PTA 110L Ultrasound

Soft Tissue shortening

Deep vigorous heating provided by continuous ultrasound while stretching increases extensibility of connective tissue in muscle.

Deep vigorous heating provided by continuous ultrasound while stretching increases extensibility of connective tissue in muscle.

extensibility of connective tissue in muscle.

Soft Tissue shortening application must be what

long enough to heat target tissue

During Soft Tissue shortening how should you apply the stretch

while tissue is heated and maintain the stretch for 2 to 3 minutes following termination of application.

Pulsed ultrasound is effective for

short-term decreases in joint stiffness of patients with rheumatoid arthritis. Burn scars and keloid scars are not responsive

Calcific Tendinitis

May help dissolve calcium deposit and decrease pain, although results are inconsistent

Osteoarthritis

With appropriate dosage and combined with exercise, can decrease pain, which in turn can increase range of motion, facilitate increases in strength, function and gait.

Osteoarthritis do not recommend ultrasound for what

osteoarthritis

Rheumatoid arthritis

Can increase range of motion, decrease duration of morning stiffness, number of swollen and painful joints

Lateral Epicondylitis

Increase tissue metabolism and soft tissue extensibility, relieve pain, and promote muscle relaxation.

Subacute and chronic inflammation such as bursitis Rationale

Reduction in pain and improved mobility. Results are not consistent. Anti-inflammatory effects have not been demonstrated

Ultrasound for Carpal Tunnel Syndrome Rationale

Pulsed ultrasound (15 min, 1 MHz, 1.0 w/cm^2, pulsed 1:4, 5 cm^2 transducer face) resulted in remission of symptoms, decreased distal latency and increased sensory velocity, improved pinch and grip strength, and decreased pain. Perhaps ultrasound reduces swelling resulting in decompression of nerve in the tunnel

Trigger points Rationale

Desensitize trigger point (either conventional ultrasound or high-power ultrasound [continuous mode, 1 MHz, elevate intensity for 4 sec to patient’s pain tolerance, reduce by one-half for 15 sec, then return to tolerance level ; repeat 3 times and follow with stretching])

Acute low back pain from prolapsed disc Rationale

Resolution of local inflammation leading to decreased pain and increased range of motion and function

Tendon healing rationale

Increased production of collagen fibrils in rats, increased tensile strength and potentially decreased healing time in rabbits

Wound healing in animal models has been accelerated Rationale

Nonthermal effect of acoustic streaming can change membrane permeability facilitating diffusion of metabolites and promote protein and collagen synthesis.

Wound healing in animal models has been accelerated results

among humans are not sufficiently positive to merit routine use

Over anesthetic areas rationale Contradiction

Patient must rely on thermal feedback to report excessive heating.

Impaired arterial circulation rationale Contradiction

Arterial circulation must be sufficient to meet the increased metabolic demand.

Hemorrhage rationale Contradiction

Increased blood flow could enhance any local bleeding already present

Over the eyes rationale Contradiction

Could cause cavitation in the fluid compartments.

Over a gravid uterus Contradiction

Could cause cavitation in the amniotic fluid and potential damage to the fetus.

Cancer-Local exposure Contradiction

May metastasize due to the increased blood flow.

Over the spinal cord after a laminectomy Contradiction

Cavitation can occur in the cerebrospinal fluid

In the presence of infection Contradiction

Can be accelerated by heat

Over the carotid sinus or cervical ganglia or over a pacemaker Contradiction

Could cause disturbance of the normal pacing of the heart or stimulus baroreceptors

Thrombophlebitis Contradiction

Potential to produce emboli.

Maintain consistent energy transfer Precaution

Burns could result. Keep the transducer moving; maintain even contact, and remove air bubbles.

Concentration of energy at the periosteum can produce burns - Precaution

Keep off bony prominences

Avoid the use of intensities higher than those considered therapeutic. - Precaution-

High intensities produce cavitation, which is a phenomenon whereby bubbles of dissolved gas from and grow during each rarefaction phase. Through their vibration and absorption of energy, they can create sites of energy concentration or actually tear tissue

In acute inflammatory pathologies. -Precaution-

May increase inflammatory response. Use low doses.

Over the epiphyses of growing bones. -Precaution-

Considered to produce growth disturbances and potentially cause early closure. Low doses delivered in usual therapeutic manner may be safe

Lateral Epicondylitis indications

Decreased pain using 10% hydrocortisone. Decreased pain, improved grip strength and function using 10% naproxen, 1 W/cm^2, 1 MHz in conjunction with exercise.

Various musculoskeletal conditions (lateral epicondylitis, bicipital, supraspinatus, Achilles, and patellar tendinitis, DeQervain’s tenosynovitis, plantar fasciitis) -indications-

Decreased pain and increased pressure tolerance using 0.05% fluocinonide gel, 8 minutes of continuous ultrasound at 1.5 W/cm^2, three times per week for 3 weeks.

Temporomandibular joint dysfunction -indications-

Decreased pain and improved mouth opening using 10% hydrocortisone ointment and 1.0-1.5 W/cm^2 continuous ultrasound for 8 minutes daily for 5 days followed by 2 days break and then daily for 5 more days.

Shinsplints

Decreased pain and increased range of motion using dexamethasone and 6 minutes of ultrasound at 1.5 W/cm^2 over a maximum of 10 treatments

Delayed onset muscle soreness indications

While ultrasound alone increased pain, ultrasound with 10% trolamine salicylate cream did not, suggesting that salicylate reduced the inflammatory reaction

Various Knee disorders requiring arthroscopy

Using 2.5% ketoprofen gel and 1 MHz ultrasound at 1.5W/cm^2 for 5 minutes, either continuous or pulsed (20% duty cycle), agent deposited in synovial tissue.

What is the rationale for Knee Osteoarthritis indication

40% had greater than 30% improvement in function following phonophoresis with 55% ibuprofen cream (ultrasound at 1 MHz, 1 W/cm2, continuous, for 5 minutes). Effect no better than with ultrasound alone.

Ultrasound advantages

capable of producing significant temperature changes deep within the tissue. It is very local treatment with few generalized responses. Application times are usually short

What are the disadvantages for ultrasound

Very little sensation is associated with treatment, making dosage difficult to monitor.

-Pressure is exerted on the part to be treated, aggravating any tenderness.

-Because ultrasound waves are highly focused upon leaving the transducer, only small areas can be treated at one time. Ultrasound is not appropriate for large body surfaces

Phonophoresis Advantages

Can introduce medication bypassing liver elimination and without invading the skin

Phonophoresis disadvantages

Difficult to determine drug dosage due to transmissivity problems with the drug or carrier.