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BackgroundNon-specific chronic low back pain (NSCLBP) is one of the most common musculoskeletal disorders around the world including Iran. One of the most widely used modalities in the field of physiotherapy is therapeutic ultrasound (US). Despite its common use, there is still inconclusive evidence to support its effectiveness in patients with NSCLBP. The objective of this study was to evaluate the effect of continuous US compared with placebo US additional to exercise therapy for patients with NSCLBP.MethodsIn this single blind placebo controlled study, 50 patients with NSCLBP were randomized into two treatment groups: 1) continuous US (1 MHz &1.5 W/cm2) plus exercise 2) placebo US plus exercise. Patients received treatments for 4 weeks, 10 treatment sessions, 3 times per week, every other day. Treatment effects were assessed in terms of primary outcome measures: 1) functional disability, measured by Functional Rating Index, and 2) global pain, measured by a visual analog scale. Secondary outcome measures were lumbar flexion and extension range of motion (ROM), endurance time and rate of decline in median frequency of electromyography spectrum during a Biering Sorensen test. All outcome variables were measured before, after treatment, and after one-month follow-up. An intention to treat analysis was performed. Main effects of Time and Group as well as their interaction effect on outcome measures were investigated using repeated measure ANOVA.ResultsAnalysis showed that both groups had improved regarding function (FRI) and global pain (VAS) (P < .001). Lumbar ROM as well as holding time during the Sorensen test and median frequency slope of all measured paravertebral muscles did not change significantly in either group (P > .05). Improvement in function and lumbar ROM as well as endurance time were significantly greater in the group receiving continuous US (P < .05).ConclusionsThe study showed that adding continuous US to a semi supervised exercise program significantly improved function, lumbar ROM and endurance time. Further studies including a third group of only exercise and no US can establish the possible effects of placebo US.Trial registrationNTR2251

Osteoarthritis (OA) is a chronic multifactorial disease characterized by progressive joint degeneration. The purpose of this study was to compare the effects of ultrasound-guided corticosteroid injection with oxygen-ozone injection in patients with knee OA. This double-blind randomized clinical trial was performed on 62 patients with knee OA. The patients were randomly divided into two groups. In the first group 40 mg triamcinolone (1 cc) and in the second group 10 cc (15 μg/ml) oxygen-ozone (O-O) were injected into the knee joint under ultrasound guidance. Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis (WOMAC), knee flexion range of motion (ROM), effusion in ultrasound images of the suprapatellar recess, and visual analog scale (VAS), which were evaluated before injection, 1 week, 1 month, and 3 months after the treatment. Sixty-two patients (10 men and 52 women) were enrolled with mean age of 57.9 years. VAS improved in both groups (steroid P value = 0.001, oxygen-ozone P value > 0.001). The improvements seen in VAS and WOMAC scores 3 months after treatment were in favor of the oxygen-ozone group when compared to the steroid group (P = 0.041 vs P = 0.19). There was no significant difference between the two groups in ROM and joint effusion seen under ultrasound (ROM p = 0.880, effusion p = 0.362). However, in the oxygen-ozone-receiving group, joint effusion was decreased significantly (p < 0.001). Both steroid and oxygen-ozone injections are effective in patients with knee osteoarthritis. Our study showed that the effects of oxygen-ozone injection last longer than those of steroid injection to the knee joint.

Objective The aim of the study was to investigate the overall estimates of cross-sectional areas of the median nerve measured by ultrasonography in accordance with the electrodiagnostic classification of carpal tunnel syndrome severity. Design MEDLINE (PubMed), Embase (Ovid), and Web of Science were searched for studies reporting the median nerve cross-sectional area measured by ultrasonography for mild, moderate, and severe carpal tunnel syndrome based on electrodiagnostic study. Cross-sectional area values measured at the carpal tunnel inlet were included in the analyses. Results Overall, 866 citations were retrieved and checked for eligibility. Finally, 16 articles were included for meta-analysis. These studies included a total sample of 2292 wrists including 776 mild, 823 moderate, and 693 severe carpal tunnel syndrome. The pooled analysis revealed a mean cross-sectional area of 11.64 mm2 (95% confidence interval = 11.23–12.05 mm2, P < 0.001) for mild carpal tunnel syndrome, a mean cross-sectional area of 13.74 mm2 (95% confidence interval = 12.59–14.89 mm2, P < 0.001) for moderate carpal tunnel syndrome, and a mean cross-sectional area of 16.80 mm2 (95% confidence interval = 14.50–19.1 mm2, P < 0.001) for severe carpal tunnel syndrome. Conclusions This is the first meta-analysis that provides the pooled median nerve cross-sectional area values in accordance with the electrodiagnostic classification of carpal tunnel syndrome severity. The values obtained in this study have clinical utility in ultrasonographic assessment of patients with carpal tunnel syndrome.