Quote Originally Posted by Wahine View Post
I knew there was a reason why I never use ultrasound!!

Seriously Knot, I hadn't heard about damage to cartilage or periosteal effects when ultrasound was applied properly. I don't pay attention to US research, because I don't really use it but I'd be interested in a reference if you've got one. I'm probably pretty out of date in this realm.

TIA.
We had it DRILLED into our heads in school: no US over joints, no US over the spinal cord. (cavitation in the cerebrospinal fluid, just like in synovial fluid). US only over muscle, never over bone less than 1/2 inch deep to the skin.

Of course, US is only recognized as a heat modality at 8x the cost of a hot water bottle... but because of the increased transport over the cell membrane it causes we also had it drilled into our heads that we could cause tumor formation if we used US over questionable tissue.

The periosteal heating is one way you can find stress fractures, and I watched a PT use US once to cause extraordinary pain in a young man's shin: "Yup, there's a fracture there!" and send the kid back to his orthopod.

US is scarey stuff, and I only use it if directly ordered by an MD. Otherwise I tell folks to get a hot pack. The effect is the same and the risks are so much less.

"Manual for Physical Agents" by Karen Hayes talks about the cavitation and periosteal heating. This book is from 2000, so not quite up to date.

"Physical Agents; Theory and Practice" by Behrens and Michlovitz (1996) gets more into the physics of cavitation and reflection, and into some of the other nasties US can do, like degranulating mast cells, producing excess histamine (which isn't always a bad thing) and such. Also out of date, but the physics is nice.

I don't have current research, just anecdotes from other clinicians who read current research and told me about it. I pretty much gave up US a few years ago.

I used to love US, it made me feel so sexy and powerful "oooh, look at me wielding this magic wand, and I get to bill $60 for it!"

Now I see it as a waste of my time, my patients' time, their money, their insurance company's money; and unnecessarily creating dependence on me when all I'm providing is warmth (with added risks) that the patient could achieve for free on their own.