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Is there evidence that phonophoresis is more effective than ultrasound in treating pain associated with lateral epicondylitis?
Abstract
A48-year-old woman was referred to our clinic with pain in the lateral epicondyle region of her right elbow. She is right-hand dominant. This pain started about 1 year ago, and the pain gradually increased throughout the past summer. During the warmer months she rides a motorcycle almost every day. The right hand is responsible for controlling the throttle of her motorcycle, and the wrist extensor muscles must contract to maintain active wrist extension for long periods of time. The right hand also controls the front brake lever, which is squeezed to apply the brake. This action also requires that the wrist extensor muscles contract to stabilize the wrist as the finger flexor muscles contract to squeeze the lever. The patient, therefore, uses her right wrist extensors continuously when riding a motorcycle, and these muscles might be overused during frequent or lengthy rides.
... Phonophoresis is the migration of drug molecules through the skin using ultrasound (US) therapy [9], which is used to enhance percutaneous absorption of drugs. Phonophoresis with antiinflammatory and local anesthetic agents is used in the management of pain and inflammation in musculoskeletal conditions. ...
... Phonophoresis is commonly used in physical therapy practices. The procedure generally utilizes an ultrasound apparatus that generates frequencies of 0.7 to 1.1 MHz and intensities usually range from 0.0 to 3.0 Watts / cm 2 [9,18]. US is often used in physical therapy because of its deep-heat and pain-relieving effects. ...
... Phonophoresis has been suggested by early studies to enhance the absorption of analgesics and anti-inflammatory agents [9]. Effectively, medicines contained within or under the ultrasound gel are pushed by the sound waves of the US and driven to a much deeper level than those massaged by hand [17]. ...
The purpose of this study was to compare the efficacy of ibuprofen phonophresis versus topical application of ibuprofen in improvement of hand grip strength in psoriatic arthritic patients. Methods: Forty patients who had asymmetrical psoriatic arthritis in hand participated in this study. Their ages ranged from 30 to 50 years. Patients were classified randomly into two groups of equal numbers; group (1) (control group) received routine
physical therapy (hot therapy, stretching and strengthening exercises), in addition to sham ibuprofen phonophoresis, while group (2) (studied group): received routine physical therapy, in addition to ibuprofen phonophoresis. Each patient was evaluated for grip strength, tender and swollen joint count before and after one month of treatment. The
results revealed that there was a significant difference between both groups regarding to grip strength, tender and swollen joint count, with the percentage of improvement in group 1 were 56%, 54%, and 55% ,while in group 2 were 82%, 80% and 76% respectively. It is concluded that the results of the current study confirms the effectiveness of phonophoresis as a therapeutic modality enhancing the delivery of ibuprofen so increasing the percentage of improvement of grip strength in the studied group .
[Amal M. Abd El Baky and Intsar S. Waked. Non-steroidal anti-inflammatory phonophoresis versus topical application in improvement of hand grip strength in psoriatic arthritic patients. Journal of American Science 2011;
7(6): 110-114].(ISSN: 1545-1003). http://www.americanscience.org.
Key Words: Ultrasound, phonophoresis, ibuprofen, grip strength, psoriatic arthritic.
... Istnieje wiele prac badawczych poświęconych stosowaniu jonoforezy [12,13,24,25], fonoforezy [10,14,[24][25][26][27][28] i pola magnetycznego [29,30] w leczeniu entezopatii stawu łokciowego. Większość autorów wskazuje na korzystne efekty zastosowanej terapii. ...
... There are numerous scientifi c studies that explore the issues of using iontophoresis [12,13,24,25], phonophoresis [10,14,[24][25][26][27][28] and magnetic fi elds [29,30] for the treatment of epicondylitis of the elbow joint. Majority of the authors indicate positive effects of the applied therapy. ...
Aims: There are many physical therapy options that can be recommended in management of epicondylitis. From a wide range of them we have chosen iontophoresis, phonophoresis and low frequency magnetic field. Our goal was to compare the effectiveness of these three methods and to evaluate the effectiveness of applied treatment in terms of the functional skill's limitation, severity and frequency of pain. Material: The research was carried out on 55 patients of Rehabilitation Outpatient Unit at University Hospital in Krakow, treated for epicondylitis. The group consists of 45 females and 10 males, in the age of 37 to 79 years (54 years on average). Methods: The patients were assigned to: the iontophoresis group, the phonophoresis group and the low frequency magnetic field group. Two evaluations were performed, the first one before 10 therapeutic interventions and another one after completed series. The assessment included: the subjective evaluation of the pain severity as well as the pain frequency, the functional skill's limitation, the pain radiation, the Thompson's test, the Mill's test and the converse Cozen's test. Conclusions: All applied therapeutic modalities (iontophoresis, phonophoresis and low frequency magnetic field) were found to be effective on a very high level of significance. However there was no statistically significant difference between them. To conclude, physical therapy interventions offer benefits in epicondylitis and the methods can be used alternatively as none of them was superior to the rest.
... Anti-inflammatory or analgesic agents could be introduced to ultrasound gel to increase the efficiency of treatment [156,157] . According to the US procedure, ultrasound waves caused transitory changes to the skin, so that drug ingredients could be taken by the skin through absorption, pointing to an inflammatory zone, and relieving the muscular pain. ...
Ultrasound procedures are widely used in assessing and diagnosing a wide variety of medical conditions. For example, in ultrasound imaging, which is utilized for mapping or identifying internal aspects of the patient's body such as fetus, tendons, muscles, and other organs, etc. It is also used for treating skin conditions such as reducing wrinkles, supporting tissue healing, analysis, and improving the extensibility of connective tissues. Medical ultrasound imaging has advantages over magnetic resonance imaging (MRI), such as portability, real-time imaging, reasonable cost, and its harmless effect. Ultrasound gel is used as a coupling medium in all ultrasound procedures to replace air between the patient's skin and the transducer, as ultrasound waves have trouble in traveling through air. But the availability and cost of commercial ultrasound gel are its major limitations. This review article describes the properties and applications of ultrasound gel and some materials that could be used in the formulation of an ultrasound gel. Generally, an ultrasound gel could be prepared by mixing these seven ingredients: vehicle, thickening agent, anti-inflammatory agent, skin conditioning agent, chelating agent, preservative, and neutralizer.
... 87 The relative transmission quality of coupling agents used for phonophoresis remains questionable, so it is not a favorable option to the other physical agents. 93 Laser or low-level light therapy only recently received Food and Drug Administration approval in the United States. However, it has been widely used to treat minor musculoskeletal pain in Europe, Canada, and Australia. ...
... The association of US and active substances to relieve pain and improve functionality is used in clinical practices, but there is little scientific evidence supporting this therapy (39). Anti-inflammatory substances like Diclofenac and Ibuprofen are largely used. ...
Introduction:
Osteoarthritis is a disease that affects millions of Brazilians.Therapeutic ultrasound has been used in its treatment, either alone or associated with drugs.
Objective:
The aim of this study was to evaluate the effects of ultrasound (US) associated with Copaiba oil (CO) on knee osteoarthritis.
Methods:
Patients were divided into three different groups: US, US+CO, CO.Ten treatment sessions were held twice a week, 30 minutes each.Pain intensity was assessed through the Visual Analog Scale (VAS) and Range of Motion (ROM) by goniometry, and muscle strength was assessed by means of the Medical Research Council Scale. Statistical analysis was performed by Cohen’s d test, student’s t test and ANOVA, considering p<0.05 as significant.
Results:
Pain reduced in all groups.The US+CO group (d = -3.50) presented larger effect size when compared to the other groups. Regarding ROM, the largest effect size was observed in the US+CO group for flexion (d = 0.86) and extension (d = 0.97) in comparison with the remainder groups. Muscle strength increased in the US (d = 1.54) and US+CO (d = 1.60) groups for flexion.Regarding extension, the US group presented the largest effect size (d = 1.80).
Conclusion:
Therapeutic ultrasound associated with copaiba oil is a practical and effective therapy for the treatment of inflammatory diseases such as osteoarthritis.
... PP is a therapeutic method used with US (10). The cell permeability, transdermal migration by local vasodilatation (10) are increased thus percutaneous absorption of intended drugs are enhanced (28,29). ...
... The subjects were carefully educated on the use of the VAS and it was observed that subjects could identify their pain levels or scores on the scale without any difficulties. Subjects pain perception was subjectively assessed or measured and recorded using a 10cm visual analogue scale (VAS) marked " no pain" at one end and "worst pain ever" at the other (Klaiman et al, 1998;Hoppenrath and Ciccone, 2006). A sensory test was also conducted to ascertain that the subjecs had no sensory loss (Oakley, 1978). ...
This study was designed to investigate the efficacy of phonophoresis and cryotherapy as combined therapy (double-modality therapy – DMT) in the management of pain among subjects with musculoskeletal injuries (MSIs).Subjects were assigned randomly to one of three groups: DMT group (n=17) received cryotherapy and 15% methyl salicylate phonophoresis, PHONO group (n=14) received 15% methyl salicylate phonophoresis, andCRYO group (n=19) received cryotherapy and ‘sham’ phonophoresis. Ultrasound at an intensity of 1.5 W/cm² and frequency of 1MHz was used to apply methyl salicylate while intermittent cryotherapy was the mode ofapplication. The pre- and post-treatment pain perception scores (PPS) of the patients were assessed using the visual analogue scale (VAS), and the sessions of treatment in all groups were recorded. Treatment was administered on alternate days and subjects in all groups were discharged when they were pain free. In total, 233 treatment sessions were recorded – 61(26.2%) in DMT, 77(33.0%) in PHONO and 95(40.8%) in CRYO group respectively, which indicated no significant difference (P > 0.05). In the DMT, CRYO and PHONO groups, 16, 12 and 7 subjects respectively were pain free after 1 to 5 treatments. The difference in the severity of pain was significant (P < 0.05) in each group post-treatment, which suggests that DMT, phonophoresis and cryotherapy were equally effective. The study has demonstrated the therapeutic efficacy of DMT, but it was not superior to the single treatment protocol of phonophoresis or cryotherapy. It might however, take less treatment sessions to reduce pain among the subjects with the use of DMT compared with other two modalities.KEYWORDS: cryotherapy, double-modality therapy, musculoskeletal injury, phonophoresis, ultrasound
... The ultrasound machine (EMS Therasonic MK IV) and the transducer (5cm², 1MHz and 3MHz treatment head) were all tested and certified functional. Subjects pain perception was subjectively assessed or measured and recorded using a 10cm visual analogue scale (VAS) marked " no pain" at one end and "worst pain ever" at the other (Klaiman et al, 1998;Hoppenrath and Ciccone, 2006) after the subjects were carefully educated on the use of VAS and it was observed that subjects could identify their pain levels or scores on the scale without any difficulties. This form of assessment was considered most appropriate because of its high level of repeatability when used serially on the same patient (Bleakley et al, 2006). ...
This study was designed to compare the efficacy of double-modality therapy, phonophoresis and cryotherapy in the management of pain among subjects who suffered from musculoskeletal injuries (MSIs).Sixty (60) subjects were assigned randomly to one of three groups: DMT group (n=20) received cryotherapy and 15% methyl salicylate phonophoresis, PHONO group (n=20) received 15% methyl salicylate phonophoresis and CRYO group (n=20) received cryotherapy and "sham‟ phonophoresis. Ultrasound at an intensity of 1.5 W/cm² and frequency of 1MHz was used to apply methyl salicylate while intermittent cryotherapy was the mode of application. Subjects‟ pre- and post-treatment pain perception scores (PPS) using visual analogue scale (VAS) were assessed and the sessions of treatment in all groups were recorded. Treatment was administered on alternate days and discharges were made in all groups when subjects were pain free. A total of 275 treatment sessions was recorded - 72 (26.2%) in DMT, 105 (38.2%) in PHONO and 98 (35.6%) in CRYO group respectively which indicated no significant difference (P>0.05). Nineteen (19), thirteen (13) and twelve (12) subjects were pain free in DMT, CRYO or PHONO groups respectively after 1 to 5 treatments. The difference in the severity of pain was significant (P<0.05) in each group post-treatment which suggests that DMT, phonophoresis and cryotherapy were equally effective. The study has demonstrated therapeutic efficacy of DMT, but it was not superior to the single treatment protocol of phonophoresis or cryotherapy. However, it might take fewer sessions in the DMT group to treat and make more than 90% of the subjects pain free and fit to return to active performance.
... Ultrasound gel is used on all surfaces of the head in order to reduce friction and assist in the transmission of the ultrasonic waves [1]. Analgesic or anti-inflammatory drugs could be added into ultrasound gel for improving treatment efficacy [2,3]. According to ultrasound wave caused temporary skin changing, so drug molecules could be absorbed through the skin, point to inflammatory area and muscle pain will relieve. ...
... Ultrasound gel is used on all surfaces of the head in order to reduce friction and assist in the transmission of the ultrasonic waves [1]. Analgesic or anti-inflammatory drugs could be added into ultrasound gel for improving treatment efficacy [2,3]. According to ultrasound wave caused temporary skin changing, so drug molecules could be absorbed through the skin, point to inflammatory area and muscle pain will relieve. ...
Plai oil extracted from Zingiber cassumunar Roxb. rhizome which contained (E)-1-(3,4-dimethoxyphenyl) butadiene (DMPBD) as active ingredient has been proved to show the anti-inflammatory effect. This research aims to find out the suitable plai emulgel formulation which could be used as an alternative medicine combining with ultrasound physical therapy for either acute or chronic muscle inflammatory treatment. 18 formulas of plai emulgel were formulated by various type and concentrations of gel forming agents (1-2% w/w), such as carbopol 121, carbopol 934, carbopol 940, hydroxypropyl cellulose (HPC), hydroxypropylmethyl cellulose (HPMC), and methyl cellulose (MC), combined with similar amount of plai oil (5% w/w), propylene glycol (20% w/w), EDTA (0.2% w/w) and paraben concentrate (0.2% w/w) in individual formula. These formulas were physical property, chemical property stability, and allergic skin test analyzed, in order to find out the suitable formula which is appropriated for applying with ultrasound transmission through gel. By this experiment, the formula numbered 4 which contained 1% carbopol 934 was found to be the suitable formula, which resulting in good appearances with good texture and spreadability. The chemical properties stability of this formula was also analyzed, by measuring content of the marker compound, (E)-1-(3,4-dimethoxyphenyl) butadiene (DMPBD). After keeping at 15C, the remaining content of this marker was still more than 95%.
... According to reviews, there is no clear effect of exercises or strength training on epicondylitis [76,77,79,87,90]; however, a recent study reported beneficial short effects of physiotherapy combining elbow self-manipulation and exercise [84]. The effectiveness of ultrasonography [76,77,87,90], iontophoresis with non-steroidal antiinflammatory drugs [77,87,91], phonophoresis [87,92], electromagnetic field therapy [77,87], mobilisation techniques [76,77,79,87,90], botulinum toxin [9,77] and topical nitrates [77] in the treatment of epicondylitis is not well known. Extracorporeal shockwave therapy [76,77,79,91,93,94], laser therapy [77,87,90,93] and autologous blood injections [9,77] are not beneficial in the treatment of epicondylitis. ...
Geriatric patients with rheumatic conditions, undergoing rehabilitation, have some specific features that necessitate a different approach, compared with younger ones.
Elektrophysikalische Maßnahmen (im englischen Sprachgebrauch »electrophysical agents«, kurz EPAs) stellen in der Handtherapie einen wichtigen Teil der Behandlung dar. Physio- und Ergotherapeutinnen wenden thermische, elektrische, mechanische und zum Teil auch chemische Modalitäten an. Elektrophysikalische Maßnahmen sind eine gezielt eingesetzte Ergänzung zu weiteren therapeutischen Maßnahmen. Sie werden auch »passive« Maßnahmen genannt. Seit den Anfängen der Physiotherapie sind diese Anwendungen ein fester Bestandteil des Berufstandes (Watson 2016). Elektrophysikalische Maßnahmen sind weltweit ein Thema: 2009 wurde die International Society for Electrophysical Agents in Physiotherapy³, eine Untergruppe der World Confederation for Physical Therapy (WCPT) gegründet. Elektrophysikalische Modalitäten wirken primär auf der Ebene der Köperfunktionen, um in der Folge dem Patienten eine verbesserte Aktivität zu ermöglichen und seine Partizipation, seine Rollenerfüllung zu stärken. Zu den Körperfunktionen gehören u. a. Schmerzen, Gelenksbeweglichkeit, die Funktionen der Haut (Vernarbung), Muskelaktivität oder die Durchblutung. Jede Therapeutin wendet physikalische Mittel an und hat damit mehr oder weniger positive Erfahrungen sammeln können. Auch die Anwendung von elektrophysikalischen Maßnahmen sollte auf den Prinzipen der evidenzbasierten Medizin gründen: Es handelt sich um die Integration von Evidenz aus der Literatur, den Erfahrungen der Therapeutin und den Werten und Erwartungen des Patienten (Sackett 2000).
Introduction: Epicondylitis is commonly seen in Rehabilitation Departments. Although physical rehabilitation is an important and efficient tool for the management of this condition a large number of modalities are being used. On the other hand there are few studies comparing the different therapeutic modalities. Patients and methods: A prospective cohort of 84 patients was analyzed. Their average age was 44.9 years. In all cases, visual analogic scales (VAS) were used to assess pain and function. Moreover, patients were evaluated according to the Disability of Arm, Shoulder and Hand (DASH) scale. After inform consent, patients were randomly included to one of the following treatment groups: cryotherapy, electrophoresis, laser therapy, sonophoresis and ultrasound therapy followed by two months of stretching exercises, after which the patients were reevaluated. For statistical purposes a blinded research method was used. Results: The VAS pain score before treatment was 5.08 points and the VAS function score 4.55 points. The mean overall score of the DASH scale was 69.14 points. After treatment VAS pain scale decreased to 3.23 and VAS function scale to 2.84. The DASH scale at the end was 54.61 points. Although the differences before and after treatment were significant (p<0.05) we couldn't find significant differences between the various modalities of electrotherapy. Conclusions: Electrotherapy and stretching exercises are effective in the treatment of elbow tendinoses. However, we couldn't demonstrate differences between the different modalities of electrotherapy used in this study.
Tennis elbow is a term commonly used when referring to lateral epicondylosis (LE). Le is believed to result from repetitive overuse and microtrauma, which leads to degenerative changes at the common extensor tendon origin. Nonoperative treatment is considered the main treatment approach. It is imperative for clinicians to understand the pathophysiology of this condition, so an evidence-based rehabilitation regime can be implemented. This chapter will provide the reader with an in-depth review of the various therapeutic treatments described in the literature and their efficacy. This will allow the clinician to apply a systematic evidence-based treatment approach. This chapter also includes a description of a validated, reliable outcome measure which can be used by researchers and clinicians in order to determine the effectiveness of the various therapeutic interventions.
Low-frequency ultrasound may facilitate debridement and healing of chronic wounds, including lower leg wounds in patients with chronic venous insufficiency (CVI). To evaluate the use of a low-frequency ultrasound (LFU) device with a curette, two patients with CVI and chronic wounds were treated for a period of 2 to 3 weeks. A 63-year-old woman with rheumatoid arthritis and two wounds, one on the right lower leg (250 cm3) and one wound on the left medial leg (0.80 cm3), present for 12 months; and a 77-year-old man with cardiopulmonary issues with seven wounds, three on the left medial calf (1.2 cm3, 11.40 cm3, and 0.72 cm3), one on the left anterior calf (0.30 cm3), two on the right posterior calf (0.90 cm3, 0.30 cm3), and one on the right anterior calf (0.14 cm3), present for 3 months consented to participate in the study. Both patients received low-intensity (50-70 μm), low-frequency (35 kHz) ultrasound at an intensity of 50% through a saline mist in addition to antimicrobial dressing with silver, a multilayer compression bandage system applied at every visit, and pain medication as needed. Both patients received treatments every 1 to 3 weeks that were not timed. Treatment continued until no additional slough or other necrotic tissue could be removed from the wound bed; the female patient received two treatment sessions and the male received three. Average wound volume did not change significantly from the first to last treatment session (t(8) - 1.2, P = 0.26). Five wounds (56%) with initial measurements of 0.8 cm3, 0.72 cm3, 0.3 cm3, 0.3 cm3, and 0.14 cm3 reduced in volume by 100%. Mean wound characteristic scores changed significantly (P <0.05) for amount of fibrin, periwound skin, drainage amount, and color. In addition, the number of wounds filled with slough decreased from 89% at the first session to 22% at the final treatment session. The results of this study suggest LFU may have been beneficial for these patients with CVI. Additional studies using larger sample sizes are needed to evaluate the effect of this treatment on a variety of chronic wounds and to compare its effectiveness to other debridement methods.
The aim of this trial was to investigate and compare the effects of phonophoresis (PP), placebo PP and exercise therapies on pain, disability, sleep quality, and depression in the patients with chronic neck pain (CNP). This is a randomized, single-blind, placebo-controlled study. A total of 61 patients with definite CNP were included in this study. The patients were randomized into three groups. Group 1 (n = 21) received PP with capsaicin treatment and exercises. Group 2 (n = 20) received placebo PP with capsaicin and exercises. Group 3 (n = 20) was given only exercises. All of the programs were performed 3 days a week, for 6 weeks. The pain (visual analog scale), disability (the neck pain disability index), depression (Beck Depression Inventory scores), and sleep quality (Pittsburgh Sleep Quality Index) of all participants were evaluated. Measurements were taken before and after treatment. All of the groups showed statistically significant improvements in pain, disability, sleep quality, and depression. While there was no difference between groups regarding depression and sleep quality, intergroup comparison showed significant differences in pain and disability among three groups. These differences were statistically significant in group 1 and 2 compared to group 3, and also in group 1 compared to group 2. We observed that PP treatment was effective in the treatment for patients with CNP. A combination of PP with exercises can be used to obtain optimal clinical results.
In literature, the explanations for the origin of tennis elbow are numerous and probably not really well-known. So, there are many different treatments proposed. We have reviewed many works on the subject and, through the results, not found superior therapeutic method.
The aim of this trial is to investigate and compare the effects of phonophoresis (PP) and ultrasound (US) therapy on pain, disability, trunk muscle strength, walking performance, spinal mobility, quality of life (QOL), and depression in the patients with chronic low back pain (CLBP). A total of 60 patients with definite CLBP were included in this study. The patients were randomized into three groups. Group 1 (n = 20) was accepted as the control group and was given only exercises. Group 2 (n = 20) received US treatment and exercises. Group 3 (n = 20) received PP and exercises. All of the programs were performed 3 days a week, for 6 weeks. The pain (visual analog scale, VAS), disability (Oswestry Disability Questionnaire, ODQ and pain disability index, PDI), walking performance (6 min walking test, 6MWT), depression (Beck Depression Inventory scores, BDI), and QOL (Short Form 36, SF-36) of all participants were evaluated. The trunk muscle strength was measured with a handheld dynamometer. All of the groups showed statistically significant improvements in pain, disability, muscle strength, endurance, 6MWT, mobility, QOL, and depression. The intergroup comparison showed significant differences in VAS pain, 6MWT, and EMS, among three groups. These differences were statistically significant in groups 2 and 3 compared with the group 1. The intergroup comparison showed significant difference in pain, physical function, and energy subgroups of SF-36. The differences were statistically in group 3 compared with group 1 and 2. We observed that US and PP treatments were effective in the treatment of patients with CLBP but PP was not found to be superior over ultrasound therapy.
Therapeutic ultrasound to drive medication (phonophoresis) has been a mainstay in physical therapy. The most common drug used in phonophoresis is hydrocortisone acetate (HA). A number of studies have been done examining phonophoresis in the delivery of HA through the skin to underlying tissues; however, a study has never been done examining the absorption of HA using phonophoresis on human connective tissue.
Phonophoresis will facilitate the transmission of HA in human connective tissue.
Randomized controlled study.
Twenty-one patients undergoing anterior cruciate ligament reconstruction surgery were randomly assigned to either a sham or true phonophoresis treatment group. The latter group received 6 minutes of 10% HA ultrasound at a point consistent with the gastrocnemius slip of the semitendinosis tendon (treatment site). The sham group received 6 minutes of 10% HA ultrasound to the same area, but the ultrasound was not turned on. The slip and a sample of the distal attachment of the tendon (control) were removed. Samples were analyzed for HA levels.
Although the mean and median levels of HA found at the treatment site were greater than those of the control site (means, 34.1 vs 22.9 parts per billion; medians, 7 vs 0 parts per billion), the levels of HA found at the treatment site were not significantly greater than those at the control site (P = 0.15). There were no statistically significant differences between the true and sham phonophoresis groups in HA levels (P = 0.80) nor in age, sex, or skin thickness.
Phonophoresis does not appear to facilitate the absorption of HA in connective tissue when compared with simple absorption (sham).
Phonophoresis does not appear to enhance the transmission of HA in human connective tissue; therefore, use of phonophoresis should be reconsidered in inflammatory conditions.
The aim of this study is to compare the effect of phonophoresis, ultrasound and placebo ultrasound therapies in the treatment of myofascial pain syndrome (MPS). This is a randomized, double-blind placebo controlled study. Sixty patients (48 women, 12 men, mean age 37.9 ± 12.2 years) with MPS were included in this study. Patients were allocated into three groups. Group 1(n = 20) was received diclofenac phonophoresis, group 2(n = 20) was received ultrasound and group 3(n = 20) was received placebo ultrasound therapies over trigger points, 10 min a day for 15 session during 3 weeks (1 MHz-1,5 watt/cm²). Additionally, all patients were given neck exercise program including isotonic, isometric and stretching. Patients were assessed by means of pain, range of motion (ROM) of neck, number of trigger points (NTP), algometric measurement and disability. Pain severity was measured by visual analog scale (VAS) and Likert scale. The neck pain disability index (NPDI) was used for assessing disability. Measurements were taken before and after treatment. After treatment, there were statistically significant improvements in pain severity, NTP, pressure pain threshold (PPT), ROM and NPDI scores both in phonophoresis and in ultrasound therapy groups (P < 0.05). Statistically significant increase in cervical lateral flexion and rotation was observed in the placebo US group. While there was no statistically significant improvement in the cervical flexion-extension joint movement, pain levels, number of trigger points and NPDI score, pressure pain threshold (P > 0.05), also there were no significant differences in all parameters between group 1 and 2 (P = 0.05). Both diclofenac phonophoresis and ultrasound therapy were effective in the treatment of patients with MPS. Phonophoresis was not found to be superior over ultrasound therapy.
To evaluate the available evidence of the effectiveness of physiotherapy for lateral epicondylitis of the elbow.
Randomised controlled trials (RCTs) identified by a highly sensitive search strategy in six databases in combination with reference checking. Two independent reviewers selected RCTs that included a physiotherapy intervention, patients with lateral epicondylitis, and at least one clinically relevant outcome measure. No language restrictions were made. Methodological quality was independently assessed by two blinded reviewers. A best evidence synthesis, including a quantitative and qualitative analysis, was conducted, weighting the studies with respect to their internal validity, statistical significance, clinical relevance, and statistical power.
23 RCTs were included in the review, evaluating the effects of lasertherapy, ultrasound treatment, electrotherapy, and exercises and mobilisation techniques. Fourteen studies satisfied at least 50% of the internal validity criteria. Except for ultrasound, pooling of data from RCTs was not possible because of insufficient data, or clinical or statistical heterogeneity. The pooled estimate of the treatment effects of two studies on ultrasound compared to placebo ultrasound, showed statistically significant and clinically relevant differences in favour of ultrasound. There is insufficient evidence either to demonstrate benefit or lack of effect of lasertherapy, electrotherapy, exercises and mobilisation techniques for lateral epicondylitis.
Despite the large number of studies, there is still insufficient evidence for most physiotherapy interventions for lateral epicondylitis due to contradicting results, insufficient power, and the low number of studies per intervention. Only for ultrasound, weak evidence for efficacy was found. More better designed, conducted and reported RCTs are needed.
The purposes of this study were to determine whether ultrasound and a 10% hydrocortisone ointment (phonophoresis) was superior to ultrasound and a placebo ointment, and to determine whether friction massage was superior to no friction, in patients with the clinical diagnosis of extensor carpi radialis tendinitis (proximal tendon). Forty consecutive lateral epicondylitis patients fulfilling the eligibility criteria were entered into the study. Using a 2 by 2 factorial design, the patients were stratified on the basis of pain-free grip strength. They were then randomly assigned to 1 of the 4 treatment groups. The patients' outcomes were assessed following 9 treatments within 5 weeks of the initial visit. No one therapy was demonstrated to be superior to another; however, site of lesion and history of a prior occurrence were found to be predictors of outcome, independent of therapy. The results suggest that the most cost-effective method of treating the lateral epicondylitis patient is by ultrasound alone.
The relative effectiveness of four treatment protocols on lateral epicondylitis of the elbow were compared by assessing patient pain responses with a modified McGill Pain Questionnaire. The four protocols examined were ultrasound and a home program, ultrasound with 10% hydrocortisone and a home program, transcutaneous electrical nerve stimulation and a home program, and subcutaneous injection with a steroid and a home program. A total of 48 subjects were used in the study, with 12 in each treatment category. All protocols descriptively showed a decrease in mean pain intensity after the 5-day treatment time, and all of the pain indexes showed some statistical differences between pre- and post-treatment values, indicating that all the treatments were effective in reducing pain. The analysis also demonstrated, however, that the four treatment protocols did not differ significantly in their effectiveness, so the treatment of choice should be based on clinical considerations. J Orthop Sports Phys Ther 1986;8(2):62-69.
Visual analogue scales (VAS) of sensory intensity and affective magnitude were validated as ratio scale measures for both chronic and experimental pain. Chronic pain patients and healthy volunteers made VAS sensory and affective responses to 6 noxious thermal stimuli (43, 45, 47, 48, 49 and 51 degrees C) applied for 5 sec to the forearm by a contact thermode. Sensory VAS and affective VAS responses to these temperatures yielded power functions with exponents 2.1 and 3.8, respectively; these functions were similar for pain patients and for volunteers. The power functions were predictive of estimated ratios of sensation or affect produced by pairs of standard temperatures (e.g. 47 and 49 degrees C), thereby providing direct evidence for ratio scaling properties of VAS. Vas sensory intensity responses to experimental pain, VAS sensory intensity responses to different levels of chronic pain, and direct temperature (experimental pain) matches to 3 levels of chronic pain were all internally consistent, thereby demonstrating the valid use of VAS for the measurement of and comparison between chronic pain and experimental heat pain.
Twenty-seven college women participated in a study to evaluate the reliability and validity of four tests of hand strength: grip, palmar pinch, key pinch, and tip pinch. Standardized positioning and instructions were followed. The results showed very high inter-rater reliability. Test-retest reliability was highest in all tests when the mean of three trials was used. Lower correlations were shown when one trial or the highest score of three trials were utilized. The Jamar dynamometer by Asimow Engineering and the pinch gauge by B&L Engineering demonstrated the highest accuracy of the instruments tested.
Measurement of Joint Motion: A Guide to Goniometry
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