Ultrasound therapy and metal implant

[kiren alberini]

hi kaushal, well to tell you the truth i have done one mistake in my life .. and im not doing again- i had a patient who had wrist fracture- cant remember which carpal bone- they had done k- wiring and metal implantment - it was very bad thats why they got to put it in that way.she was having bad scar after few months- plus with stiffness.. although doctor had said that she will never be able to gain full flexion and extension of her wrist due to the lifetime implantment but yet she couldnt even flex 5 degrees of wrist flexion- so i thought of trying u/s to relieve the scar mark plus increase extensibility- but to my dismay it didnt work- she start screaming of pain after 15 secs of u/s with very low intensity ...she told mie that she got some sort of electrocuted shock at her wrist and it was very bad... mind you... i dunt really agree that metal will not get heat with u/s... you better change your view on this articles..

[erafPT]

Hi Kiren Alberini! Can I just ask, did you place the probe on with gel directly over the wrist or did you do an underwater technique?

[kiren alberini]

well.... eraf- i think i done a direct contact!!!! hehehehe just kidding!

[erafPT]

Sorry, I didn't intend to imply anything with the question, Kiren. It's completely fine to do a probe-gel-skin technique. I have done this using a small head probe on a 5th MCP fracture which was k-wired without any untoward event.

But to some hands that are bony and may have very uneven surfaces and in the absence of a small probe, you would want to use underwater technique. That was all i wanted to point out. Even direct contact would be fine so long as there was enough gel. US should not heat the appliance...well in theory and in most cases...

[kiren alberini]

well eraf... i was juz being cautious as the metal seems slightly palpate-able..so under water technique was the best way to be safe ( i thought)...but it turn out to be ! neway... i would like to ask- if anyone knows what is the structure involved -if pain starts on the hip -lateral aspect- radiating sometimes towards the upper part of groin? could it be gleutues medius?iliac- psoas? well i tried doing tests on g.med/ iliac-psoas/ t.f.l... but it turn out to be negative.... anyone knows? the pain is more like pulling- so i thought it must be a tight soft tissue- but the patient is very active in sports- he does his gym-foot ball player--and also does yoga..- but i did found out he has hamstring tightness with lower back muscles tightness.... so what do yu guys think?

[erafPT]

Have you ruled out Rectus Femoris strain--football player an dlikely to have strained with bad kicking mechanics...

Does he have pain on particular mvts only or constant? How is it with straining? Ruled out hernia?

[chovik]

I haven't seen any valid research that actually says US is of any use at all. Causing pain due to applying over metal does not validate that US is, or would have been, of any use in the first place

[RTP]

I agree, there's insufficient evidence to say that ultrasound is of use. That doesn't necessarily mean that it's useless, but rather just that no-one has (as yet) been able to prove that it's beneficial. Having said that, I never use ultrasound in my clinic.

However, ultrasound over implants is ALWAYS going to be a bad idea, not because it heats the implant itself, but because too much heat is deposited into too small a volume of soft tissue. Normally when we use ultrasound, the "energy" of the vibration is slowly absorbed over a 3-4cm depth of soft tissue, meaning that the heat is distributed and the resulting heat effect isn't going to be too intense in any 1 spot. If there's an implant, the sudden change in density at the soft tissue/implant border means that the vibration can't carry across from one into the other, which means that all the remaining "energy" of the original vibration will be dumped into the tissues just before the implant. In other words, the tissues immediately superficial to the implant get too hot, and this can cause a burn. Unfortunately, since the burn is inside the body, you may not be able to see any sign of it on the skin at all. Best thing to do is explain the risks to your client (patient) and make sure they understand the importance of telling you immediately if they feel any heat concentrating in any 1 spot. Or better yet, use another modality, like scar massage?

[AussiePhysio]

I thoroughly agree with RTP's reply

WHY do we use u/s so much? - we have so many better options.

basic u/s physics will tell you that a soft tisue/metal interface = reflection of sound energy from the sound head (instead of absorption or transmission of the enery. This means the soft tissue surrounding the metal gets an extra (reflected) dose of sound energy, heating adjacent tissues much more quickly and possibly burning them. Thats one possible mechanism for pain from U/S around highly reflective areas.

The metal is not what gets hot as far as i have been taught- it's the tissue immediately adjacent.

At any rate, there is little evidence to support the use of ultrasound for most conditions it has been studied in - so does the risk outway the benefit?

we have far better tools to use than U/S