"PULSED SHORT WAVE IN THE TREATMENT OF BURSITIS WITH CALCIFICATION"

                                                                                    BY

                                                            ABRAHAM J. GINSBERG, M.D.

                                                   Presented at the 36th Annual Meeting of the
                                  AMERICAN CONGRESS OF PHYSICAL MEDICINE AND REHABILITATION
                                                   Philadephia, Pa., August 24-29, 1958

High-frequency electrical energy in the treatment of disease has been with us in many forms for more than two decades. Most modalities involve continuous excitation of tissue for the duration of treatment at energy transfer rates which produce pyrexia—to the extent that heating was at one time considered the source of benefit to patients. This regime was named diathermy.

However, since 1935 the technique of pulsed short wave therapy, which does not produce pyrexia, has rather radically changed (1) our physiological explanations. 2 our regimes, (3) the syndromes which indicate short wave therapy, and (4) our clinical effectiveness. Original experimentation with laboratory animals, and extensive clinical experience, confirm the relative safety and efficacy of this new approach. In addition new applications of electrotherapy are made possible.

The clinical data given here relates to subdeltoid bursitis with associated calcification in 94 patients as treated by me over a period of 1 5 years with pulsed short wave therapy.

The modality that 1 used for treatment delivered short bursts of power at the usual and assigned medical frequencies. Each burst persisted only 50 microseconds, but at the high instantaneous power level of 1300 watts. Two operating settings were used. one at 400 pulses per second and the other at 600 pulses per second. Thus the period of emanation of energy was only 1/50th or 1/33rd of the elapsed time, and average level power delivery to patient less than 18 or 25 watts.

Although treatment could be administered for indefinite periods without measurable pyrexia (as indeed it has been on laboratory animals), the procedure followed here in treating the 94 calcified bursitis cases was uniform as follows: 10 minutes of irradiation at 600 pulses per second and maximum setting of 6 on the penetration dial over the affected area (right or left deltoid), plus 10 minutes each of irradiation at 400 pulses per second and a setting of 4 on the penetration dial over both the liver and the adrenals.

Patients did not disrobe. The treatment head of the unit ( 10 ) inches in diameter was as placed against the patient. Treatments were given at frequencies varying from a day to twice a week, and the average was three times a week.

The exposure of the liver and the adrenals in addition to conviction and long experience that the centers of the host defense mechanism are as important to treat as the affected area. Mounting clinical evidence and current basic research lend encouragement to the procedures I have followed since 1 935.

The symptoms exhibited by patients before treatments started varied from mild to excruciating pain accompanied by limitation of motion. Some patients said they came for treatment immediately after feeling the first symptoms, while others said they were seeking ielief after months and even years of intermittent pain.

More than half of the 94 patients claimed to have received one or more other forms of treatment including aspiration of the bursa, diathermy, immobilization, Vitamin B injections, local anesthesia, massage, novocaine injections, surgery, osteopathic manipulations and X-ray therapy.

All 94 of the bursitis cases reported here were X-rayed prior to treatment to demon- strate the presence of calcium. Since many of the patients were referred by other physicians. it was not possible to insist that they continue treatment after pain and symptoms were relieved. Since the period of treatment required to show evidence of decalcification is three or four times as long as the period required to restore mobility and comfort, only 46 of my patients continued treatment to the point at which final investigation with X-ray of decalcification could be made.

In these 46 cases, Thefore and after" shoulder X-rays are available for comparative study together with the case history file cards. The average number of treatments per patient for these 46 cases, was thirty over periods of ten to twelve weeks. Symptoms were relieved after 6 to 8 treatments during the first two or three weeks of therapy.

Results

Table I summarizes the symptomatic relief, and Table H the calcium absorption ap- parent on X-rays, in all of the cases.

                                                                            TABLE I

                                                                   SYMPTOMATIC RELIEF

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