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Ultrasound clinical application review

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  • 1. Therapeutic Ultrasound Clinical Application Review Casey Christy, MA, ATC, CSCS
  • 2. Clinical Application Review
    • Beam Nonuniformity Ratio (BNR) The ratio between the highest intensity in an ultrasound beam and the output reported on the meter.
      • Peak area of the maximum BNR (PAMBNR) the size of the area that produces the peak intensity
    • Effective Radiating Area (ERA) The portion of the sound head’s surface that emits ultrasonic energy.
  • 3. Clinical Application Review
    • Frequency The number of cycles per second. 1 MHz or 3 MHz frequencies are commonly used in athletic training applications. Each frequency has its own characteristics and its selection depends on the depth of the targeted tissues.
      • 1 MHz for deep tissue, 3 MHz for superficial tissue
  • 4. Clinical Application Review
    • Technique Tips
      • Overlap by half
      • Observe the speed limit (4cm/sec)
      • Appropriate treatment size area (2-3x ERA)
      • Appropriate frequency and intensity
      • Calculate thermal effect
        • Know .2 and .6 constants
  • 5. Clinical Application Review
    • Frequency Characteristics
    1 MHz 3 MHz Beam profile Relatively divergent Relatively collimating Penetration Depth 5 or more cm 0.8 to 3 cm Maximum heating rate 0.2°C (.36°F) 0.6°C (1.1°F) per min per w/cm 2 per min per w/cm 2 “ Slow heater” “Fast heater” Heat latency Longer Shorter
  • 6. Clinical Application Review
    • Selecting a Duty Cycle
      • Pulsed for non-thermal effects, acute injury
      • Continuous for thermal effects, and when heat is not contraindicated
  • 7. Clinical Application Review
    • Tissue temperature effects
        • Mild 1°C (1.8°F) increase: Reduces mild inflammation, accelerates metabolic rate.
        • Moderate 2°C (3.6°F) increase: Decreases muscle spasm, decreases pain, increases blood flow, reduces chronic inflammation.
        • Vigorous 3-4°C (5.4°F+) increase: Tissue elongation (with load applied), scar tissue reduction.
  • 8. Clinical Application Review
    • Phonophoresis
      • Moving topical anti-inflammatory medication in the tissues
      • Examples are cortisol and dexamethasone
      • Effectiveness inconclusive
  • 9. Clinical Application Review
    • Phonophoresis cont…
      • Stationary rx done with very low intensity (.25w/cm 2 or pulsed)
      • Invisible method: rubbing med into skin then applying traditional US with regular US gel.
  • 10. Clinical Application Review
    • Alternate application methods
      • Immersion
        • Small or irregular, bony areas
        • Soundhead 1 cm away from treatment area
        • Wipe bubbles off soundhead as they accumulate
        • May need higher intensity than normal
  • 11. Clinical Application Review
    • Alternate application methods cont…
      • Gel pad
        • Irregular areas
        • Apply thin layer of US gel on both sides of gel pad
      • Combination with electrical stimulation
        • Muscle spasm
  • 12. Clinical Application Review
    • Contraindications
      • Never over or near spine, heart, head or genitalia/reproductive organs (includes abdomen)
      • Growth plates
      • Pregnancy
      • Cancer
      • Infection
  • 13. Clinical Application Review
    • Contraindications cont..
      • Joint replacements
      • Cardiac pacemaker
      • Persons with vascular probs (ie: thrombophlebitis)
      • Areas of decreased sensation
      • Metal implants: check with physician
  • 14. Clinical Application Review
    • State practice acts vary on use of therapeutic ultrasound by certified athletic trainers
    • In NJ, standing orders or physician script required
  • 15. Clinical Application Summary
    • Ask yourself…
      • Do you know US terminology?
      • Do you know US indications and contraindications?
      • Do you know how to select the appropriate treatment parameters?
      • Can you calculate the thermal effect of US?
      • Can you explain the benefits of US?
      • Do you know all of the methods to administer US?
    If yes to all of these, then you are a well-prepared AT Student!
  • 16. References
    • Denegar et al. Therapeutic Modalities for Musculoskeletal Injuries.
    • Knight and Draper, Therapeutic Modalities; The Art and Science.
    • Starkey, Therapeutic Modalities.