LYON HOSPITALS GROUP
EDOUARD HERRIOT HOSPITAL - Place d'Arsonval - 69437 LYON
EVALUATION OF GAS CRYOTHERAPY IN THE TREATMENT OF TENDINOPATHIES
E. Brunet-Guedj, B. Brunet, J. Girardier, E. Renaud, M. Daubard, R. Manigand, Department of Sports Medicine, Edouard Herriot Hospital, 69437 LYON CEDEX 03, France
CRYONIC MEDICAL Copyright ©
INTRODUCTION
A randomized comparative trial in athletic patients was undertaken to evaluate the efficacy of gas cryotherapy in the treatment of acute and chronic (present for more than two months) tendinopathies.
MATERIAL AND METHODS
21 patients were treated in a randomized comparative trial using gas cryotherapy or standard methods.
Inclusion criteria were :
- Hobby or competition sport.
- Age over 18.
- Micro-traumatic tendinopathy of the shoulder, elbow, wrist, knee or Achilles tendon. Exclusion criteria consisted of :
- Allergy to cold.
- Tendinopathy treated surgically.
- Metabolic (gout, dyslipidemia) or iatrogenic (fluoroquinolones) tendinopathy.
Classification as acute or chronic tendinopathy was arbitrary according to how long pain had been present, i.e. a month or more.
The equipment used was a Cryotron apparatus (CRYONIC MEDICAL), delivering carbon dioxide at 78°C, using the technique invented by C.Cluzeau and patented by the CRYONIC MEDICAL company.
The treatment protocol was as follows :
- Acute tendinopathies : 6 sessions of gas cryotherapy (one session a day) with thermal shock by scanning the painful area in one group, and standard treatment (systemic and topical anti-inflammatory together with ice packs) in the other group.
- Chronic tendinopathies : 6 sessions of gas cryotherapy (three sessions a week) by slow and regular scanning of the painful area until the patient reported a burning sensation, in one group, or standard treatment (systemic and topical anti inflammatory together with ultrasound and stretching) in the other group.
None of the patients took analgesics.
The study population consisted of :
- Acute tendinopathy group : 12 patients, 11 men and 1 woman, mean age 25. - Chronic tendinopathy group : 9 patients, all men, mean age 43.
The distribution of tendinopathies treated was as follows :
ACUTE
CHRONIC
Rotator cuff (supraspinatus, long head of biceps)
7
Anterior cubital
1
Epicondylar tendons
4
Patellar tendon
3
Achilles tendon
6
Sports responsible :
Gymnastics
8
Tennis
5
Volleyball
2
Basketball
2
Golf
1
Soccer
1
Walking
1
Squash
1
Sporting level :
National or international
9
Regional or county
4
Hobby
8
Symptoms had been present on average for 10 days before treatment in acute tendinopathies, and for 4.5 months (excluding a patient with the problem for 10 years) in chronic tendinopathies.
RESULTS
Several parameters were evaluated :
- Grading of pain using a visual analog scale at pre-treatment examination, at the end of treatment and a month later : palpation, opposed movements, stretching.
- Variations in the clinical stage of tendinopathy.
- Sports activity a month after the end of treatment.
These factors are reported in the two summary tables concerning acute cases (Table 1) and chronic cases (Table 2).
Global functional result was graded according to return to sports activity and persistence or not of pain.
Excellent: return to sport at same level without pain.
Good: return to sport at same level with pain.
Average: return to sport with pain and at lower level.
Poor : no return to sport because of pain.
Overall :
- Results in acute tendinopathies were as follows (Table 1) :
CRYOTHERAPY
STANDARD TREATMENT
EXCELLENT
5
0
GOOD
1
1
AVERAGE
2
2
POOR
0
1
- Results in chronic tendinopathies were as follows (Table 2) :
CRYOTHERAPY
STANDARD TREATMENT
EXCELLENT
0
2
GOOD
1
0
AVERAGE
2
2
POOR
1
1
More detailed results are reported in Tables 3, 4, 5, 6.
DISCUSSION
The use of cryotherapy in recent acute tendinopathies provided more satisfactory and faster results than standard treatment, with 75% excellent and good results, without any adverse effect being seen. Results on pain were fast, and 5 out of 8 patients were able to restart their sport by the end of treatment wihout any relapse afterwards.
In contrast, in chronic tendinopathies, cryotherapy, in the few cases in which it was used, showed no evidence of efficacy greater than that of standard treatment, though the latter lasted longer. At any event, conclusions must be prudent because of the small number of cases, such that no statistical study was possible.
It can be concluded overall that this is certainly a technique to be used first line in the treatment of acute tendinopathies, because of its rapid efficacy and absence of adverse effects. As far as chronic tendinopathies are concerned, more refined analysis in large series of cases is required before any final conclusion can be drawn.
Table 3 : ACUTE TENDINOPATHIES
Sex
Age
Site
Time
Sport
Sport
level
Type of treatme nt
Blazin
a
before
Blazina after
Sport at 1 month
Same
level
Pain
D0
*
Pain
end
Treat.
Pain 1
mo. after
RESULT
M
22
ShoulderSupraspin atus
8d
Gym
National
Standard
2
1
YES
YES
4251**
35***
151515
111111
GOOD
M
18
Wrist
Anterior
cubital
8d
Gym
National
Cryo
3
0
YES
YES
0320
000
000
EXCELLENT
M
22
ShoulderLong head biceps
21d
Gym
National
Standard
3
1
Relapse
Stade 3
NO
6548
52
15100
7055
40
POOR
M
23
Shoulder
Long head biceps
10d
Gym
National
Standar d
2
2
YES
NO
53
48
42
45
40
40
40
40
32
AVERAGE
M
18
KneePatellar
tendon
4d
Gym
National
Cryo
2
0
YES
YES
31355
000
000
EXCELLENT
M
20
Shoulder
Cuff
2d
Gym
Int'l
Cryo
2
0
YES
YES
79
88
35
0023
000
EXCELLENT
M
18
Achilles
15d
Gym
National
Cryo
3
2
YES
NO
010
21
005
15010
AVERAGE
M
51
Elbow
Epicondyl e
8d
Tenni
s
Hobby
Standar d
3
2
YES
NO
5163
48
27
3215
22
2510
AVERAGE
M
28
ShoulderCuff
21d
Volley
Regional
Cryo
3
2
NO
NO
45720
47380
50420
AVERAGE
F
46
Shoulder
Cuff
8d
Tenni
s
Hobby
Cryo
3
2
YES
YES
52
800
23
3715
000
GOOD
M
20
KneePatellar
tendon
8d
Volley
National
Cryo
3
0
YES
YES
7540
48
500
000
EXCELLENT
M
21
Shoulder
Supraspin atus
7d
Gym
National
Cryo
3
0
YES
YES
60
52
45
18
25
25
000
EXCELLENT
Pain on palpation (scale graded from 0 to 100)
Pain on opposed contraction
Pain on passive stretching
Table 4 : CHRONIC TENDINOPATHIES
Sex
Age
Site
Time
Sport
Sport level
Type of
treatment
Blazina
before
Pain
daily
life
Blazina
after
Pain
daily
life
Blazina
at 1
month
Sport at
1 month
Same
level
Pain
D0
Pain
end
Treat.
Pain 1
mo.
after
RESULT
M
62
Elbow
Epicondyle
3 mos
Golf
Hobby
Cryo
2
+
1
ζ 0
1
YES
YES
55*
55**
40***
38
48
27
42
45
18
GOOD
M
42
Achilles
3 mos
Soccer
Tennis
Depart.
Standard
1
0
1
0
1
YES
NO
68
0
0
58
0
0
36
0
0
AVERAGE
M
42
Elbow
Epicondyle
10
mos.
Tennis
Regional
Standard
1
+
1
ρ
1
NO
NO
60
50
30
8
8
8
12
10
10
POOR
M
45
Elbow
Epicondyle Epitrochlear
6 mos
Tennis
Hobby
Cryo
2
+
2
0
1
YES
NO
35
45
20
0
0
0
19
0
7
AVERAGE
M
35
Achilles
3 mos
Soccer
Hobby
Cryo
3
+
3
+
3
NO
NO
82
0
0
62
0
0
57
0
0
POOR
M
29
Elbow
Epicondyle
2 mos
Squash
Hobby
Standard
3
+
0
0
0
YES
YES
59
65
48
0
0
0
0
0
0
EXCELLENT
M
66
Achilles
10 yrs
Jogging
Hobby
Standard
3
+
1
0
0
YES
YES
62
25
20
15
0
0
11
0
0
EXCELLENT
M
22
Knee
Patellar
tendon
6 mos
Basket
Regional
Cryo
2
+
2
0
2
YES
NO
71
0
25
60
0
20
50
0
22
AVERAGE
M
50
Achilles
3 mos
Basket
Hobby
Standard
3
0
2
0
2
YES
NO
63
21
25
50
0
0
55
0
0
AVERAGE
