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Description of the therapy of full thickness tear of the enthesis of the right supraspinatus tendon in case of 64-year-old man.

Medical history:

A 64-year-old man with shoulder pain came for the therapy. The right supraspinatus tendon injury occurred as a result of a workplace accident four months ago.

MR showed the following:

  • Higher amount of the fluid in the subacromial/shoulder bursa;
  • Degenerative lesions in the acromioclavicular joint with the pressure against the tendon and muscle connection of the supraspinatus muscle tendon;
  • Thinned tendon of the supraspinatus muscle with the features of the damage to superficial and deep layers;
  • Signs of the damage to the tendon of the supraspinatus muscle.

Diagnosis:

Full thickness tear of the enthesis of the right supraspinatus tendon.

Indications:

Qualification for surgical treatment: reconstruction of the enthesis of the right supraspinatus tendon. LHB tenodesis. Acromioplasty.

Previous treatment methods:

The patient had undergone two series of therapeutic sessions so far. The first of them took place three weeks after the injury. It included ten procedures such as:

  • Biostimulation laser therapy,
  • Ultrasounds,
  • Magnetic field,
  • Self-assisted exercises at the Universal Therapeutic Rehabilitation Unit.

Another series was repeated one month after the first series ended.

Patient’s impressions:

The patient continued to complain about pain in the shoulder joint; however, he did not want to opt for the surgery.

Pain in the Laitinen scale was as follows:

  • Pain intensity: very strong pain, intensifying at night (4 points),
  • Pain frequency: continuous pain (4 points),
  • Frequency of taking painkillers: sporadic (1 point),
  • Possibility of taking up daily activities: need for some assistance from another person (3 points).

Total = 12 points

Treatment method:

One procedure was used only, which was the high power laser therapy. The therapy took three weeks. It involved three sessions a week, on Monday, Wednesday and Friday. A total of nine sessions.

High power laser therapy. Methods of the procedures:

  • Irradiation:

Manual scanning: areas of pain; the patient felt mild warmth during the procedure.

Point-wise: stimulation of trigger points: until the patient feels distinct warmth.

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• High power laser therapy. Parameters of the procedure for the areas of pain:

Wavelengths of 808 nm Wavelengths of 980 nm
Power [W] 5 W 5 W
Frequency [Hz] 700 Hz 700 Hz
Radiation mode Pulse Pulse
Fill factor [%] 80% 70%
Dose [J/cm2]  30 J/cm2 30 J/cm2
Application adapter  5 cm2  5 cm2

 

• High power laser therapy. Parameters of the procedure for trigger points:

Wavelengths of 808 nm Wavelengths of 980 nm
Power [W] 2 W 2 W
Frequency [Hz]
Radiation mode continuous continuous
Fill factor [%]
Dose [J/cm2] 8 J/cm2 8 J/cm2
Application adapter 1 cm2 1 cm2

 

Result after the high power laser therapy:

Pain in the Laitinen scale was as follows:

  • Pain intensity: mild (1 point);
  • Pain frequency: sporadic (1 point);
  • Frequency of taking painkillers: none (0 points);
  • Possibility of taking up daily activities: fully independent (0 point)

Total = 2 points

The ultrasound examination showed a considerable improvement in the continuity of the supraspinatus tendon. In addition, the quantity reduction of the fluid in the subacromial/shoulder bursa was observed.

Conclusions:

  • The high power laser therapy had a considerable effect on the perception of pain in this case.
  • The high power laser therapy may be considered as an effective treatment method in chronic conditions.
  • The high power laser therapy is an alternative to a surgical procedure. Any surgical interference is invasive. High power laser therapy procedure is not invasive. It is worth taking up the therapy in a host of cases and if it does not bring about any results, it does not exclude the surgery in the future.
  • The high power laser therapy proved to be effective in this case while previous procedures involving laser therapy, ultrasounds and magnotherapy did not produce expected results. It may be concluded that the high power laser therapy has the possibility of dealing with more difficult cases.

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