Therapeutic Ultrasound for Chronic Pain Management in Joints: A Systematic Review.

Author: Aiyer R1, Noori SA2, Chang KV3, Jung B1, Rasheed A1, Bansal N1, Ottestad E4, Gulati A5
1Department of Anesthesiology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York.
2Department of Pain Management, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA.
3Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei City, Taiwan.
4Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California.
5Department of Anesthesia and Critical Care, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Conference/Journal: Pain Med.
Date published: 2019 May 16
Other: Pages: pnz102 , Special Notes: doi: 10.1093/pm/pnz102. [Epub ahead of print] , Word Count: 321

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.

© 2019 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail:

KEYWORDS: Chronic Pain; Hip; Joint Pain; Knee; Shoulder; Therapeutic Ultrasound

PMID: 31095336 DOI: 10.1093/pm/pnz102