Page Fourteen P H Y S I O T H E R A P Y April, 1956. A Review of Some Ultrasonics Treatments at the Johannesburg General Hospital. By MISS CAROL BAKER, B.Sc.(Physiotherapy)Rand. & MISS JILL BURTON, M.S.C.P. IN re c e n t years m o s t p h y sio th e ra p ists h a v e be co m e a c q u a in te d w ith u ltra so n ic s. S o m e a re e n th u sia stic a n d o th e rs still sceptical. A larg e a m o u n t o f lite ra tu re h as b een p u b lish e d , a lo t o f w h ich a p p e a rs to be c o n tra d ic to ry . W e d o n o t p re su m e to a d d to th is lite ra tu re b u t m erely to give a review o f so m e cases tre a te d a t th e Jo h a n n e s b u rg G e n e ra l H o s p ita l. T h e d osages u se d , ra n g e d fro m • 3 w a tts /sq . c entim etre— 1 w a tt/s q . c e n tim e tre o f h e a d . T im e v a rie d fro m 3— 10 m in u te s except in la rg e a re a s w hich w ere d ivided in to tw o , th re e o r fo u r sections, w ith a m a x im u m tim e o f n o t m o re th a n 20 m in u te s. T h e freq u e n c y o f tre a tm e n ts w as th re e tim e s a w eek, o r d aily in a c u te cases. O n e o f th e e ssentials o f efficient tre a tm e n t is to m a in ta in g o o d c o n ta c t b etw een th e h e a d a n d th e su rfa ce tre a te d . O n m o s t a re a s th is w as p o ssib le w ith lib e ra l a p p lic a tio n o f o live oil o r liq u id paraffin o n th e h e a d a n d th e a re a . I n th e case o f sm a ll b o n y a re a s, i.e. h a n d s a n d feet, g o o d c o n ta c t w as im p o ssib le a n d th ese a re a s w ere th ere fo re tre a te d u n d e r w a te r a t i " — 1" d istance. C a re w as ta k e n to re m o v e a ir b u b b les fro m th e h e a d a n d th e su rfa ce to be tre a te d a s th e s e deflect th e u ltra s o n ic waves. V aricose ulcers w ere a lso tre a te d u n d e r w ater. I n a n u m b e r o f cases p a ra v e rte b ra l tre a tm e n t w as u sed as well as lo ca l tre a tm e n t. T h e tim e w as th e n a b o u t o n e a n d a h a lf tim es a s lo n g a s th e lo c a l tre a tm e n t. P a ra v e rte b ra l tre a tm e n t is d o n e o v e r th e ro o ts o f th e nerves supplying th e p a in fu l a rea . S p o t tre a tm e n t o v e r iso la te d a re a s su c h a s a n o b stin a te fib ro sitic n o d u le , w as som etim es given a s well a s local tre a tm e n t. I n th e s e cases a v ery low w a tta g e w as u se d e.g. •2 w a tts /s q . cm . fo r a b o u t 30 seconds. IN D IC A T IO N S 1. S o ft T issue In ju rie s: V a rico se u lce rs, p o st-m a s te c to m y o e d e m a , D u p y tre n s c o n tra c tu re , sc a rs, ten o sy n o v itis, sp ra in s, stra in s , fibrositis, h a e m a to m a , b u rsitis. 2. J o in t C o n ditions: O s te o -a rth ritis, rh e u m a to id a rth ritis , p ro la p s e d inter- v e rte b ra l discs. C o n tra-in d ica tio n s: T h ese a re few b u t include— tu m o u rs , p re g n a n t u teru s, th e eyes, th ro m b o -p h le b itis a n d h e a r t disease w hen tr e a t­ m e n t is o v e r th e ste lla te g a nglion. S O F T T IS S U E I N J U R I E S . V aricose U lcers. R e p o rts o f u ltra s o n ic tre a tm e n ts fo r v a ric o se ulcers a re v ery g o o d c o m p a re d w ith o th e r m o re c o n se rv a tiv e m eth o d s. W e tre a te d o n ly tw o in th e d e p a rtm e n t, o n e o f w h ich w as com p le te ly c u re d a n d th e o th e r v ery m u ch b e tte r, w h e n th e p a tie n t u n fo rtu n a te ly de v elo p ed ’flu a n d d id n o t re tu rn fo r tre a tm e n t. Po st-m a stec to m y O edem a. T h e s e cases o n th e w hole im p ro v e d im m e d ia tely a fte r tre a tm e n t w h en th e a r m fe lt so fte r a n d m o v e d m o re freely, b u t th e o e d em a in m o s t cases, re tu rn e d w ith in a day o r tw o. T h e m o s t sa tis fa c to ry re su lts w ere o b ta in e d w ith daily tre a tm e n t. O n e p a tie n t tre a te d f o u r m o n th s a g o w as very m u c h im p ro v e d a n d th e o e d em a h a s n o t y e t re tu rn e d . D u pytrens c o n tra ctu re . O f th e tw o cases tre a te d — o n e , in th e e arly stag es im p ro v e d a n d th e o th e r o f fo u rte e n y e ars’ s ta n d in g re m a in e d static. T h ese cases w ere tre a te d locally b u t th e y c a n be trea te d p a ra v e rte b ra lly (C 5 -7 ). S c a rs. Success h a s b een p ro v e d in th ese cases. S c a rs w ith re s u lta n t p a in re s p o n d e d very well a n d a d h e re n t scars b ecam e so ft a n d p liable. O n e p a tie n t ho w ev er w ith a scar a fte r re m o v a l o f a n exostosis calca n e u s w as tre a te d in d ire c t c o n ta c t o v e r th e heel. T h e re su lt w as a n in cre ase in p a in , p o ssib ly d u e to tre a tm e n t o v e r su p e rficial bone, w h e re u n d e r w a te r te c h n iq u e w o u ld h a v e b een p referable. Tenosynovitis. U ltra -s o n ic s a p p e a rs to h a v e as m u ch effect o n ten o sy n o ­ vitis as o th e r a c c e p te d fo rm s o f tre a tm e n t a n d is c ertain ly less p a in fu l th a n cro ss-frictio n s. S p ra in s and S tra in s. W ith th e cases tre a te d th e re su lts w ere sa tisfac to ry th o u g h n o t d ra m a tic . O f th e cases tre a te d b y us, tw o o f six p a tie n ts w ere com p le te ly c u re d , a fte r o th e r fo rm s o f tre a tm e n t h a d failed. F ib ro sitis is o fte n a ttrib u te d to p sy c h o lo g ic al causes, in w hich case u ltra -so n ic s b e ing new , stre am -lin e d a n d m u c h p u b licised is o f g re a t value. W h ere th e sp a sm was a c u te it definitely h a d a se dative effect. C h ro n ic fibrositis in p a tie n ts t h a t w ere tre a te d by in fra -re d a n d m assage a n d w ere b e tte r b u t sta tic w ere som etim es com pletely c u re d a fte r a few tre a tm e n ts o f u ltra -so n ics. A sthm a w ith a tte n d a n t psy c h o lo g ic al fa c to rs h a s been tre a te d w ith success b u t th e re h a v e b een n o n e in th e d e p a rt­ m e n t. H aem otom a. O n e case o n ly h a s b een tre a te d b u t th is show ed a re m a rk ­ a b ly q u ic k recovery. O th e r re p o rts h a v e co n firm ed this. P re -p a te lla r B ursitis. T h is p a tie n t w as tre a te d w ith u ltra -so n ics in c o n ju n c tio n w ith sh o rt-w a v e d ia th e rm y a n d a fte r tw elve tre a tm e n ts th e p a tie n t w as c u re d a n d discharged. J O I N T C O N D IT IO N S . O ste o -arth ritis. G r e a t success h a s b een c laim ed fo r th ese cases, b u t w e ' h a v e o n th e w h o le fo u n d th e re su lts d isa p p o in tin g . T his m a y h a v e b een d u e t o in c o rre c t te c h n iq u e a n d we will be g la d to h e a r d e ta ils o f successful cases. R heum atoid a rth ritis . T w o cases w ere tre a te d , o n e elb o w a n d o n e fo o t. B o th re p o rte d increase o f p a in a fte r tre a tm e n t a n d n e v e r show ed a n y im p ro v e m en t. P ro la p se d In te rv e rte b ra l Discs. T h ese h a v e b een successfully tre a te d b u t a n y im p ro v e ­ m e n t c a n o n ly b e d u e to re lie f o f sp a sm a n d th e sedative effect, as u ltra -so n ic s c a n h a v e n o effect o n th e a c tu a l disc. Conclusion. M u c h h a s still to be le a rn t a b o u t th e m o s t beneficial tec h n iq u es fo r th e differe n t c o n d itio n s, a n d th is c a n only be d o n e by e x p erim e n t a n d e xchange o f ideas. T h e u se o f u ltra -so n ic s w e n t th ro u g h a p e rio d o f d is re p u te w hen h ig h e r do sag es w ere given w ith u n sa tis fa c to ry re su lts. T he ten d e n cy n o w is t o give low doses fo r a s h o r t tim e a n d any ill-effects a re th u s m inim ised. P a in sh o u ld n e v e r be felt fro m u ltra -so n ic s p ro v id e d t h a t th e h e ad is k e p t m o ving o v e r th e a re a being tre a te d . R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) April/ 1956. P H Y S I O T H E R A P Y Page Fifteen = = = = = ----------- - ------ ---------,— - --------------------- C O N D IT IO N . N u m b e r cases tre a te d . A v e rag e N o . o f tre a tm e n ts given. C u re d . B etter. I.S .Q . W orse. Varicose U lcers .............................. 2 17 1 1 — p o st-m aste cto m y o e d e m a ................. 12 12 7 4 1 p u p y tre n s c o n tra c tu re ................. 2 9 1 1 Scars ......................................................... 6 7 1 4 — 1 T enosynovitis ............................................ 5 8 2 1 2 — Sprains a n d S tra in s .............................. 6 5 2 2 2 — F ib ro sitis ............................................ 9 8 2 6 1 — H a em o to m a ............................................ 1 6 1 — — — B ursitis ......................................................... 1 12 1 — — — O ste o -arth ritis ............................................ 19 8 1 8 8 2 R h e u m a to id a rth ritis .............................. 2 7 — — — 2 p ro lap sed in te rv e rte b ra l discs................. 5 7 — 2 3 — CHANGES OF ADDRESS M rs. H . B arn es to P .O . B ox 175, E m p a n ze n i, Z u lu la n d . M iss S. L e v itt to 6, Is b e rn M a n sio n s, 44, O livia R o a d , B erea, J o h a n n e sb u rg . M rs. B. B lieden (nee K a p la n ), to 706, T afelberg, E sselen S treet, H illb ro w , J o h a n n e sb u rg . M iss M . O dgers to 37, St. D a v id ’s R o a d , H o u g h to n , Jo h a n n e sb u rg . M rs. W . C h a rlto n to B a p tist C h u rc h , K ro o n s ta d , O .F .S . M rs. J. C h in ery to 604, C a stle M a n sio n s, E lo ff S treet, Jo h a n n e sb u rg . M iss L y n H a lla c k to 101, D a tu r a A venue, L u a n y s h a , N . R h o d e sia . M rs. S. Lew is to 13, F irs t A v e n u e, P e a ce h av e n , V ereeniging. M rs. M . M c C a rta n to c /o M r. F . M c C a b e, 97, S o m e rse t S tre et, G r a a f f R ien e t, C ape. M iss M . H e a le y S m ith to E u ro p e a n H o s p ita l, N k a n a , N . R h o d e sia . M rs. J. B ra a tv e d t to N o . 3, 25, C heryl R o a d , Salisbury, S. R h o d e sia . M iss B. S etzer to S a n la m B uildings, J o n e s S tre et, K im b erley , C ape. M rs. J. J o o s te to c / o D r . F . Jo o s te , S w artru g g en s, T ra n sv a a l. M iss M . G o ld sw o rth y to c / o E rn e st O p p e n h eim er S chool, W elk o m , O .F .S . M rs. Y . Sw indell to 8, St. A id e n A venue, G ra h a m s to w n . M iss M . G . S m it to 49, M in o r S tre et, Y eoville, J o h a n n e s ­ burg. M iss J. M u lle r to 128, Buffels R o a d , R ie to n d a le , P re to ria . M rs. v a n B re d a to 5, O re g o n C o u rt, O re g o n R o a d , P o r t E liz ab e th . P E T E R R O T H E N B E R G E L E C T R I C A L A N D I N D U S T R I A L I N S T R U M E N T S E L E C T R O - S U R G I C A L RE PAI R S P E C I A L I S T S 9 8 c M O O I STR EET, JO H A N N E S B U R G P.O. B O X 3 9 0 4 P H O N E 2 3 - 0 7 3 0 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )