Andrew M. Ball MS MBA PT
Posts: 271
Joined: September 30, 2001
From: Chapel Hill
Status: offline
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(Sigh)
We're never going to be primary care pracitioners if PT's don't start doing their own reviews of the research. Tell your friend that she's missing the bigger picture. In the words of Ted Worrel, EdD at Duke . . .
"Mushrooms people. You're looking at mushrooms." Take a step back . . . notice the tree? Pretty cool huh? Step back a few more feet . . . impressive 'eh? It's called a FORREST. Look into it.
Anyway, there are only 8 articles on the subject in the MEDLINE database using the search string:
Dupuytrens
Three are in German, and two others have no abstract, but of what I could get from the following article:
Hagstrom P. Ulnar nerve compression at the elbow. Results of surgery in 85 cases. Scand J Plast Reconstr Surg 1977;11(1):59-62
A surprisingly common association with Dupuytrens contracture and hypertension was encounted. If the hand therapist, therefore, didn't encourage (and document) efforts to get the patient to a cardiac screening, they're playing with fire. As a hand therapist, they would certainly be expected to know this link. Should the patient fall ill with cardiopulmonary problems, and I were a lawyer, I'd certainly not only go after the doctor for negligence, but the hand therapist as well.
As for ultrasound, there are 0, nada, zip articles on using ultrasound for this purpose (e.g. Dupuytrens AND ultrasound). So the question beggs asking --- why do it in the first place? It's unethical. Unless of course you're not charging the patient for the experimental procedure, and writing a case study of your results.
Why do any PT or OT at all after surgery? The 1-18 year post-op, of 79 patients showed positive results after surgery regarless of patients age, duration, or type of symptoms. Seems to me like once the surgery has been done, rehab is just a nice way to take the patient's money.
As an MBA, I'd therefore have to ask the hand specialist . . . "And what exactly are you providing the patient beyond natural history?" Without a good answer (and there doesn't seem to be one), were I a claims processor I'd not only halt payment for any further treatments, I'd fine the therapist for all of the previous monies paid out, and consider charges of fraud against the therapist.
As for heating, according to Sue Michlovitz's literature review(as published in "Thermal Agents in Rehabilitation" - 2nd edition p.146. "Following 10 to 20 minutes of ultrasound, at intesities greater than 2.0 W/cm squared, 1.0 MHz frquency, continuous wave, skeletal muscle temperatrue and blood flow increases have been found. At lower intensities and for shorter durations, either no change or inconsistent changes in blood flow were noted." To do anything less for heating effects is, in the words of friend and inspiration Jules Rothstien, "professional masterbation."
The two morals of the story - - -
First, no, there doesn't seem to be any contraindications that I could find, but there doesn't seem to be much point either. There are more important issues for a health professional to address anyway.
Second, we've got to get people like this to get over themselves. Treating on the basis of tradition and staring at mushrooms helps no one. She's not alone though, Most PT's and OT's don't do ultrasound long enough, or with great enough intensity to cause any kind of increase in temperature or blood flow in the first place. So to borrow once again from Dr. Rothstien's analogy . . . if we don't stop that, we could go blind!"
Drew
[This message has been edited by Andrew M. Ball MS MBA PT (edited November 09, 2001).]
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