|
|
Re: US for THR
|
Logged in as: Guest
|
|
Users viewing this topic:
none
|
|
Login  | |
|
Re: US for THR - February 4, 2006 3:58:00 AM
|
|
|
MPT
Posts: 161
Joined: April 4, 2004
From: Syracuse, New York
Status: offline
|
The only studies I find that show US did anything clinical, use parameters that are out of the norm. .5-.4 w/cm2 for 15-20 min, 5xs per wk for a month. Or something like that. Also the treatment area that is commonly used is often way too big. I have never even seen a unit that has .5 or .4 as a settting. US may have potential to help but not the way we commonly use it.
_____________________________
Where am I
|
|
|
|
|
Re: US for THR - February 4, 2006 10:19:00 AM
|
|
|
certMDT
Posts: 154
Joined: April 5, 2004
From: Durham, NC
Status: offline
|
Steve -
You're probably right. But I think it's at least in the ballpark. A better example would probably be the contraindication of using US during pregnancy. I don't imagine that there is a documented case in which birth defects were caused an a human after US, but it is known that US affects fetal nervous tissue in other animals (I can probably find the reference). You don't need a worst-case scenario case study for something to be contraindicated.
To be fair, I don't know the exact mechanism proposed to disrupt the prosthesis, so you may be absolutely correct.
_____________________________
Charles Sheets PT OCS Dip MDT
|
|
|
|
|
Re: US for THR - February 4, 2006 3:29:00 PM
|
|
|
Shill
Posts: 1092
Joined: February 13, 2003
From: Madison WI USA
Status: offline
|
AR15,
The "norm" parameters are exactly the arbitrary settings I was referring to.
Charles,
I hear you. Isnt it strange that US is used to visualize the fetus, measure limb length, determine sex, etc, etc, and yet it, in therapeutic form is contraindicated. I should be reluctant to quote Arsenio Hall, but it is indeed one of those things that make you go hmmmmm. No one wants to be the first one to find out after the fact that it is detrimental to use the frequencies we use. Nevertheless, its still interesting that a different frequency is frequently used.
_____________________________
Steve Hill PT
|
|
|
|
|
Re: US for THR - February 5, 2006 4:38:00 AM
|
|
|
jma
Posts: 2409
Joined: August 24, 2000
From: NY
Status: offline
|
That is interesting. What frequence/intensity are they using during these diagnostic tests?
|
|
|
|
|
Re: US for THR - February 5, 2006 9:44:00 AM
|
|
|
stan1980
Posts: 19
Joined: February 4, 2006
From: U.K.
Status: offline
|
Let us not get carried away here. Current research states that no or little physiological benefits from US have been demonstrated SO FAR. Nobody said that it is not effective. But then again someone might add that of course they would never say that, because of the industry behind that.Another question: Aren't the latest systematic reviews on manipulation on any joint inconclusive as well? Both are growing fields. Just my point of view.
|
|
|
|
|
Re: US for THR - February 5, 2006 10:46:00 AM
|
|
|
nari
Posts: 1568
Joined: November 14, 2003
From: Australia
Status: offline
|
jma
I can't remember the exact figures (too long ago) but diagnostic US is far smaller intensity than therapeutic US. The radiographers used to tease us about these 'lethal' doses that PTs use.
Stan,
Once again, I totally agree. Probably US does do something, but there has been very little evidence; empirically, it works sometimes. Here US has almost ceased to exist except in private practices where patients often demand it and time is money....excuse the sour note.
Nari
|
|
|
|
|
Re: US for THR - February 5, 2006 11:04:00 AM
|
|
|
maykee
Posts: 5
Joined: January 13, 2006
From: New York
Status: offline
|
If you are unsure of the effects and CI of US to THR patient try not to apply it. Try other procedures/modalities/manual therapy just to decrease pain and swelling. Besides you'll get the same effect from other modalities without the use of sound waves.
|
|
|
|
|
Re: US for THR - February 6, 2006 1:09:00 AM
|
|
|
stan1980
Posts: 19
Joined: February 4, 2006
From: U.K.
Status: offline
|
But what modalities would be safe for a THR? Or could help? I have never used any modalities in a THR for any reason. Exercise does the trick for me, or manual (grade I) therapy.
I just had a chat with a biomedical engineer and therapeutic (not diagnostic) US in her opinion (based on research of course) is a contraindication for cemented prostheses.
|
|
|
|
|
Re: US for THR - February 6, 2006 3:51:00 AM
|
|
|
PTupdate.com
Posts: 1474
Joined: October 8, 2001
From: Pittsburgh, PA USA
Status: offline
|
Simple modalities, such as heat/ice can help. Russian style NMES to the gluteus med. could be used to strengthen more stubborn cases (I have used with good success). Iontophoresis could be used for those with trochanteric bursitis that cannot undertake ITB stretching.
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
|
|
|
|
|
Re: US for THR - February 6, 2006 4:07:00 AM
|
|
|
ehanso
Posts: 355
Joined: September 14, 2004
From: Minnesota
Status: offline
|
Great discussion. One of the problems with the modality choices is that Medicare will not pay for Iontophoresis. So that option is removed from the table. What other specific treatments would be recommended for a trochanteric bursitis in a 78 yo pt with a THR?
|
|
|
|
|
Re: US for THR - February 6, 2006 6:45:00 AM
|
|
|
stan1980
Posts: 19
Joined: February 4, 2006
From: U.K.
Status: offline
|
Very interesting comments, John. I will definitely keep in mind the russian currents.
What i really had in mind (random) is whether one would use SW diathermy, which i dont think i would. I would try to stay away from creating electromagnetic fields (thus risk of cement fracture)and would just stick to heat/ice.
For a 78 y.o. patient with trochanteric bursitis, heat/ice could help (apart from exercise/stretching). I wouldn't use ultrasound, phonophoresis, diathermy for the same reason as in the THR case (creating fields).
|
|
|
|
|
Re: US for THR - February 6, 2006 5:37:00 PM
|
|
|
hmgross
Posts: 292
Joined: February 28, 2003
From: Minnesota
Status: offline
|
FallsPT
If I am correct in recalling, you work in a hospital outpatient setting so your Medicare is Noridian and you are correct--they dont pay for Ionto.
Now I am a bit south of you, in my own private practice, and WPS Medicare does cover Ionto.
Crazy isn't it. Kinda like the therapy cap.
_____________________________
Holly Gross PT
|
|
|
|
|
Re: US for THR - February 7, 2006 2:11:00 PM
|
|
|
bp2317
Posts: 55
Joined: July 31, 2005
From: Columbus, GA
Status: offline
|
for what it's worth, i finally got a reply from our clinical educator regarding the study (mentioned in my posts above) that he always quotes regarding proper use of ultrasound to help "advance" the inflammatory process. the study was: Dyson, M. Non-thermal cellular effects of ultrasound Br J Cancer Suppl. 1982 March;45(5):165-71. PMID:6950755
i haven't gotten a chance to look for the article. i was surprised at the age of the article, but i won't jump to conclusions until i can read the article.
_____________________________
Brian Phillips, PT
|
|
|
|
|
Re: US for THR - February 8, 2006 3:32:00 AM
|
|
|
ehanso
Posts: 355
Joined: September 14, 2004
From: Minnesota
Status: offline
|
hmg, and I thought coverage was suppose to be universal and equal. LOL. Ed
|
|
|
|
 New Messages |
 No New Messages |
 Hot Topic w/ New Messages |
 Hot Topic w/o New Messages |
 Locked w/ New Messages |
 Locked w/o New Messages |
|
 Post New Thread
Reply to Message
Post New Poll
Submit Vote
Delete My Own Post
Delete My Own Thread
Rate Posts |
|
0.078
|
Printable Version
