Ultrasound, Diathermy, Cold Laser Flashcards
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
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
Precautions for ultrasound?
Bony prominences- avoid, or use indirect technique and smaller sound head
Epiphyseal plate- may alter bone growth
Is it ok to ultrasound a pregnant woman’s ankle?
Yes
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
Does pulsed US produce heat?
NO, only continuous
Duty cycle for acute treatments? Chronic?
Acute= 50% (no heat) Chronic= 100% (heat)
What US frequency provides the deepest penetration at 4-5 cm?
1MHz
What US frequency is the most superficial at 0-2.5cm?
3/3.3 MHz
How is underwater US performed?
Same as direct US, either pulsed or continuous
Indications for US/Estim combo treatment?
Interferential (premod) for pain relief
Pulsed/mechanical US and/or thermal effects of continuous US
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
Which channel does the lead need to be plugged into for combo treatment?
Channel 2, electrode is connected to black plug
“red is dead”
Size of treatment area for direct US/combo?
2-3x size or ERA, move in slow circles
When would underwater US be best?
When the head won’t contact the skin flat
Clinical goal of pulsed direct US? (no heat)
Increase healing
Clinical goal of continuous direct US? (heat)
Decrease chronic pain or muscle spasm
Clinical goal of underwater US? (heat or no heat)
Increase healing
Decrease pain
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
