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PT 6221: Therapeutic Procedures > Deep Heat: Ultrasound > Flashcards

Deep Heat: Ultrasound Flashcards

1
Q

When should you NOT use deep heat ultrasound? (6)

A
  1. ANY musculoskeletal problem
  2. Pain
  3. Soft tissue injury
  4. LBP
  5. Frozen Shoulder
  6. Acute Ankle Sprain
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2
Q

Why do you not use deep heat ultrasound on the conditions like pain, soft tissue injury, musculoskeletal problems, etc.?

A

Research shows NO diff. with or without

It is passive

Considered not a skilled service

No good quality study has demonstrated a clinically significant benefit

Wasting healthcare $ providing US for lumbar spine conditions

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3
Q

What is ultrasound?

A

Acoustic energy/vibrations via sound waves causing mechanical pressure waves at ultra high frequency

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4
Q

What is ultrasound’s frequency requirement?

A

> 20,000 Hz considered US

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5
Q

Ultrasound can produce ____ or _____ effects

A

thermal; mechanical

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6
Q

When using ultrasound, you use a gel because the sound waves require what to travel through?

A

An elastic medium

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7
Q

US converts electrical energy to

A

sound waves

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8
Q

Sound energy travels faster through what kind of materials?

A

denser

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9
Q

Transmission of acoustic energy requires a medium. What is NOT a good conductor of waves?

A

air

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10
Q

Sound waves vary in a ______ pattern

A

sinusoidal

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11
Q

Condensations are areas of

A

compression or increased molecular density

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12
Q

Rarefactions are areas of

A

decreased molecular density

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13
Q

What are 3 main parts of the US wave?

FMI

A
  1. Frequency
  2. Mode
  3. Intensity
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14
Q

Deeper penetration is at ___ MHz and reaches about ____ inches. You’d want to use this on muscles like the soleus or deep hip rotators

A

1 MHz; 1-2 inches

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15
Q

Superficial penetration is at ____ MHz and is absorbed more easily, raises ____ faster and has less penetration. You’d want to use this on conditions like plantar fasciitis.

A

3; temperature

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16
Q

What are the 2 modes of US?

A
  1. Continuous

2. Pulsed

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17
Q

What is the continuous US mode?

A

uninteruppted stream of sound waves

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18
Q

What is the pulsed US mode?

A

periodic interupptions in sound waves

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19
Q

What is the duty cycle?

A

fraction of time during a single pulse period that US beam is present

% of pulsed duration

on-time to the sum of on-time plus off-time (10 sec on, 30 sec off so sum = 40 sec total time –> 10/40 = 25% duty cycle)

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20
Q

The intensity of US is the strength of the

A

wave

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21
Q

The intensity of US is determined by the

A

quantity of energy or acoustic power

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22
Q

The intensity of US is measured in

A

watts (W)

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23
Q

Intensity is not uniform across

A

sound head

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24
Q

The Effective Radiating Area (ERA) is a measure of the actual what?

A

Cross-sectional area of the US beam as it exits the metal plate

expressed in square centimeters

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25
Q

Intensity equation

A

W/cm^2

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26
Q

US can be transmitted, absorbed, reflected and ____; it depends on the ____ and tissue ____ (impedance).

A

refracted; angle; type

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27
Q

Acoustic impedance is

A

material / tissue’s ability to transmit sound

molecular density and structure of material/tissue

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28
Q

If acoustic impedance is low, transmission is ___ and materials absorb ____ sound

A

high; little

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29
Q

Greater changes in impedance = greater % of energy is

A

reflected

i.e. muscle/bone interface

30
Q

The depth of penetration is ____ related to frequency

A

inversely

31
Q

Lower frequency causes ___ penetration

A

deeper

32
Q

Higher frequency causes ____ penetration

not increase/decrease; think about what layer is penetrated with a higher freq on US machine

A

superficial

33
Q

Due to increased attenuation (decrease in sound energy by increased absorption/dispersion), higher frequency US is more

A

superficial

34
Q

Factors affecting absorption of US waves/energy include

A
  • attenuation
  • US frequency
  • Mode
  • Intensity of US wave
  • Tissue composition
  • Medium used for transmission
  • Angle of US beam
35
Q

The angle of the US beam should be ____ deg from perpendicular

A

15

36
Q

What are the 6 physiologic effects of US?

TM MC HN

A
  1. Thermal
  2. Mechanical
  3. Muscular
  4. Connective Tissue
  5. Hemodynamic
  6. Neurologic
37
Q

The thermal effects of US include

A

deep heating

increased metabolic rate, decreased muscle spasm/pain, increased blood flow, increased collagen extensibility and decreased sympathetic activity

38
Q

What are the 2 main mechanical effects of US (non-thermal)?

hint: MC

A
  1. Microstreaming

2. Cavitation

39
Q

What is microstreaming?

A

Small magnitude movements of ions and cellular fluids that alter cellular activity and cell membrane permeability

40
Q

What is cavitation?

A

small gas bubbles present in body fluids are subject to compression during condensation/expansion during rarefactions when exposed to US

CAUTION: when exposed to high intensity US, it may cause violent collapse or implosion of gas bubbles which leads to tissue destruction

41
Q

Rate and magnitude of mm temp depend upon (3)

IDF

A
  • intensity
  • duration
  • frequency
42
Q

No studies completed looked at ____ of temp elevation in human mm after US treatment

A

duration

43
Q

Connective tissue heats up faster and to a higher temp than mm because connective tissue is more ____, has higher _____ content and is more __vascular

A

dense
collagen
avascular

44
Q

The thermal mechanism of US include

A

Increased tissue temperature as US energy is absorbed

Local blood flow then increased to area to dissipate heat

45
Q

Non thermal mechanisms of US on hemodynamics include

A
  1. Reflexive vasodilation

2. Local histamine release changes vascular tone

46
Q

Regardless of mechanism, blood flow returns to baseline less than ___ after US

A

1 minute

47
Q

Motor nerve conduction velocities (MNCV) change during US can be

A

increased, decreased or stay the same

48
Q

Sensory nerve conduction velocities (SNCV) appear to ____ with thermal US

A

increase

49
Q

___ perception also can be altered in US

A

pain

50
Q

Thermal is achieved with _____ US

A

continuous

0.75-3.0 w/cm2

51
Q

Non-thermal is achieved with ____ US or ___ intensity continuous US

A

pulsed; low

52
Q

The gentle tissue temperature rise should be ___ enough not to cause pain, ____ enough for depth of penetration and ____ enough for heating to occur

A

low; high; long

53
Q

What are the main clinical uses of US?

A
  1. Inflammation
    a. Pain
    b. Edema
  2. Tissue Healing
54
Q

For tissue healing, what does US promote?

A
  • # of tissue repair cells
  • collagen
  • protein synthesis
55
Q

Pain is ____ and Edema is ____ effect-wise with US

A

thermal; non-thermal

56
Q

US ___ circulation, ___ mobility, and ____ extensibility of collagen

A

increases; increases; increases

57
Q

What are the main 5 indications for using US?

A
  1. Contractures/scarring
  2. Chronic arthritis
  3. Muscle strain/spasm
  4. MM Guarding/trigger pts
  5. Subacute/chronic inflammation
58
Q

What are contraindications for using US?

A
  1. Pacemaker
  2. Pregnancy
  3. Malignancies/tumors
  4. DVT/thrombophlebitis
  5. Infected areas
  6. Spinal laminectomy
  7. Growing bone/epiphyseal plate not closed
  8. Areas tending to bleed
  9. Eyes
  10. Over heart, carotid sinus, cervical ganglia
59
Q

What are precautions to using US?

A
  1. Unhealed Fx sites
  2. Primary repair of tendon or ligament
  3. Osteoporosis
  4. Plastic implants
  5. Metal implants
60
Q

When using indirect contact, you either are doing ______ or _____

A

water immersion; gel pad

61
Q

Indirect contact only delivers how much energy vs direct contact?

A

32%

62
Q

Phonophoresis uses what in addition to US gel?

A

hydrocortisone (10%) or lidocaine

63
Q

DON’T DRAG _____ in the gel for US

A

tip of gel bottle

64
Q

If selecting pulsed US, you also have to select

A

the duty cycle

65
Q

The size of the treatment area should be ____x size of the soundhead (____x ERA)

A

2-3; 3-4

66
Q

Pressure on the transducer should ____ skin and be moving ______

A

indent; continuously

67
Q

The appropriate time using US should be _____ minutes per site

A

5-10

68
Q

Less than ____ minutes shows NO physiological effects

A

3

69
Q

__ MHz takes 10 minutes to reach a therapeutic temperature, so ___ MHz is advised as it is faster

A

1; 3

70
Q

What 2 motions are used with US?

A

Either longitudinal stoking or circular movements

71
Q

The US Intensity should be ____ with more acute conditions and ____ with chronic conditions/CT shortening

A

lower; higher

72
Q

The transducer/sound head MUST be…….when starting

A

in contact with skin

otherwise crystal will break with air contact

PT 6221: Therapeutic Procedures (7 decks)

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