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Therapeutic Ultrasound for Soft-Tissue Injuries of the Elbow (Protocol)

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Therapeutic Ultrasound for Soft-Tissue Injuries of the Elbow (Protocol) Therapeutic ultrasound for soft-tissue injuries of the elbow (Protocol) Baker KG, Senior HE, Parag V This is a reprint of a Cochrane protocol, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2009, Issue 1 http://www.thecochranelibrary.com Therapeutic ultrasound for soft-tissue injuries of the elbow (Protocol) Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. TABLE OF CONTENTS HEADER....................................... 1 ABSTRACT ...................................... 1 BACKGROUND .................................... 2 OBJECTIVES ..................................... 2 METHODS ...................................... 2 ACKNOWLEDGEMENTS . 4 REFERENCES ..................................... 4 ADDITIONALTABLES. 5 APPENDICES ..................................... 6 WHAT’SNEW..................................... 7 HISTORY....................................... 7 DECLARATIONSOFINTEREST . 8 SOURCESOFSUPPORT . 8 Therapeutic ultrasound for soft-tissue injuries of the elbow (Protocol) i Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. [Intervention Protocol] Therapeutic ultrasound for soft-tissue injuries of the elbow Kerry G Baker2, Hugh E Senior1, Varsha Parag3 1Neurological and Mental Health Division, The George Institute for International Health, Sydney, Australia. 2School of Health Sciences, The University of Newcastle, Callaghan, Australia. 3Clinical Trials Research Unit, University of Auckland, Auckland, New Zealand Contact address: Hugh E Senior, Neurological and Mental Health Division, The George Institute for International Health, Level 10 King George V Building, Missenden Road, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia. [email protected]. Editorial group: Cochrane Bone, Joint and Muscle Trauma Group. Publication status and date: Edited (no change to conclusions), published in Issue 1, 2009. Citation: Baker KG, Senior HE, Parag V. Therapeutic ultrasound for soft-tissue injuries of the elbow. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD006368. DOI: 10.1002/14651858.CD006368. Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. ABSTRACT This is the protocol for a review and there is no abstract. The objectives are as follows: To determine the efficacy of therapeutic ultrasound in the treatment of soft-tissue injuries of the elbow when compared to placebo intervention, no treatment or other types of intervention. To determine the effect of therapeutic ultrasound on function (elbow specific and general), pain, swelling, and range of motion. Therapeutic ultrasound for soft-tissue injuries of the elbow (Protocol) 1 Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. BACKGROUND alleged to be due to a combination of cavitation, where the sound wave causes gas-filled bubbles in the tissue to expand and con- tract resulting in an increase in fluid flow within the surrounding Description of the condition tissue, and acoustic streaming, where the sound waves cause lo- Lateral epicondylitis (also known as tennis elbow, lateral tendi- calised unidirectional movement of fluids across cells membranes nosis, lateral tendonitis, lateral epicondylalgia and elbow periten- by altering cell membrane permeability and stimulating cell activ- donitis) has been described as the most common source of elbow ity (Ter Haar 1987; Ter Haar 1999). However, whether cavitation pain in the general population (Scuderi 2005). Lateral epicondyli- or acoustic streaming is powerful enough to cause the biophysical tis occurs equally in males and females, usually between the ages effects proposed in vivo at the intensities used for therapeutic ul- of 35 to 50 years (Nirschl 1993). It is a chronic tendonitis of the trasound is debatable (Baker 2001). Pulsing the ultrasound beam extensor muscles of the wrist resulting in lateral elbow pain. Indi- can minimise the thermal effects while maintaining the non-ther- viduals who use repetitive hand movements in their employment mal effect for different therapeutic applications (Ter Haar 1987). are at risk (Ranney 1995), as are tennis players due to repetitive Therapists can control the dose of the ultrasound by altering the extension of the wrist against a resistant force. It can also occur in intensity of the beam and can focus the ultrasound wave to a spe- sports with similar movement such as baseball, swimming, gym- cific tissue depth by adjusting the wave frequency (1 to 3 MHz). nastics and golf (Shaw 2004). Medial epicondylitis (golfer’s elbow) is also a common soft-tissue injury of the elbow but occurs 5 to 10 times less frequently than Why it is important to do this review lateral epicondylitis (Gabel 2000; Leach 1987). It is associated with sports that involve repetitive wrist flexion such as golf, tennis Physical therapy is a common treatment approach. Physiother- and baseball (Scuderi 2005) or as an occupation injury of manual apists have traditionally treated lateral and medial epicondylitis labourers. It is a tendonitis of the flexor-pronator group (respon- using a combination of massage, ice and ultrasound followed by sible for bending the wrist and rotating the forearm) and is caused physical interventions to gradually increase flexibility, strength and by repetitive valgus (outward) force on the flexors of the forearm endurance. There have been a number of reviews on the use of causing pain and tenderness at their origin on the anterior medial therapeutic ultrasound for musculoskeletal injuries (Beckerman epicondyle. The anterior medial epicondyle is a prominence on 1993; Falconer 1990; Gam 1995; Ogilvie-Harris 1995; Van der the inner part of the elbow where the flexor/pronator muscles of Heijden 1997; Van der Windt 1999; Van der Windt 2001). How- the forearm attach via tendons. ever, none of these systematic reviews focused on soft tissue in- Other soft-tissue injuries of the elbow such as posterior tendinosis, juries of the elbow or investigated the effect of different treatment valgus instability, posterolateral rotatory instability, radial (lateral) parameters, and as such a review is warranted to provide clinicians collateral ligament injury and tendon rupture are less common and patients with the current available evidence of its efficacy and than either lateral or medial epicondylitis. safety. The scope of this protocol does not extend to looking at trials comparing ultrasound therapy to surgical procedures. Description of the intervention Therapeutic ultrasound is used to promote healing, reduce pain and modulate inflammation in soft tissues i.e. muscles, ligaments and tendons. It consists of inaudible high-frequency and low in- OBJECTIVES tensity sound waves made by a transducer converting electrical To determine the efficacy of therapeutic ultrasound in the treat- energy into acoustic waves (Ter Haar 1987; Ter Haar 1999). ment of soft-tissue injuries of the elbow when compared to placebo intervention, no treatment or other types of intervention. How the intervention might work To determine the effect of therapeutic ultrasound on function (elbow specific and general), pain, swelling, and range of motion. Theoretically, the setting of different insonation parameters will se- lect either thermal or non-thermal ultrasound to provide different therapeutic effects. Both forms of ultrasound will be present, but one will dominate over the other based on the parameters chosen. METHODS The production of heat within tissues due to thermal ultrasound may result in an increase in the extensibility of collagenous struc- tures, change in blood flow, and decrease in joint stiffness, muscle Criteria for considering studies for this review spasm and pain relief (Speed 2001). The non-thermal effects are Therapeutic ultrasound for soft-tissue injuries of the elbow (Protocol) 2 Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Types of studies ter of Controlled Trials (in The Cochrane Library), MED- We will consider the following studies for this systematic review: LINE, EMBASE, CINAHL, AMED, SPORTDiscus, Cur- 1. Randomised controlled trials (RCTs); rent Contents, PEDRo (Physiotherapy Evidence Database: 2. Controlled trials (CCTs) where treatment allocation is pseudo- http://www.pedro.fhs.usyd.edu.au/index.html), Current Con- randomised such as alternating allocation, allocation based on trolled Trials (controlled-trials.com), United Kingdom Na- birth date, or day of inclusion. tional Research Register (http://www.update-software.com/na- tional/), NHS Health Technology Assessment Programme (www.hta.nhsweb.nhs.uk/), Bandolier (www.jr2.ox.ac.uk/ban- Types of participants dolier/), and reference lists of articles. No language restrictions will Participants in trials with soft-tissue injuries of the elbow who be applied. exhibited pain, swelling, and/or functional disability. This will In MEDLINE (OVID Web) the subject-specific search strategy include trials in which participants have had surgery for the elbow will be combined with the optimal trial search strategy described injury and trials where people have been managed conservatively. in the Cochrane Handbook (Higgins 2005)(see Appendix 1). This will be modified for other databases. Types of interventions One group in the controlled trial must involve participants treated Data collection and analysis with active ultrasound therapy. Ultrasound therapy can be com- pared with either placebo (sham therapeutic ultrasound), no treat- ment, or other treatments
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