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Dear list, I seem to have recieved some criticism of my comments, all be it constructive as I'm sure it is intended. I am still unconvinced that ultrasound is an appropriate modality for early stage tendon repair. Now, I admit, I'm not great at quoting research studies, and, if I had the study available I would give details of its parametre (I do read these things analytically and critically). However, let me further state my case. Firstly, to wendy who suggests that mast cells degranulate, not (as I put it) break down. Here is possibly an error in my understanding. I was of the opinion that when a mast cell releases histamine granules, that it does so at the expense of it's cell wall, and thus its life. However, after consulting several physician friends and my texts, I am unable to substantiate this. could someone in a more authoritative position on cellular physiology please help me to understand this process better. Secondly, my description of a controlled inflammatory process was also questioned. Is not inflammation a good thing when limited to a certain amount, however above this destruction of live and viable cells occurs. Is this not why we use ice, elevation, compression etc (not necessarily in that order - before I get into more trouble!). And as for the NSAID question also posted recently, is it not why we use NSAIDs. Thus, if US creates a hap hazard and uncontollable inflammatory response you'd better stop using it now!! I was always taught that as another respondant suggested, US was very dose related in its effects. Thirdly, with reference to tendon repairs and US. Is not a surgical incision and debridment inflammatory enough to stimulate healing!!! Why does one feel the need to further inflame the process in order to aid healing. Infact, this is detrimental to the outcome in my opinion because one of the major problems of tendon repairs is adhesions to surrounding tissue. And unless your US machine is focal enough to not promote mast cell degranulation in the various surrounding tissues, you are, without a doubt going to cause increased fibroblastic activity in these tissues and collagen deposition, and adhesions! Now,no, I can't back th is up with any research study, but it makes sense to me. Fourthly, it was suggested that I was following a protocol because "that is the way it has always been done". However, the only rebuttal to my answer was a quote from another lecturer, prefaced by "I was always taught"! I think I have shown some logic and self thought on this topic, be I right or wrong. I hope this is taken as it is intended, for further discussion. Scott Epsley. -- On Wed, 10 Nov 1999 09:33:37 Mclean, Chris wrote: >Could not agree more, Wendy > >Simon Mesner B.Sc. (HONS) MCSP SRP > >> -----Original Message----- >> From: Wendy Johnson [SMTP:[log in to unmask]] >> Sent: 09 November 1999 23:04 >> To: [log in to unmask] >> Subject: Re: u.s. & tendinitis >> >> My thoughts.... >> >> --- Scott Epsley <[log in to unmask]> wrote: >> > Dear vanessa, >> > I haven't read the article, but it's funny you >> > should mention this >> > because it is something that I have long considered. >> > I guess >> > you need to look at what you are doing with the US, >> > and that is >> > breaking down mast cells to create a contolled >> > inflammatory >> > process (as I'm sure you know). >> >> I have a problem with this statement - who has shown >> that ultasound breaks down mast cells and who has >> shown that it creates a CONTROLLED inflammatory >> process. Literature and lectures from Dr. Tim Watson >> of Hertfordshire University have taught me that >> ultasound is stimulatory to the main inflammatory >> process cells - such as "ultrasound can stimulate >> platelets and mast cells to degranulate and >> macrophages to release several chemical faactors which >> in turn activate local fibroblasts and stimulate the >> revascularisation process (Fyfe & Chal, 1982)". >> >> > Then you need to look at how >> > tendons heal. Firstly we know that they have a poor >> > blood >> > supply. Tendons heal via the "common wound >> > concept". ie >> > proliferation of fibroblasts to creat a scar >> > (extrinsic healing). We >> > now know that they also heal via "intrinsic >> > healing", ie. tenocytes >> > can produce collagen. In light of these facts, US >> > is good at >> > encouraging fibroblastic activity, but the question >> > is what does >> > it do to new collagen? Does it decrease the cross >> > links and thus >> > deteriorate its tensile strength? My feeling is >> > that this is quite >> > possibly the case. My tendon repair post op >> > management notes >> > state that you shouldn't use US in the first 6 weeks >> > as this can >> > have a detrimental effect on healing. >> >> Is this protocol that based on common/ previous >> practise? "we've always done it like this" - again the >> lectures by Tim Watson have the following to say ... >> "Ultrasound in the early stage [of inflammation] would >> therefore appear to be a pro-inflammatory treatment >> which results in the stimulation of the proliferative >> repair stage." Inflammation is a very good and >> effecient method of repair of many body tissues - it >> seems that the use of ultrasound would stimulate the >> inflammation process to move quicker through it's many >> over-lapping phases - surely a good thing in the >> appropriate circumstances. Therefore - why not in >> tendon repair? >> >> And having >> > said all of this I >> > have just found the reference I think you are >> > looking for: >> > van Strein G. (1990). Postoperative Management of >> > Flexor Tendon >> > Injuries. In Rehabilitation of the Hand, Hunter, >> > Schneider, Mackin, >> > Callahan (Eds), Ch, 30, 3rd edit. Mosby Co, StLouis, >> > Baltimore >> > Philidelphia, Toronto. >> > I also know of a study that looked at using US in >> > horses for >> > tendonitis, and found that it actually made the >> > problem worse when >> > used daily for ? number of weeks as opposed to >> > imtermitent use. >> >> Thoughts .... (but I haven't read the paper) >> Overall outcome of problem worse or initial pain and >> other symptoms worse? How appropriate was the >> dosages? How appropriate was the frequency of >> treatment in relationship to dosage? Are horses >> comparable to human healing parameters? >> >> > Thus, I would be wary of US in know tendon damage >> > and would >> > prefer to use digital ischaemic pressure, grI >> > frictions and gentle >> > stretches. >> > Hope this helps, >> > Scott Epsley >> > Physiotherapist >> > Brisbane, QLD. Australia. >> > -- >> > >> > On Mon, 8 Nov 1999 19:11:05 fizzy wrote: >> > >Hi colleagues, >> > > >> > >I recently heard there's been some research >> > suggesting that ultrasound may be harmful when >> > treating tendinitis. I think the general idea was >> > that it is not possible to distinguish if tendon >> > degeneration/ to what degree degeneration is >> > present, and that ultrasound could be harmful if >> > degeneration of the tendon is present as opposed to >> > inflammation without tendon degeneration. As you can >> > tell I haven't read the article and wondered if >> > anyone had heard of this and had any references or >> > comments on the matter? >> > > >> > >look forward to hearing your ideas >> > > >> > >Vanessa MCSP >> >> >> __________________________________________________ >> Do You Yahoo!? >> Bid and sell for free at http://auctions.yahoo.com > Get your FREE Email at http://mailcity.lycos.com Get your PERSONALIZED START PAGE at http://my.lycos.com %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%