Here are a few abstacts regarding the use of ultrasound that seem relevent
to the discussion.  The first is a meta-analysis of the use of us for all
musculoskeletal condtions of which they essentially found that it was not
effective, save the possibility of lat epicondylitis (however notice that
the confidence interval crosses the no effect threshold).  the 2nd abstract
seems to suggest that there is a use for ultrasound in fracture healing.
There may be some sub-populations that respond to this modality but it may
also be that the other interventions or placebo/social reciprocity etc
effects, are being attributed to the ultrasound.  One can not forget the
favourable natural history of these conditions.
Sincerely,
John Dufton

ABSTRACT 1

Authors
van der Windt DA. van der Heijden GJ. van den Berg SG. ter Riet G. de Winter
AF. Bouter LM.

Title
Ultrasound therapy for musculoskeletal disorders: a systematic review.

Source
Pain. 81(3):257-71, 1999 Jun.

Abstract
BACKGROUND: Ultrasound therapy is used frequently to reduce pain and related
disability, mainly by physiotherapists. The objective of this review was to
evaluate the effectiveness of ultrasound therapy in the treatment of
musculoskeletal disorders. METHODS: Published reports of randomized clinical
trials investigating the effects of ultrasound therapy on pain, disability
or range of motion were identified by a systematic search of MEDLINE, EMBASE
and the Cochrane databases, supplemented with citation tracking. The quality
of methods of all selected publications was assessed systematically by two
independent and 'blinded' reviewers, using ten validity criteria. Data from
the original publications were used to calculate the differences between
groups for success rate, pain, disability and range of motion. Statistical
pooling was performed if studies were homogeneous with respect to study
populations, interventions, outcome measures and timing of follow-up.
RESULTS: 38 Studies were included in the review, evaluating the effects of
ultrasound therapy for lateral epicondylitis (n = 6), shoulder pain (n = 7),
degenerative rheumatic disorders (n = 10), ankle distorsions (n = 4),
temporomandibular pain or myofacial pain (n = 4) and a variety of other
disorders (n = 7). In 11 out of 13 placebo-controlled trials with validity
scores of at least five out of ten points, no evidence of clinically
important or statistically significant results was found. Statistical
pooling was only feasible for placebo-controlled trials on lateral
epicondylitis, and produced a pooled estimate for the difference in success
rate of 15% (95% confidence interval -8%-38%). CONCLUSIONS: As yet, there
seems to be little evidence to support the use of ultrasound therapy in the
treatment of musculoskeletal disorders. The large majority of 13 randomized
placebo-controlled trials with adequate methods did not support the
existence of clinically important or statistically significant differences
in favour of ultrasound therapy. Nevertheless, our findings for lateral
epicondylitis may warrant further investigation.

ABSTRACT 2
Authors
Busse JW. Bhandari M. Kulkarni AV. Tunks E.

Title
The effect of low-intensity pulsed ultrasound therapy on time to fracture
healing: a meta-analysis. [Review] [49 refs]

Source
CMAJ. 166(4):437-41, 2002 Feb 19.

Abstract
BACKGROUND: The effect of low-intensity ultrasonography on fracture healing
is controversial, and current management of fractures does not generally
involve the use of ultrasound therapy. We describe a systematic review and
meta-analysis of randomized controlled trials of low-intensity pulsed
ultrasound therapy for healing of fractures. METHODS: We searched 5
electronic databases (MEDLINE, EMBASE, Cochrane Database of Randomised
Clinical Trials, HealthSTAR and CINAHL) for trials of ultrasonography and
fracture healing, in any language, published from 1966 to December 2000. In
addition, selected journals published from 1996 to December 2000 were
searched by hand for relevant articles, and attempts were made to contact
content experts in the area of ultrasound therapy and fracture healing as
well as primary authors of reviewed trials. Trials selected for review met
the following criteria: random allocation of treatments; inclusion of
skeletally mature patients of either sex with 1 or more fractures; blinding
of both the patient and the assessor(s) as to fracture healing;
administration of low-intensity pulsed ultrasound treatments to at least 1
of the treatment groups; and assessment of time to fracture healing, as
determined radiographically by bridging of 3 or 4 cortices. Two reviewers
independently applied selection criteria to blinded articles, and selected
articles were scored for methodologic quality. The internal validity of each
trial was assessed with the use of a 5-point scale that evaluates the
quality of trial method on the basis of description and appropriateness of
randomization and double-blinding, and assessment of study withdrawals and
likelihood of bias. RESULTS: We identified 138 potentially eligible studies,
of which 6 met our inclusion criteria. Agreement beyond chance of quality
assessments of the 6 trials was good (intraclass correlation coefficient
0.77, p = 0.03). One trial was a repeat analysis of previously reported
data, and 2 trials appeared to report on a shared group of subjects. Three
trials, representing 158 fractures, were of sufficient homogeneity for
pooling. The pooled results showed that time to fracture healing was
significantly shorter in the groups receiving low-intensity ultrasound
therapy than in the control groups. The weighted average effect size was
6.41 (95% confidence interval 1.01-11.81), which converts to a mean
difference in healing time of 64 days between the treatment and control
groups. INTERPRETATION: There is evidence from randomized trials that
low-intensity pulsed ultrasound treatment may significantly reduce the time
to fracture healing for fractures treated nonoperatively. There does not
appear to be any additional benefit to ultrasound treatment following
intramedullary nailing with prior reaming. Larger trials are needed to
resolve this issue. [References: 49]




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