Use of Pulsed Shortwave Diathermy and Joint Mobilization to Increase Ankle Range of Motion in the Presence of Surgical Implanted Metal: A Case Series

Abstract

Study Design: Case series. Background: Traditionally, all forms of diathermy have been contraindicated over metal implants. There is a lack of research-based evidence for harm regarding the use of pulsed shortwave diathermy (PSWD) over orthopaedic metal implants. Because PSWD is an effective modality for deep heating, we investigated whether ankle range of motion (ROM) could improve with the cautious use of PSWD and joint mobilizations, despite orthopaedic metal implants being in the treatment field. Case Descriptions: Four subjects presented with decreased ankle ROM due to extensive fractures from traumatic injuries. All subjects were postsurgical, with several internal fixation devices. Subjects previously received rehabilitation therapy involving joint mobilizations, therapeutic exercises, moist heat, and ice, but continued to lack 15°to 23°of ankle dorsiflexion. The Human Subjects Review Board of Brigham Young University approved the methods of this case series. Subjects gave written informed consent. Initial dorsiflexion active ROM for each patient was -3°, 0°, 8°, and 5°, respectively. Treatment regime consisted of PSWD to the ankle for 20 minutes at 27.12 MHz, 800 pps, 400 microseconds (48 W). Immediately after PSWD, mobilizations were administered to the joints of the ankle and foot. Ice was applied posttreatment. Outcomes: Dorsiflexion improved 15°, 15°, 10°, and 14°, respectively, after 8 or 13 visits. All patients returned to normal activities with functional ROM in all planes. Follow-up 4 to 6 weeks later indicated that the subjects maintained 78% to 100% of their dorsiflexion. No discomfort, pain, or burning was reported during or after treatment. No negative effects were reported during the short-term follow-up. Discussion: When applied with appropriate caution, we propose PSWD (48 W) may be an appropriate adjunct to joint mobilizations to increase ROM in peripheral joints, despite implanted metal. We continue to advise caution when applying diathermy with machines other than the Megapulse II. Further research is needed to determine the safety parameters of other diathermy machines. As a final caution, we advise that diathermy not be used in the presence of a cardiac pacemaker or neurostimulator.

Continuous-mode 448 kHz capacitive resistive monopolar radiofrequency induces greater deep blood flow changes compared to pulsed mode shortwave: a crossover study in healthy adults

“…Similar studies involving only SWT that were conducted on either asymptomatic subjects (12,14,15,31) or patient groups (10,32,33) have been reported previously. However, to our knowledge this will be the first in vivo study that investigated the deep physiological responses to RF exposure below the shortwave frequency band.…”

Pulsed Shortwave Diathermy and Joint Mobilizations for Achieving Normal Elbow Range of Motion After Injury or Surgery With Implanted Metal: A Case Series

“…The elbow should extend to a full AROM (08) as measured by a goniometer. 1 Many [1][2][3][4][5][6] are of the opinion that using heat in concert with joint mobilizations can increase accessory and physiologic movements. In 2010, I…”

Muscle Heating With Megapulse II Shortwave Diathermy and ReBound Diathermy

“…The higher residual temperature that the Megapulse II produced is important because it allows the clinician a greater potential to elongate the tissues when a mechanical stress is applied and a longer stretching window in which to apply the mechanical stresses, such as stretching or joint mobilizations. 18 Researchers 13,21,22 have found that these high-temperature increases when followed by joint mobilizations increase range of motion in the shoulder, elbow, knee, and ankle. ReBound diathermy was inadequate to heat the tissues to a level of vigorous heating.…”

“…10 Given that the initial change in tissue-temperature increase is important for producing various physiologic effects, the decay in the temperature increase is also vitally important to a clinician when trying to increase joint range of motion. 7,21,22 A diathermy device that initially causes a 48C tissue-temperature increase, producing more potential to elongate the tissues, and then has a slower temperature decay will give a clinician a longer stretching window, during which joint mobilizations and stretching will be more effective. 1 After the 30-minute treatment, ReBound diathermy produced a slower temperature decay than the Megapulse II diathermy.…”