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Hypersensitivity to pulsed ultrasound over the greater trochanter

Has there been any reports of hypersensitivity to pulsed ultrasound?

I have a patient who reports sharp pain when the ultrasound is used over the greater trochanter, even with minimal pressure and a dose of 1MHZ 50% 0.3/cm2 (turned down from 0.5w/cm2)

Greater trochanteric bursitis secondary to gluteal muscle tear has been diagnosed via ultrasound scan and she is otherwise improving. We have tried low level laser and she did not have any reaction to that.

Many thanks for your feedback

Anna Risius

5 months ago

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Prof Tim Watson
Prof Tim Watson

These heightened sensitivity responses do accur from time to time. There are various 'explanations' but none are especially convincing. I have certainly seen them over periosteal bruising or haematomas and sometimes over highly sensitised nerves, but not consistently - i.e. there are some people with periostal bruising who demonstrate no reaction at all/ The stress fracture one is real - IF there is a stress fracture and you go directly over it with US, then a strong, local and very sharp pain reaction is the normal - good diagnostic trick with some 90% + accuracy

gvpetrov223
gvpetrov223

Hi Anna, could it be a wrong technique (i.e. not moving the transducer enough)? I doubt it.. Or could it be a hidden bone stress injury (i.e. avulsion fracture)? https://www.medscape.com/viewarticle/803373 I have an experience with a patient with scaphoid fracture. The sensation was the similar to what you have described - sharp stabbing pain. Tell us if you find what's the problem.

Prof Gad Alon
Prof Gad Alon

Can it be that your US is not calibrated and thus has hi density w/cm??

Cliff Eaton
Cliff Eaton

Dear Anna I agree with Richard the periosteum can surely be the only tissue to evoke such an unusual reaction Nothing wrong with reverting to LLLT as both optimising the inflammatory process Cliff

annarisiusphysio379
annarisiusphysio379

Thank-you, yes that is the only explanation I could think to give to her!

I've suggested trying 3MHZ but she's understandibly a little put off and wanted to try more laser. Interestingly she met a colleague (both retired GPs) who had had the same experience years ago but could never find an explanation. Thanks again.

Prof Richard Liebano
Prof Richard Liebano

Hi Anna, I have never seen this using such low intensity. The periosteum is probably very sensitized. You can try to use 3 MHz and see if the patient feels less discomfort.

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