***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Of 76 patients with lateral epicondylitis , 38 were r and omly allocated to receive ultrasound treatment and 38 placebo .  All 76 were given 12 treatments each over four to six weeks . The conditions of 24 patients ( 63 % ) treated with ultrasound and 11 ( 29 % ) given placebo improved , the difference being significant at the 1 % level . Improvement in particular clinical variables ( pain score , weight lifting , grip strength ) also showed an advantage for the patients given ultrasound treatment . A simple underwater radiation balance showed considerable fluctuation in ultrasonic output , and frequent checks of output were shown to be necessary . Ultrasound enhances recovery in most patients with lateral epicondylitis OBJECTIVE To investigate the effects of two dosages of pulsed ultrasound therapy ( 1 MHz , spatial averaged peak intensity 0.8 W/cm2 , mark space ratio of 1:4 ) on  acute-stage delayed onset muscle soreness ( DOMS ) .  DESIGN Double-blind , placebo-controlled , r and omized trial . SETTING Laboratory of a university physiotherapy department . PARTICIPANTS Forty-eight healthy volunteers ( 24 men , 24 women ) with no arm pathology or pain at the time of the study . INTERVENTIONS Subjects were r and omly allocated to one of four treatment groups : control , placebo ( sham insonation ) , low-dosage pulsed ultrasound ( mean dosage 172.8 J ) , or high-dosage pulsed ultrasound ( mean dosage 345.6 J ) . DOMS was induced in the nondominant elbow flexors in a st and ardized fashion through repeated eccentric exercise until exhaustion . MAIN OUTCOME MEASURES Elbow extension , flexion , and resting angles ( universal goniometer ) , pain ( visual analogue scale ) , mechanical pain threshold/tenderness ( pressure algometer ) , and a McGill pain question naire . Measurements were taken before and after treatment each day except for the McGill pain question naire , which was completed at the end of the trial . RESULTS Significant differences were seen between groups in relation to range of flexion ( p = .0032 ) , with the control group losing least range of flexion . There were no other significant differences between the groups . CONCLUSION No convincing evidence was found to support the use of pulsed ultrasound therapy in the management of DOMS at the parameters discussed here The efficacy of ultrasound therapy in the management of  back pain result ing from rupture of the intervertebral disc was evaluated in 3 groups : treatment , placebo , and control .  Range of motion of total flexion and extension , total side flexion and total rotation of the lumbar spine , and subjective assessment of pain were used as criteria to determine the efficacy of treatment . Group comparisons showed statistical significance in favor of the treatment group ( p 0.01 ) , leading to the conclusion that ultrasound therapy is significantly effective in the treatment of back pain result ing from prolapse of the lumbar intervertebral disc To study the effect of pulsed ultrasound in shoulder pains , 35 patients were treated with pulsed ultrasound and 37 patients with placebo ultrasound  in a double-blind design . The therapy was given during inpatient rehabilitation , 10 - 12 treatments over 3 - 4 weeks . Treatment time was 10 minutes , frequency 1.0mHz , on-off ratio 1:4 and intensity 1.0w/cm2 . Follow-ups were done after 4 - 12 months . No differences ( p < 0.05 ) in outcomes were found between the groups after the treatment period or at follow-ups . These results discourage the adding of pulsed ultrasound therapy with the variables used to the conservative treatment of the painful shoulder OBJECTIVE To assess the effects of acetic acid iontophoresis ( AAI ) and ultrasound on calcifying tendinitis of the shoulder , and to determine the relation between changes in the radiological measures of calcium deposit ( CD ) and shoulder function . DESIGN R and omized control trial . SETTING General community , private practice . PATIENTS Twenty-two adults ( 7 men , 15 women ) with a calcifying tendinitis of the shoulder , without associated conditions , stratified according to the type of lesions ( X-ray : type I , fleecy appearance : type II , homogeneous ) , were r and omly allocated to an experimental ( EXP , n = 11 ) or to a control ( CTL , n = 10 ) group . INTERVENTIONS CTL group , no treatment ; EXP group , nine treatments including AAI ( 5 % acetic acid solution via the negative electrode , 5mA galvanic current , 20 minutes ) followed by continuous ultrasound ( 0.8w/cm2 , 1MHz , 5 minutes ) . MAIN OUTCOME MEASURES Area and density of the CD , passive shoulder abduction ( range of motion [ ROM ] ) , pain intensity . RESULTS Significant reduction in the area and density of CD ( ANCOVA , p = .01 and .03 ) over time in the EXP and CTL groups , but no significant difference between groups for any of the variables measured . The decrease in the area of CD in type I lesions ( n = 5 ) was larger ( Mann-Whitney U test , p < .01 ) than in type II ( n = 16 ) lesions . The relation was stronger ( rs = .90 ) between changes in area and density of CD than between ROM and pain ( rs = -.67 ) . Correlations were weak ( rs = .21 to .41 ) between radiological and functional changes . CONCLUSION The reduction in CD area and density likely results from a natural process rather than treatment ( AAI and ultrasound ) ; type I lesions ( resorptive phase ) are more likely to display resorption of the CD than type II lesions ( formative phase ) . Reduction of the CD area does not necessary result in a functional improvement Abstract Objective : To assess the efficacy of ultrasound treatment for mild to moderate idiopathic carpal tunnel syndrome . Design : R and omised , double blind , “ sham ” controlled trial with assessment s at baseline , after 2 weeks ' and 7 weeks ' treatment , and at a follow up assessment 6 months later ( 8 months after baseline evaluation ) . Setting : Outpatient clinic of a university department of physical medicine and rehabilitation in Vienna . Subjects : 45 patients with mild to moderate bilateral carpal tunnel syndrome as verified by electroneurography . Intervention : 20 sessions of ultrasound ( active ) treatment ( 1 MHz , 1.0 W/cm2 , pulsed mode 1:4 , 15 minutes per session ) applied to the area over the carpal tunnel of one wrist , and indistinguishable sham ultrasound treatment applied to the other . The first 10 treatments were performed daily ( 5 sessions/week ) ; 10 further treatments were twice weekly for 5 weeks . Main outcome measures : Score of subjective symptom ratings assessed by visual analogue scale ; electroneurographic measures ( for example , motor distal latency and sensory antidromic nerve conduction velocity ) . Results : Improvement was significantly more pronounced in actively treated than in sham treated wrists for both subjective symptoms ( P<0.001 , paired t test ) and electroneurographic variables ( motor distal latency P<0.001 , paired t test ; sensory antidromic nerve conduction velocity P<0.001 , paired t test ) . Effects were sustained at 6 months ' follow up . Conclusion : Results suggest there are satisfying short to medium term effects due to ultrasound treatment in patients with mild to moderate idiopathic carpal tunnel syndrome . Findings need to be confirmed , and ultrasound treatment will have to be compared with st and ard conservative and invasive treatment options . Key messages Chronic entrapment of the median nerve at the wrist ( the carpal tunnel syndrome ) is probably the most common peripheral nerve lesion No satisfactory conservative treatment is available at present Twenty sessions of ultrasound treatment show good short and medium term efficacy in patients with bilateral , mild to moderate forms of the carpal tunnel syndrome Optimal treatment schedules of ultrasound treatment alone or in combination with other non-surgical treatments await This study was carried out to explore the pain-alleviating effect of pulsed ultrasound in lateral epicondylalgia . Forty-five patients were consecutively assigned at r and om to two groups for pulsed ultrasound or placebo . The parameters for ultrasound were 1 MHz ; 1:4 ; 1 W/cm2 . Each session was for 10 min , two to three times weekly , ten treatments in all . Follow-ups were done after three and twelve months . The statistical analysis showed no significant differences in relation to subjective or objective outcomes between the groups after the treatment period or at the follow-ups . Our results do not support the use of pulsed ultrasound treatment with the chosen parameters in lateral epicondylalgia A controlled study of the effects of ultrasound on healing chronic leg ulcers  was carried out in conjunction with st and ard treatment on 38 patients divided r and omly into two groups . All patients received st and ard treatment ( paste impregnated b and age and a self-adhesive elastic b and age plus placebo ultrasound or ultrasound ( 1.0 watt/cm2 at 1 MHz , for 10 min ) twice weekly for 8 weeks . Percentage healed ulcer area and number of healed ulcers were compared after 2 , 4 , 6 and 8 weeks . There were no significant differences in the proportion of healed ulcers or ulcer area in the ultrasound group as compared with the placebo group BACKGROUND AND PURPOSE The purpose of this study was to compare in patients with spinal cord injury the effect on wound healing of nursing care alone with the effect on wound healing of nursing care combined with either laser treatment or a regimen of ultrasound and ultraviolet-C ( US/UVC ) . SUBJECTS Twenty patients ( 22 wounds ) were r and omly assigned to the treatment groups . METHODS All patients received st and ard wound care consisting of wound cleaning twice daily , application of moist dressings , and continuous relief of pressure until the wounds were healed . The laser protocol consisted of three treatments weekly using a cluster probe with an 820-nm laser diode and 30 superluminous diodes ( 10 each at 660 , 880 , and 950 nm ) , and energy density of 4J/cm2 , and a pulse repetition rate of 5,000 pulses per second . The US/UVC regimen consisted of five treatments weekly , alternating the treatment modality daily . The pulsed US was applied at a frequency of 3 MHz and a spatial average-temporal average intensity of 0.2 W/cm2 ( 1:4 pulse ratio ) for 5 minutes per 5 cm2 of wound area . The UVC dosage ( 95 % emission at 250 nm ) was calculated each session according to wound appearance . The dosage level was E1 for clean/granulating areas , E3 for purulent/slow-granulating areas , E4 for heavily infected areas , and 2E4 for wound debridement . Wounds were traced every 14 days , and surface areas were calculated using the Sigma-Scan Measurement System . Weekly percentage changes in wound area were compared . RESULTS Results showed that US/UVC treatment had a greater effect on wound healing than did nursing care , either alone or combined with laser . CONCLUSION AND DISCUSSION Ultrasound/ultraviolet-C may decrease healing time and may allow faster return to rehabilitation programs , work , and leisure activities for patients with spinal cord injury who have pressure ulcers BACKGROUND AND PURPOSE The purpose of this study was to assess the effects of ultrasound ( US ) therapy in the treatment of  pressure ulcers as an adjunct to st and ardized treatment . SUBJECTS Eighty-eight patients from 11 nursing homes and one hospital participated . Subjects were r and omly assigned to either a US group ( n = 45 ) or a sham US group ( n = 43 ) . METHODS This was a multicenter placebo-controlled r and omized trial . Wound survival , healing rates of wound surfaces , and changes on a clinical rating scale were measured over 12 weeks . RESULTS Comparison of the 12-week cumulative incidences of wound closure showed that 40 % ( 18/45 ) of ulcers in the US group and 44 % ( 19/43 ) of ulcers in the sham US group were closed . An analysis in which between-group baseline differences and the days of wound closures were accounted for showed that the wound closure probability per unit of time ( ie , closure rate ) was almost equal in the two treatment groups ( Cox proportional-hazards ratio of 1.08 ) . Mean absolute healing rates were 0.18 and 0.31 cm2/wk in the US and sham US groups , respectively . Relative healing rates and healing speeds were similar in the two treatment groups . A panel scored slides of the ulcers with a report mark between 1 ( bad ) and 10 ( excellent ) . The improvement was 0.71 and 0.46 points per week in the US and sham US groups , respectively . CONCLUSION AND DISCUSSION These data do not support the idea that US speeds up the healing of pressure ulcers Ultrasound and pulsed electromagnetic energy therapies arc increasingly used for perineal trauma sustained during childbirth . The study included 414 women with moderate or severe perineal trauma r and omly allocated to receive active ultrasound , or active pulsed electromagnetic energy , or corresponding placebo therapies ; the allocation was double‐blind for each machine . Overall , more than 90 % thought that treatment made their problem better . There were no clear differences between the groups in outcome either immediately after treatment , or 10 days or 3 months postpartum , other than more pain associated with pulsed electromagnetic energy treatment at 10 days . 
    Output:
    
DISCUSSION AND CONCLUSION There was little evidence that  active therapeutic ultrasound  is more effective than placebo ultrasound  for treating people with pain or a range of musculoskeletal injuries or for promoting soft tissue healing .