Physio Charlie

I have a new website!!

 

http://physiocharlie.vpweb.co.uk

 

 

 

 

I found a website selling TENs belts:

http://www.medi-stim.com/access/tensbelt.htm

 

http://www.electrotherapy.org/downloads/Modalities/TENS%2...

http://www.electrotherapy.org/downloads/Modalities/Therap...

We had IST today on competencies and we went through electrotherapy modalities.  I was a bit rusty so I downloaded these from:

www.electrotherapy.org

 

I was wondering what the evidence was for Ultrasound and fracture detection as per the previous post on the foot.  So I did some research and found that there was a mixed opinion:

Ultrasound in the Diagnosis of Scaphoid Fractures, SHENOUDA and ENGLAND, Journal of Hand Surgery (British and European Volume) 1987; 12; 1  http://jhs.sagepub.com/cgi/reprint/12/1/1-c

"In a period of ten months, seventy-four patients presented at the Accident and Emergency Department. In sixty-nine patients (93%) the ultrasound test could be correlated with the X-ray appearances in the presence or absence of a fractured scaphoid. In twelve of these patients (27.9%) the fracture was diagnosed using the ultrasound before radiographic evidence was apparent".

"A continuous wave of ultrasound with an intensity of 3 watts/cm’ and a frequency of 3mHz was used in water at a distance of 2.5cms for 50 seconds.  Ultrasound had an accuracy of 93%, by 6-8 weeks the ultrasound test has become negative"
 

Ultrasonic assessment of fractures and its use in the diagnosis of the suspected scaphoid fracture, Bedford et al, (1982) Injury, 14: 180 -18

"Ultrasound in the therapeutic range was found to produce pain or severe tingling when applied to 80 of 87 fractures of all types less than 2 weeks old".

Ultrasound assessment of the suspected scaphoid fracture. DaCruz et al Arch Emerg Med. 1988 Jun;5(2):97-100.  http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=128...

"A prospective study of 111 patients thought to have sustained a recent scaphoid fracture on clinical grounds but who were radiologically negative was undertaken over a period of 7 months. All such patients were subjected to ultrasound scanning within a week of their injury under double blind conditions. All patients were re-X-rayed 2-3 weeks after their injury. The authors' results suggest that ultrasonic diagnosis of the possibly fractured scaphoid is unreliable". 

"Ultransonic diagnosis was carried out by a single senior physiotherapist using a Therasonic machine. In keeping with the experience of Bedford et al. (1982), ultrasonic energy at 0-5-1-5 W/cm2 and a frequency of 1 MHz was applied to the skin overlying the anatomical snuffbox. A water-based coupling medium was employed and the probe used had a diameter of 0-75 cm. Patients were asked to compare the sensation produced with that obtained on the same area of the opposite, un-injured limb. The test was deemed positive when pain or severe tingling was experienced on the injured side alone".

Ultrasound for Diagnosis of Scaphoid Fractures, Munk et al (2000) Journal of Hand Surgery (British and European Volume) 2000; 25; 369


"We decided to evaluate the diagnostic value of a true imaging ultrasonic technique (not the ultrasound we use) and the Doppler technique in the assessment of wrists with clinically suspected scaphoid fractures.... The accuracy of the ultrasound assessment was 84% and its specificity was 91%. However, its sensitivity was only 50%. We conclude that ultrasound examination is unreliable for the diagnosis of acute scaphoid fractures."

Diagnostic value of ultrasound in scaphoid fractures, CHRISTIANSEN et al, Injury. 1991 Sep;22(5):397-9

"We found that the ultrasound test, applied with a frequency of 1 MHz and intensity of 0.5 W/cm2 and 2.0 W/cm2 for 30s, had a sensitivity of 37 per cent and a specificity of 61 per cent. We thus conclude that ultrasound is not suitable for early diagnosis of scaphoid fracture".

 Conclusion.

Good results are reported by: Bedford et al., 1982; Shenouda and England, 1987 and Moss et al 1983. However, Christiansen et al. (1991) and DaCruz et al. (1988) could not reproduce these good results.  The quality of the studies supporting the use of ultrasound as a diagnostic tool is poor with no double blinding, control or random allocation of subjects.

ultrasound_review.doc

A senior physio and I went through Interferential and ultrasound combined therapy.  We used the black interferential lead at 50/80Hz underneath the rx site.  The ultrasound was turned up to 0.5wcm and then the Inf slowly turned up until the patient feels the sensation with the ultrasound node being placed above where the Inf pad is located.  The ultrasound is then moved around until a trigger point is located. 

Uses:  Trigger points for tennis elbow