By galvanization we can, according to modern views, influence the restoration of the hydrogen on concentration and OH ions to their normal ratio. In employing galvanization for this purpose in the acute stage, the positive pole is placed at the region of the injury. This pole possesses the property +The positive pole is also a vasoconstrictor, i.e., it lessens hyperemia. This property still more adds value to its employment in the acute stage where hyperemia is always present. of collecting oxygen, from which acid Acid is a sedative, and its presence, too, contributes to the relief of pain. is formed.
The acid, as stated by Neiswenger,9Neiswenger: “Electrotherapeutic Practice,” o.32, 23rd edition, 1925. replaces the excess of the alkalinity, i.e., the excesses of the hydroxyl ions, resulting in the restoration of the normal ratio of the two kinds of ions. Favorable conditions are reestablished for the relief of pain and repair of the injured tissues.
Technic of Galvanization. I suggest that the application of the galvanic current, using just tap water without the addition of any medication, should be termed galvanization. My definition of the latter is: The employment of a galvanic current with the purpose of utilization of the properties of a given pole in diseases. This is distinguished from ionization, the standard definition of which is: Ionization or ionic medication is the introduction of chemical ions into the superficial tissues, for medical purposes, by means of a direct current.
Ionization with mag. sulphate is here preferred to galvanization. The author employs instead of plain water, a solution of 1 per cent mg. sulphate, because this medication takes the positive pole and possesses also a definite affinity for edema, i.e., the mg. ion reduces edema as pointed out by the author elsewhere. 10 Echtman, Joseph: “Infra-red Therapy,” Med. Rec., vol. 1142, p. 82, July 17, 1935.- Prepare and apply a compress to the shoulder as described above in discussing cold applications. Place a sufficiently large piece of blocked tin on the compress, taking care that none of the metal is in contact with the skin.
The compress and the metal constitute the active electrode. Attach the metal to the positive pole of your galvanic apparatus. A similar electrode, larger in size, but soaked in warm water, is attached to the negative pole and applied at the region of the neighboring spine (or the patient may sit on it). The current is opened, a straight galvanic current only being used. Increase the current gradually to the patients tolerance for twenty to thirty or forty-five minutes.
This treatment, which shortens considerably the period of the acute stage, is kept up until the latter is over. (In concluding the discussion of the treatment of the first stage, I wish to mention that aspiration of the fluid of the distended bursa, in addition to or independently of the treatment here described, has been employed by some with good results. The needle is inserted 2 cm. below the level of the acromion process. However, this procedure has been the direct cause of suppuration.).
Pathology of the Second Stage.- Fibrous adhesions are forming in the bursa, nearby tendon sheaths, and between adjacent muscles; the adhesions causing definite mechanical hindrances to abduction and rotation, atrophy of muscles and periarticular fibrosis may be present or forming.
Treatment.- This consists of (1) infrared radiation followed by massage, alternated by (2) ionization with sodium chloride followed by sinusoidalization.
(1) Infrared and massage.- The patients shoulder is exposed to infrared rays + The application of infrared radiation causes occasionally a return of the pain. This indicates that the acute stage is not yet entirely over. Infrared should be discarded and the treatment of the first stage continued for a few more seances. For twenty minutes or one-half hour. This is followed or accompanied by massage and manipulations to the point of causing no pain to the patient.
(2) Ionization with sodium chloride followed by sinu-sodialization.- The sodium chloride on the negative pole, because of its ability to in hence the “lytic” (dissolving) action of that pole, has proven to be one of the best treatments for fibrous adhesions. The sinusoidal current breaks up the latter and serves as a marvelous massage for the muscles that tend to become or are already atrophied. Technic: Prepare and apply the electrodes as for the electrode placed on the shoulder.
Attach this electrode to the negative pole. The galvanic current is brought up gradually to the patients tolerance for twenty minutes to one-half hour. After this treatment the electrodes are left in situ, and the galvanic current is changed to a sinusoidal one with a frequency of twenty interruptions per minute. A very mild voltage is employed at the beginning, increasing it gradually at each seance until a maximum tolerance is reached. The treatment time is started with two minutes and is increased by one minute at each seance until four to five minutes are given.
Diathermy, This treatment causes occasionally a sudden exacerbation, indicating that the subacute stage is still in its early phases. Diathermy is then discarded, and infrared and ionization continued for another week or so. instead of infrared, may be employed towards the termination of the subacute stage. When the latter becomes protracted or chronic (forming Codman type of adherent bursitis ++ Codmans prognosis for recovery is: about two years!) because the patient was not or was improperly treated, the method described in this paragraph is probably the most ideal.
In the writers experience, some patients who started treatments early (on the third or fourth day after the onset of the illness) were cured with twenty or less seances. For instance, in the case above cited, the patient was cured with twelve treatments which he received almost daily. No other treatments, such as aspiration, were used. (He developed “acuphobia” – fear of a needle-due to the morphine injections.) Of course, the number of cases that get well so soon is rather small. The majority go into the third or chronic stage.
Pathology of the Chronic Stage.- This stage has two varieties: the protracted adherent one just considered and another one characterized by the deposit of lime salts, forming the calcified (Subdeltoid) bursitis. It remains for us to discuss the latter. 11Brickner: “American Atlas of Stereorentgenology,” vol. 1, No.2, January, 1916. describes the calcification as follows: It may be as small as a pinhead or so large a as to form a cap over the outer portion of the humerus.
Its shadow as revealed by x- ray may sometimes be obscured by the acromion process. The shadow is not due to thickening of the bursa. It is due to lime salt deposit, but the deposit is not in but beneath the bursa, or in and upon the supraspinatus tendon.” Others, like Montgomery, 12 Montgomery, Albert: “Subdeltoid Bursitis Associated with Deposit of Lime,” J.A.M.A. vol. 66, p. 269, January 12, 1916. state that “The amorphous masses of lime salts were deposited and confined to the upper wall of the bursa.” For our method of treatment the exact location of the deposit is immaterial.
Treatment of Calcified Subdeltoid Bursitis.- The only treatment employed by the writer with uniform success is diathermy applied to the affected shoulder.
Technic.- There are two methods. (1) The antero-posterior and (2) the cap method. In the former, two metal electrodes of equal and sufficient size, say four by four inches or larger are placed at the shoulder joint, one anteriorly and the other posteriorly, and held in place by a bandage. The current is gradually increased to 800 M.A. or the patients tolerance for one-half hour to forty-five minutes. From twenty to forty treatments may be necessary for a cure. The treatments are given daily or three times a week.
The Cap Method.- This consists of a cap-shaped electrode five by five inches or larger. Its concavity is molded so that it conforms to the shoulder curve and is the active electrode. The inactive electrode consists of a large plate ten by twelve inches applied to the opposite side of the body, its upper border being about two inches below the tendon of pectoralis major. From my experience in treating calcified bursitis, I feel that it is safe to say that diathermy is the treatment of choice for this condition.
It is the pleasant treatment that, in the hands of the writer, has seldom, if ever, failed to cure a bursitis associated with lime deposit. The writer believes with many others that the diathermy causes the absorption of that deposit. If x-rays are taken after each series of eight to ten treatments, they will show a gradual diminution of the lime deposit as illustrated by the following case. Mrs. M., aged forty-two, the wife of a New York physician, suffered from a chronic subdeltoid bursitis.
She was treated by her husband for over a year with baking and massage, manipulations, exercise, medications, etc., but without results. Her suffering was so great that during that year she lost twenty-three pounds (her usual weight being 130 pounds).
