/strong>Re-injury pain- caused if the patient stresses the tissue to the point of re-injury. Such pain will not be covered up by the numbness.<\/p>\n

The subject is in comfortable supine position. Cryo pack is applied around the involved shoulder covering posterior, superior and anterior aspects, and treatment was given for 20 minutes following which active exercises were given for 5-7 minutes. Again cryo pack was applied for 5 minutes then another set of active exercises were given. Exercises include active flexion, extension and abduction of the involved shoulder, 10 repetitions.<\/p>\n

Group B<\/em>-received Ultrasound Therapy. <\/strong>In U.S group, the subject is in comfortable sitting position in a chair with the proper back support. Skin and transducer was coated with acoustic gel. U.S was then applied to superior-anterior aspect of involved shoulder by the therapist. The applicator is moved in small concentric circular movements. The transducer head was applied to the therapy region at right angle to ensure maximum absorption. Pulsed ultrasonic waves with a ratio of 1:1 with 1 MHZ frequency and 0.8 W\/cm2<\/sup>are applied with a 3cm diameter applicator. Ultrasound therapy lasted for 8 minutes in each session.<\/p>\n

Both the treatments were given 5 times a week for 3 weeks.<\/p>\n

Study Variable<\/strong><\/p>\n

VAS\u00a0<\/strong>The VAS has been shown to be a reliable valid outcome measure for pain22<\/sup>. The score was obtained from the subjects using 10 cm scale, before the start of the treatment, on 15th<\/sup> day and at the final session of the treatment after 3 weeks.<\/p>\n

1RM, 1 repetition maximum was used to measure the strength of supra spinatus muscle.17,23\u00a0<\/sup>This was obtained with the patient in standing position and shoulder in internal rotation. The patient was asked to lift the hand in abduction with the weight cuff tied around his hand. Maximum weight that patient can perform with was noted. Starting weight was 0.5 kg up to maximum 3 kgs. This was recorded on day 1, day 15 and end of third week.<\/p>\n

Results<\/strong><\/p>\n

Statistical Analysis<\/strong><\/p>\n

was done using SPSS 15.0. Descriptive statistical analysis has been carried out in the present study.<\/p>\n

Table 1: Age distribution of patients studied<\/strong><\/p>\n\n\n\n\n\n\n\n\n
Age in years<\/strong><\/td>\nGroup A<\/strong><\/td>\nGroup B<\/strong><\/td>\n<\/tr>\n
No<\/strong><\/td>\n%<\/strong><\/td>\nNo<\/strong><\/td>\n%<\/strong><\/td>\n<\/tr>\n
21-30<\/td>\n3<\/td>\n10.0<\/td>\n5<\/td>\n16.7<\/td>\n<\/tr>\n
31-40<\/td>\n15<\/td>\n50.0<\/td>\n14<\/td>\n46.7<\/td>\n<\/tr>\n
41-50<\/td>\n12<\/td>\n40.0<\/td>\n11<\/td>\n36.7<\/td>\n<\/tr>\n
Total<\/td>\n30<\/td>\n100.0<\/td>\n30<\/td>\n100.0<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Samples are age matched with P=0.876<\/p>\n

-shows the group A and group B in different age groups.<\/p>\n

-Group A has 3 number of samples at the age of 20 to 30 years , 15 number of samples at the age of 31-40 years and 12 number of samples at the age group of 41-50- years.<\/p>\n

Table 2: Gender distribution of patients studied<\/strong><\/p>\n\n\n\n\n\n\n\n
Gender <\/strong><\/td>\nGroup A<\/strong><\/td>\nGroup B<\/strong><\/td>\n<\/tr>\n
No<\/strong><\/td>\n%<\/strong><\/td>\nNo<\/strong><\/td>\n%<\/strong><\/td>\n<\/tr>\n
Male<\/td>\n14<\/td>\n46.7<\/td>\n16<\/td>\n53.3<\/td>\n<\/tr>\n
Female<\/td>\n16<\/td>\n53.3<\/td>\n14<\/td>\n46.7<\/td>\n<\/tr>\n
Total<\/td>\n30<\/td>\n100.0<\/td>\n30<\/td>\n100.0<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Samples are gender matched with P=0.605<\/p>\n

A total of 60 subjects were evaluated with 30 of subjects in each group. Group A (Cryokinetics) had 14 number of males (46.7%) & 16 number of females ( 53.3%). Group B (Ultrasound therapy) had 16 number of males (53.3% ) and 14 number of females (46.7%).<\/p>\n

Table 3: (a). Comparison of VAS score between two groups of patients (n=30)<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n
VAS<\/strong><\/td>\nDay 1<\/strong><\/td>\nDay 15<\/strong><\/td>\n3rd<\/sup> week<\/strong><\/td>\n% change at 3rd<\/sup> week<\/strong><\/td>\n<\/tr>\n
Group A<\/strong><\/td>\n\u00a0<\/strong><\/td>\n\u00a0<\/strong><\/td>\n\u00a0<\/strong><\/td>\n\u00a0<\/strong><\/td>\n<\/tr>\n
No pain<\/td>\n0<\/td>\n0<\/td>\n6(20.0%)<\/td>\n+20.0%<\/td>\n<\/tr>\n
Mild Pain<\/td>\n0<\/td>\n15(50.0%)<\/td>\n24(80.0%)<\/td>\n+80.0%<\/td>\n<\/tr>\n
Moderate pain<\/td>\n12(40.0%)<\/td>\n14(46.7%)<\/td>\n0<\/td>\n-40.0%<\/td>\n<\/tr>\n
Severe pain<\/td>\n18(60.0%)<\/td>\n1(3.3%)<\/td>\n0<\/td>\n-60.0%<\/td>\n<\/tr>\n
Group B<\/strong><\/td>\n\u00a0<\/strong><\/td>\n\u00a0<\/strong><\/td>\n\u00a0<\/strong><\/td>\n\u00a0<\/strong><\/td>\n<\/tr>\n
No pain<\/td>\n0<\/td>\n0<\/td>\n0<\/td>\n0.0<\/td>\n<\/tr>\n
Mild Pain<\/td>\n0<\/td>\n3(10.0%)<\/td>\n12(40.0%)<\/td>\n+40.0%<\/td>\n<\/tr>\n
Moderate pain<\/td>\n12(40.0%)<\/td>\n24(80.0%)<\/td>\n17(56.7%)<\/td>\n+16.7%<\/td>\n<\/tr>\n
Severe pain<\/td>\n18(60.0%)<\/td>\n3(10.0%)<\/td>\n1(3.3%)<\/td>\n-56.7%<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Table 3: (b) Comparison of VAS score in two groups of patients<\/strong><\/p>\n\n\n\n\n\n\n
VAS<\/strong><\/td>\nGroup A<\/strong><\/td>\nGroup B<\/strong><\/td>\nP value<\/strong><\/td>\n<\/tr>\n
Day 1<\/td>\n6.90\u00b11.58<\/td>\n6.70\u00b11.51<\/td>\n0.619<\/td>\n<\/tr>\n
Day 15<\/td>\n3.73\u00b11.17<\/td>\n5.20\u00b11.29<\/td>\n<0.001**<\/td>\n<\/tr>\n
3rd<\/sup> week<\/td>\n1.23\u00b10.86<\/td>\n4.03\u00b11.38<\/td>\n<0.001**<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

In inter group analysis there was decrease in VAS in group A at the end of 3rd<\/sup> week, [Table no.3a] there were 6 patients with no pain ((20.0%)), 24 with mild pain (80.0%). In group B at the end of 3ed week, there were 12 patients with mild pain (40.0%) and 17 patients with moderate Pain (56.7%) and 1 with severe pain (3.3%). When both the groups were compared\u00a0\u00a0 [Table no.3b] \u00a0at the end of 3rd<\/sup> week group A had 1.23+\/-0.86 and group B had 4.03+\/-1.38 with a P value of <0.001<\/p>\n

Table 4: (a) Comparison of repetitions maximum\u00a0 between two groups of patients (n=30)<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n
RM<\/strong><\/td>\nDay 1<\/strong><\/td>\nDay 15<\/strong><\/td>\n3rd<\/sup> week<\/strong><\/td>\n% change at 3rd<\/sup> week<\/strong><\/td>\n<\/tr>\n
Group A<\/strong><\/td>\n\u00a0<\/strong><\/td>\n\u00a0<\/strong><\/td>\n\u00a0<\/strong><\/td>\n\u00a0<\/strong><\/td>\n<\/tr>\n
Weak muscle<\/td>\n23(76.7%)<\/td>\n6(20.0%)<\/td>\n1(3.3%)<\/td>\n-73.4%<\/td>\n<\/tr>\n
Mod. strength<\/td>\n7(23.3%)<\/td>\n24(80.0%)<\/td>\n22(73.3%)<\/td>\n+50.0%<\/td>\n<\/tr>\n
Good<\/td>\n0<\/td>\n0<\/td>\n7(23.3%)<\/td>\n+23.3%<\/td>\n<\/tr>\n
Group B<\/strong><\/td>\n\u00a0<\/strong><\/td>\n\u00a0<\/strong><\/td>\n\u00a0<\/strong><\/td>\n\u00a0<\/strong><\/td>\n<\/tr>\n
Weak muscle<\/td>\n20(66.7%)<\/td>\n14(46.7%)<\/td>\n9(30.0%)<\/td>\n-36.7%<\/td>\n<\/tr>\n
Mod. strength<\/td>\n10(33.3%)<\/td>\n15(50.0%)<\/td>\n20(66.7%)<\/td>\n33.4%<\/td>\n<\/tr>\n
Good<\/td>\n0<\/td>\n1(3.3%)<\/td>\n1(3.3%)<\/td>\n+3.3%<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Table 4: (b) Comparison of Repetitions maximum\u00a0 in two groups of patients<\/strong><\/p>\n\n\n\n\n\n\n
RM<\/strong><\/td>\nGroup A<\/strong><\/td>\nGroup B<\/strong><\/td>\nP value<\/strong><\/td>\n<\/tr>\n
Day 1<\/td>\n0.90\u00b10.40<\/td>\n1.05\u00b10.49<\/td>\n0.204<\/td>\n<\/tr>\n
Day 15<\/td>\n1.45\u00b10.27<\/td>\n1.30\u00b10.43<\/td>\n0.111<\/td>\n<\/tr>\n
3rd<\/sup> week<\/td>\n1.97\u00b10.39<\/td>\n1.47\u00b10.39<\/td>\n<0.001**<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

There was increase in 1RM [Table 4a] in group A at the end of 3rd<\/sup> week, there was only one patient with weak muscle(3.3%), 22 patients with moderate strength (73.3%) and 7 with good muscle strength (23.3%). In group B at the end of 3rd<\/sup> week there were 9 patients with weak muscle(30.0%), 20 patients with moderate muscle strength(66.7%) and 1 patient with good muscle strength(3.3%). When both the\u00a0 groups were compared\u00a0 [Table 4b] at the end of 3rd<\/sup> week\u00a0 group A had 1.97+\/-0.39 and group B had 1.47+\/-0.39 with p value of <0.001.<\/p>\n

The intergroup analysis demonstrated statistical significant values for both VAS and 1RM in both groups, but statistically significant improvement is seen in group A as compared to group B in intra group analysis.<\/p>\n

Discussion<\/strong><\/p>\n

Rotator cuff disease is one of the occupational health problems on orthopedics ambulatory with high functional damages to its carrying. A comparative evaluation study with 60 patients with acute supraspinatus tendinitis was undertaken. 60 patients were divided into two groups, group A and group B. Each group consisting of 30 patients. Group A received Cryokinetics therapy and group B received ultrasound therapy. This study was undertaken to study the effectiveness of cryokinetics in comparison with effectiveness of ultrasound therapy. Between the patients interviewed, both males and females in both groups are almost equally affected with supraspinatus tendinitis. With\u00a0 46.7% of males in group A\u00a0and 53.3% in group B. 53.3% of females in group A and 46.7% in group B.\u00a0 In relation to age\u00a0 this study is showing that the patients incidence with SST is more in the age group of 31-40 years.% distribution of patients with regards to age in group A is 10.0% at the age group of 21-30 years, 50.0% at the age group of 31-40 years, 40% at the age group of 41-50 years. In group B it is 16.7% at the age group of 21-30 years, 46.7% at the age group of 31-40 years and 36.7% at the age group of 41-50 years.<\/p>\n

Discussing techniques of physiotherapeutic treatment Souza(1994) believes that modalities as cry therapy, electro therapy and exercise can have great value on shoulder lesions treatment.<\/p>\n

Cryokinetics is a systematic combination of cold application to num the injured body part and graded progressive active exercise10<\/sup>. This is the most effective form of cry therapy for the rehabilitation of ligament sprains and muscle injuries the success of Cryokinetics was due to early exercises and that the role of cold was only to decrease the pain and thereby allow earlier recovery12-13<\/sup>.US has been used widely for more than 40 years in the treatment of musculoskeletal disorders, such as tendinitis, tenosynovitis, bursitis and muscle injury. US converts electrical energy into acoustic wave forms which is converted into heat as it passes through tissues of varying resistance. US can be used as thermal agents to increase the temperature of deep tissues24<\/sup>. Raising the tissue temperature accelerates the metabolic processes including increasing enzymes activity, increasing the rate of ion exchange, increasing the rate and volume of diffusion across cell membranes US decreases pain and stiffness24-25<\/sup>.The aim of this study is to compare these two interventions in reducing pain and increasing muscle strength and enhancing functional performance in SST. Group A was treated with cry kinetics and group B was treated with US therapy. Group A has been shown more improvement than group B, which is proved statistically.<\/p>\n

The data revealed that Cryo kinetics is significantly more efficient in reducing pain. These results are consistent with those of\u00a0 Mooreet al (1967) 9<\/sup> who presented a case study on athletic\u00a0 rehabilitation with Cryo kinetics and discussed possible mechanics for a quicker rehabilitation, and with those of Grant and Hayden (1964) who discussed benefits of Cryo kinetics.14<\/sup><\/p>\n

In group A the VAS score at pre assessment was 6.90 and was decreased to 1.24+\/-0.86. in group B the VAS score at pre assessment was 6.70+\/-1.51 and was decreased to 4.03+\/-1.38 at the end of 3rd<\/sup> week. The out come based on % change was found to be more in group A.<\/p>\n

According to Lex B Verdijk (2009) I RM is a valid tool to measure shoulder strength23<\/sup>. In group A the 1RM score at pre assessment was 0.90+\/-0.40 and was increased to 1.97+\/0.39 at the end of 3rd<\/sup> week. In group B the 1RM score at pre assessment was 1.05+\/-0.49 and was increased to 1.47+\/-0.39 at the end of 3rd<\/sup> week. Outcome based difference of pre and post assessment score is more in group A when compared to group B.<\/p>\n

Conclusion<\/strong><\/p>\n

The improvement in VAS and 1RM was seen in cryokinetics group, showing it is better than ultrasound\u00a0 therapy for supraspinatus tendinitis.<\/p>\n

Conflict of Interest<\/strong><\/p>\n

There are no conflict of interest.<\/p>\n

Funding Sources<\/strong><\/p>\n

There are no funding Sources<\/p>\n

References<\/strong><\/p>\n

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