Ultrasound, Diathermy, Cold Laser Flashcards by Miranda Good

Indications for ultrasound?

Increase extensibility of collagen fibers of tendons/joint capsules
Increase blood flow
Increase cell metabolism
Increase collagen synthesis
Decreased joint stiffness
Decreased muscle spasm
Enhanced tendon, ligament, muscle healing

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Contraindications for ultrasound?

Malignancy
Hemorrhage
Ischemia
Thrombus
Infections
Gonads
Eye
Pelvic, abdominal, lumbar area of pregnant women (NOT just FIRST tri)
Spinal cord after laminectomy
Plastic and cemented implants ( METAL OK)
Near or over electronic implants
Unknown etiology

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Precautions for ultrasound?

Bony prominences- avoid, or use indirect technique and smaller sound head
Epiphyseal plate- may alter bone growth

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Is it ok to ultrasound a pregnant woman’s ankle?

Yes

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Significance of different ultrasound temperatures>

1degree C: increase in temp associated with increase in metabolic activity
2-3degreesC: increase in temp associated with reduction in muscle spasm, increases in blood flow and reduction of chronic inflammation
4degreesC: increase alters viscoelastic properties of collagen

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Does pulsed US produce heat?

NO, only continuous

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Duty cycle for acute treatments? Chronic?

Acute= 50% (no heat)
Chronic= 100% (heat)

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What US frequency provides the deepest penetration at 4-5 cm?

1MHz

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What US frequency is the most superficial at 0-2.5cm?

3/3.3 MHz

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How is underwater US performed?

Same as direct US, either pulsed or continuous

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Indications for US/Estim combo treatment?

Interferential (premod) for pain relief

Pulsed/mechanical US and/or thermal effects of continuous US

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Examples of when combo treatment would be optimal?

Chronic tendinopathies such as lateral epicondylitis and Achilles tendonosis, they are painful with ischemic and fibrotic changes of the tendon. Thermotherapy with US in combo with premod helps decrease pain and increase circulation

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Which channel does the lead need to be plugged into for combo treatment?

Channel 2, electrode is connected to black plug

“red is dead”

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Size of treatment area for direct US/combo?

2-3x size or ERA, move in slow circles

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When would underwater US be best?

When the head won’t contact the skin flat

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Clinical goal of pulsed direct US? (no heat)

Increase healing

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Clinical goal of continuous direct US? (heat)

Decrease chronic pain or muscle spasm

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Clinical goal of underwater US? (heat or no heat)

Increase healing

Decrease pain

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Clinical goal of combo US and premod interferential?

Chronic tendinosis
Trigger points
Acute/chronic pain

Intensity of US?

0.5-2.5w/cm2

Frequency of combo US and premod interferential?

US: 1 or 3 MHz
Premod: 1-15 Hz or 60-150Hz

Treatment time for US and combo?

5-10 min

Can you use heat with combo treatment?

YES- if chronic

Indications for shortwave diathermy?

Osteoarthritis
Neck/back pain
Ankle pain
Dermal wounds
Other musculoskeletal injuries/pain

Contraindications for shortwave diathermy?

Loss of sensation Electronic implants (even if just lead remains) Surgically implanted metal (clips, rods, pins) Metal in contact with skin (jewelry, tmt table) Over cancerous areas Pregnant patients- abdomen, pelvis, LB Hemorrhagic areas Ischemic areas Testes Eyes Open growth plates in kids

Precautions of shortwave diathermy?

Pregnant operator should not be exposed daily, should remain 3 ft from device Copper IUDs Other patients near the device 10 foot distance Other EPA devices should be 10 ft away Mentally confused patients

Where does the heat come from with diathermy?

From ion oscillation and dipole rotation

What is the treatment area for SWD?

Area of pain or wound | *remove all metal

Clinical goal of SWD?

Decrease pain Increase joint mobility Increase wound healing

Electrode type/placement for SWD?

Capacitive or Inductive | Towels between electrode and skin

Duty cycle of SWD?

Continuous or pulsed

Treatment time for SWD?

15-20 min

Contraindications for cold laser?

``` Cancer Pregnancy- over abdomen and pelvis Avoid direct exposure to eyes Over areas of active hemorrhage Over thyroid Directly over open wounds, unless covered with clear protective barrier Epileptic patients ```

Precautions with cold laser?

``` Infection Testes Sympathetic ganglia, vagus, cadiac region in those with heart disease Open growth plates Bruises Photosensitive skin ```

Different FDA classes for laser?

Class IM- therapeutic | Class II- non therapeutic, 500mW

Which laser class is considered safe and has no chance of eye damage?

Class IM

Contact options for cold laser?

Surface contact with over pressure Scanning/contact Scanning/non contact

Benefits of surface contact with over pressure?

Better depth of penetration More consistent dose Minimizes blood flow Aperture is closer to target tissue

Benefits of scanning/contact?

Used for large area Applicator moved 0.5 to 1.5cm per second Treatment times may need to be increased

Benefits of scanning/non contact?

When surface pressure is contraindicated (shingles, infections, anti coagulation therapy)

Clinical goal of cold laser at low intensity, 1-500Hz, 2-10 min?

Stimulate healing

Clinical goal of cold laser at high intensity, 1000Hz, 1-3 min?

Inhibit swelling

Clinical goal of cold laser at high intensity, 1000-3000Hz, 3-5 min?

Acute pain

Clinical goal of cold laser at high intensity, 1000-3000Hz, 5-10 min?

Chronic pain

A pain level of 1-3 indicates what cold laser frequency?

1000Hz

A pain level of 4-6 indicates what cold laser frequency?

1000-3000Hz

A pain level of 7-10 indicates what cold laser frequency?

3000Hz