Aiyer Rohit, Noori Selaiman A, Chang Ke-Vin, Jung Boyoun, Rasheed Abdullah, Bansal Nitin, Ottestad Einar, Gulati Amitabh
Department of Anesthesiology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York.
Department of Pain Management, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Pain Med. 2020 Nov 7;21(7):1437-1448. doi: 10.1093/pm/pnz102.
Treatments for joint pain and dysfunction focus on restoration of joint motion, improvement in pain and a return to the previous level of the patient's daily activity. Therapeutic ultrasound is a noninvasive modality widely utilized in the management of musculoskeletal disorders. The objective of this systematic review was to evaluate the effectiveness of therapeutic ultrasound in the management of patients with knee, shoulder and hip pain.
Using PRISMA guidelines, a search of the PubMed, CENTRAL (The Cochrane Library), Web of Science and Scopus databases was performed to retrieve randomized controlled trials (RCTs) that evaluated therapeutic ultrasound (continuous and pulsed) in patients with chronic knee, shoulder and hip pain.
The search strategy identified 8 trials for knee, 7 trials for shoulder and 0 trials for hip that met the criteria for inclusion. All 8 trials showed improvement in knee pain, and of these studies 3 showed statistical significance improvement for therapeutic ultrasound versus the comparator. For shoulder pain, all 7 trials showed reduction in pain, but should be noted that 4 of studies demonstrated that therapeutic ultrasound is inferior to the comparator modality.
Therapeutic ultrasound is frequently used in the treatment of knee, shoulder and hip pain and is often combined with other physiotherapeutic modalities. The literature on knee arthritis is most robust, with some evidence supporting therapeutic ultrasound, though the delivery method of ultrasound (pulsed vs continuous) is controversial. As a monotherapy, ultrasound treatment may not have a significant impact on functional improvement but can be a reasonable adjunct to consider with other common modalities. In all three pain syndromes, especially for hip pain, further trials are needed to define the true effect of low-intensity ultrasound therapy knee, shoulder and hip pain. No conclusive recommendations may be made for optimal settings or session duration.
关节疼痛和功能障碍的治疗重点在于恢复关节活动度、减轻疼痛以及使患者恢复到先前的日常活动水平。治疗性超声是一种广泛应用于肌肉骨骼疾病管理的非侵入性治疗方法。本系统评价的目的是评估治疗性超声在治疗膝关节、肩关节和髋关节疼痛患者中的有效性。
按照PRISMA指南，检索了PubMed、CENTRAL（考克兰图书馆）、科学网和Scopus数据库，以获取评估治疗性超声（连续和脉冲式）对慢性膝关节、肩关节和髋关节疼痛患者疗效的随机对照试验（RCT）。
检索策略确定了8项关于膝关节的试验、7项关于肩关节的试验和0项关于髋关节的试验符合纳入标准。所有8项关于膝关节的试验均显示膝关节疼痛有所改善，其中3项研究表明治疗性超声与对照相比有统计学意义上的改善。对于肩关节疼痛，所有7项试验均显示疼痛减轻，但应注意的是，4项研究表明治疗性超声不如对照治疗方式。
治疗性超声常用于治疗膝关节、肩关节和髋关节疼痛，且常与其他物理治疗方式联合使用。关于膝关节炎的文献最为丰富，有一些证据支持治疗性超声，尽管超声的给药方式（脉冲式与连续式）存在争议。作为单一疗法，超声治疗可能对功能改善没有显著影响，但可作为与其他常用方式联合使用时的合理辅助手段。在所有这三种疼痛综合征中，尤其是髋关节疼痛，需要进一步试验来确定低强度超声治疗膝关节、肩关节和髋关节疼痛的真实效果。对于最佳设置或疗程持续时间无法给出确凿建议。
