Dexamethasone Iontophoresis for Musculoskeletal Tendinopathies: A Case Series of Three Patients.

Iontophoresis is a non-invasive transdermal drug delivery technique that uses low-voltage electric current to deliver ionized medications into soft tissues. Despite guideline recommendations supporting dexamethasone iontophoresis for tendinopathies, the existing evidence consists primarily of condition-specific randomized controlled trials and single-site retrospective studies, with no published case series illustrating the real-world application of dexamethasone iontophoresis across multiple tendinopathy types within a single report. This case series describes the outcomes of dexamethasone iontophoresis as part of multimodal physical therapy for three distinct tendinopathies. This retrospective case series included three patients treated at a Veterans Affairs physical therapy clinic with dexamethasone sodium phosphate (4 mg/mL) iontophoresis (40 mA-min per session) using the ActivaDose II system. While the small sample size limits generalizability, this series is intended to illustrate the real-world clinical application of dexamethasone iontophoresis across multiple tendinopathy types rather than to establish efficacy. Concurrent interventions included therapeutic exercise, patient education, and orthotic management. Outcomes assessed included pain (0-10 numeric scale), range of motion, grip strength, and Upper Extremity Functional Index (UEFI) scores. Case 1 (de Quervain's tenosynovitis) is a 47-year-old man with persistent, functionally limiting wrist pain who completed seven sessions over 24 days. Pain decreased from 3-4/10 to 1/10, grip strength improved from 60 to 75 lbs (equalizing with the uninvolved side), and UEFI improved by 8 points (exceeding the MCID). Case 2 (fluoroquinolone-associated Achilles tendinopathy) is a 56-year-old woman who completed six sessions over nine weeks. Pain decreased from 8/10 to 2-3/10, and ankle dorsiflexion improved from 7° to 16° (left) and 10° to 20° (right), surpassing the normative threshold of 10°. Case 3 (lateral epicondylitis) is a 62-year-old man with acute-onset symptoms who completed 12 sessions over six weeks. Pain decreased from 8/10 to 2-3/10, grip strength improved from 22 to 110 lbs (exceeding the uninvolved side of 80 lbs), and UEFI improved by 46 points (exceeding the MCID). No adverse effects were reported. Dexamethasone iontophoresis, as part of comprehensive physical therapy, was associated with clinically meaningful improvements in pain, strength, and function across three tendinopathy types. These findings suggest that dexamethasone iontophoresis may serve as a useful non-invasive adjunct in the multimodal management of musculoskeletal tendinopathies, though prospective controlled studies are needed to confirm its independent contribution.