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Thoughts on phonophoresis and interesting pt
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Thoughts on phonophoresis and interesting pt - June 6, 2001 5:46:00 PM
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bonmar
Posts: 137
Joined: August 15, 2000
From: Boston, MA
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Does anyone use phonophoresis? I did a quick Medline search and the few studies I read stated that the penetration was not effective to cause diminished inflamation?
Also, has anyone ever heard of sesamoiditis? I have a patient who was referred from a podiatrist with this dx. The patient is a 38 y.o woman who began to get sharp pain on the plantar surface of her 1st > 2-5 metatarsal heads after playing raquetball in Feb. 2001. She continued to play for a week until the pain got so severe that walking was unbearable. She went to see the pod. who performed an x-ray and told her she fx her sesamoid bone. He placed her in a cast boot for 6 weeks. After the boot was taken off, there was no change in the pain. (That was 1 month ago). He told her that the fx had not healed and basically told her to let it ride for a while and see what happened. (???)
On the eval (2 days ago), she stated she is feeling much better except cont. pain on the plantar 1st MT head after prolonged standing/hiking. -tenderness. 8 degrees of DF. Subtalar hypomobility as well as subtalar varus > 10 degrees (in STJN as well as during gait). R great toe extension ltd by 20 degrees. Hip IR right (effected side) ltd to 20 degrees (L hip IR 45).
The podiatrist wants her to come to PT for phonophoresis (10% hydrocortisone).
I do not feel this will do anything. After the eval, I did some research in Travell's Trigger Pt Lower Extremity Book (I can't believe I forget the exact name of this book - it is one of my favorites!!) . TP's in the Flexor Hallucus Longus cause the same sxs/sgs the pt is having.
I plan on working the soft tissue of the calf as well as ST mobs, toe flexor stretching, and hip IR stretching. I also feel the pt would benefit from orthotics if there is no change within 2 weeks. Any thoughts otherwise out there? What would you do re: the phono aspect?
Thank you for any assistance.
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Re: Thoughts on phonophoresis and interesting pt - June 7, 2001 4:37:00 PM
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sarty
Posts: 65
Joined: April 22, 2001
From: Florida, USA
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Hi there,
I don't have any research studies to back it up, but I've found that in patients with more superficial inflammatory conditions (ie, plantar fasciitis, biceps tendonitis, achilles tendonitis), that phonophoresis with 10% hydrocortisone seems to bring about more speedy results than US with regular lotion/gel alone. I realize that there are many variables here... this is just my very unscientific opinion [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG].
Jen
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Re: Thoughts on phonophoresis and interesting pt - June 7, 2001 7:51:00 PM
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edilling
Posts: 139
Joined: January 10, 2000
From: pullman,wa,usa
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Of the studies I have read, all report a dose not capable of providing any anti-inflammitory effect. The depth of penetration of the medicine was also very small so that if your target tissue is below 2-3mm there is no medicine delivered.
Also- I have seen about five different preparations and all had horrible transmissivity (they reflect rather than conduct the ultrasound). If your sound head gets warmer with the phono than standard US you probably aren't getting the thermal and cellular effects of the US either.
Iontophoresis or needle are far superior as a drug delivery device.
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Re: Thoughts on phonophoresis and interesting pt - June 9, 2001 12:44:00 PM
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sarty
Posts: 65
Joined: April 22, 2001
From: Florida, USA
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Hello edilling,
I was very interested in your reply. When I first graduated, I called Iomed (the company whose phoresor units we were using) for some general information, and they told me that ionto also delivered the medication to only about 2 to 3 mm below the surface.
I had always assumed that, kind of like with a moist heat application, there would be some effect on the deeper tissues by direct means (ie, medication being picked up and dispersed through the circulatory system) and indirectly (ie, decreased inflammation locally leading to less irritation deeper).
I know that I have strayed from the initial topic of this thread here, but I am very interested in hearing what everyone has to say about why ionto and phono do or do not work.
Have a great day!
Jen [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG]
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Re: Thoughts on phonophoresis and interesting pt - June 14, 2001 8:44:00 AM
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mcap
Posts: 652
Joined: February 8, 2000
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I have pretty much given up using Phono. I am not convinced it delivers an effective dose medication and in recent studies, it was no more effective than ultrasound without phono.
I do beleive that IONTO is effective and is beneficial in correctly selected patients.
When using the modalities, I think it is imporant to at least try to determine the type of tendinopathy you are dealing with. For inflammatory tendinophathy, IONTO would work well along with ICE, Rest and activity modification.
Using IONTO in cases of non-infammatory tendon degeneration would, in my opinion not help, and could be harmful. These are the cases where you see rupture after they have been injected by the MD.
mcap
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Re: Thoughts on phonophoresis and interesting pt - June 14, 2001 1:11:00 PM
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bonmar
Posts: 137
Joined: August 15, 2000
From: Boston, MA
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Thank you all for the replies. Mcap, I agree with your post. After doing research, I have found that phono does not effectively administer the meds.
I also did try a Medline search for the use of ionto on the achilles tendon. Studies have shown that cortisone injections to this area weakens the tendon and rupture may occur. I did not have good results on the search with ionto, however.
Any research out there on ionto/achilles tendon that I am missing?
Thank you....bonmar
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Re: Thoughts on phonophoresis and interesting pt - June 14, 2001 8:08:00 PM
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mcap
Posts: 652
Joined: February 8, 2000
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Bonmar:
I would imagine that injections, if used early, during the acute phase would be beneificial. However, with cases of non-inflammatory degeneration you injecting degenerated tissue, making it weaker. This is why there is an increased chance for a rupture. So I would use IONTO accordingly - only in cases of tendonitis - not tendinosis.
It's funny, inflammation is precisely what some say tendinosis needs.
mcap
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Re: Thoughts on phonophoresis and interesting pt - June 15, 2001 7:00:00 PM
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bonmar
Posts: 137
Joined: August 15, 2000
From: Boston, MA
Status: offline
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Thank you, mcap....you have made the reasoning much clearer re: the achilles ruputre/injections. I do know the local MD's that I deal with do not want us to use ionto with achilles tendinitis as well. However, maybe they are advising this as a precaution.
Again, thanks for the input...much appreciated....Bonnie [IMG]http://www.rehabedge.com/forums/smile.gif[/IMG]
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