Ultrasound therapy and metal implant

[Kaushal Bhatt]

Hello everyone,
I am searching articles related to ultrasound therapy and metal implant. Can we give ultrasound therapy in metal implant patient? There is enough evidence in the literature to support the claim that ultrasound is safe over metal implants because the soundwaves do not vibrate the metal to cause increased heating. Although, there is evidence that ultrasound can cause increased heating of plastic implants and cemented joints.
Reference: Cameron, Michelle, (2003) Physical Agent Modalities: from Research to Practice.So will u help me to get more articles supporting this?

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[gcoe]

I know when I trained we used doses between 0.5 w/cm2 and 1.5 W/cm2, pulsed and unpulsed. We used it for mechanical effects or at the higher doses fore heating effects. But whatever we were told to always keep the head moving.

Current practice suggests we were being way too zealous and I gather that the whole idea of using US for heating is now frowned upon. the potential damage that standing waves cause on cells is well documented in the lab.

I remember even we were shocked when in a neurology placement the therapists were using US to reduce spasticity. The theory was to bombard the golgi tendon organs with mechanical energy, that would inhibit the overactivity of the muscle. So the idea was to hold the head stationary on 3 w/cm2 continuous on the tendon. Dreadful idea and think what damage we could have done. Anecdotally it did seem to reduced the stiffness of the muscle, at least temporarily.

[namratasnv]

Hi,

I think it is better if you dont go for any US as it damages the tissues permanently, when you are suspecting something in your joints or any part of your body it is better first to consult it with the doctor and try to do some exercises that will be helpful but if there is a big problem then in that case it becomes compulsory to get an x ray done.

Thanks
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[thisoldPT]

I cannot find any resources either that say you should not ultrasound over metal implants unless they are cemented in or if there is plastic in the area. I am curious as to why we are still told that you should never US over metal and that people seem to be giving their opinions but that there aren't any valid studies to support this...just word of mouth and opinions...which could be correct I know.

Also, I had a ganglion cyst while in my first year of college...18 y/o and was told that I could have it excised or that the MD would just be happy to smash it with a book.....I didn't have time for this and smashed it myself with a Websters Dictionary.....really hard, several times and this did work without return. I am sure this goes against all of are kind/caring personalities but I sure felt none of this on myself....I am glad it went away after several months of discomfort.

[gcoe]

Hi thisoldPT

You are quite right there are are studies to support the damaging effects of insonating over metal implants. However I think you are being a bit unrealistic if you expect there to be such studies. Apart from the risk studies for cervical manipulation as far as I know PT doesn't have such studies. It would be hard to do such studies as adverse events would be few and far between so you would need mammoth sample sizes. Big issues to get through an ethics committee and anyway would there be enough PTs using US these days to warrant such a study?

Animal studies - don't know of any - but they would only pick up large tissue damage.

So...opinion is what you are left with and that opinion should be based on biomedical science.

In my opinion I would interpret the use of US with metal implants as a precaution and a potential hazard not an absolute contraindication. Kitchen & Dyson both mention precautions with implants along with other things like bony interfaces. The issue is the interface of soft tissue to the hard surfaces where we know we get energy problems with changes in behaviour of the the US Waves. Another thing to consider is that the surgery may have left some of the tissue adjacent to the implant dennervated and therefore not sensitive to pain. Other things to consider would be the dosage, frequency in terms of penetration depth, pulsed and then all the usually stuff of keeping the head moving.

[thisoldPT]

Yes, thank you for your post. I just think it is strange that forever, we say we should never US over metal implants but that there is no research to say why not, only that we think it would be bad. Yet, we know we shouldn't US over cemented or plastic implants and that there is aparantly research to support this. Take care!

[thisoldPT]

Yes, that would certainly be nice to have a study to support what it is we are told. I am certainly not at all in a situation where I could do such a study so hopefully, some DPT hopeful will be able to pull this together.