Does ultrasound reduce joint inflammation?

Question

I read a 2011 paper, Low-intensity pulsed ultrasound reduces the inflammatory activity of synovitis. that mention that ultrasound can help reduce inflammation.

However, Save Yourself article states:

Unfortunately — although there are some interesting exceptions and tantalizing hopes for some conditions — ultrasound is not a promising therapy for most musculoskeletal conditions. There is a jarring, bizarre lack of research for such a popular therapy. What little research is available paints an overwhelmingly bland picture. And the principle of US itself is, at best, much more complicated and unpredictable than most therapists believe. At worst, there is no rational basis for US at all. Ultrasound therapy is almost certainly useful for some patients, some of the time — but it is not a reliable or evidence-based therapy.

So, does ultrasound work to reduce inflammation (e.g. treat musculoskeletal problems, especially inflammation such as tendonitis and bursitis)?

Answer 1

A 2010 meta-analysis suggests

US could be efficacious for decreasing pain and may improve physical function in patients with knee OA. The findings of this review should be confirmed using methodologically rigorous and adequately powered clinical trials.

But another study found

within 4 weeks of the commencement of treatment manual acupuncture, static magnets and ultrasound therapies did not offer statistically significant short-term pain relief over placebo.

I have many Physical Therapist friends who swear by US and I have personally received it for an injury. It feels warm but so does wax and one study found they are equally effective or ineffective depending on the outcome you are measuring.

Exercise alone, however, for arthritic hands yielded better improvement than wax baths combined with exercises for pain on non-resisted motion. There is no significant difference between wax and therapeutic ultrasound, or between wax and faradic bath combined with ultrasound for all the outcomes measured after 1, 2 or 3 week(s).

McMaster University is the home of Evidence Based Medicine. Their review found it is favored by Physical Therapists:

The use of US for the management of clients with nonsurgical knee OA is variable; however more than 80% of physical therapists surveyed use US, at least on rare occasions, despite the fact that only 46% endorsed the belief that US was likely to benefit the client. The primary rationale for applying US is to treat soft tissue pain.

But their review falls short of endorsing its use other than short-term relief of pain.

I benefit from and suggest to my patients to simply wash dishes in hot water. Soaks alone are not as beneficial as washing dishes as you are combining exercise with heat and this therapy is not only free but helps your spouse with daily chores therefore may provide benefits other than medical to your relationship. ;)