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

Deep Heat: Ultrasound Flashcards

(72 cards)

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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
Intensity equation
W/cm^2
26
US can be transmitted, absorbed, reflected and ____; it depends on the ____ and tissue ____ (impedance).
refracted; angle; type
27
Acoustic impedance is
material / tissue's ability to transmit sound molecular density and structure of material/tissue
28
If acoustic impedance is low, transmission is ___ and materials absorb ____ sound
high; little
29
Greater changes in impedance = greater % of energy is
reflected | i.e. muscle/bone interface
30
The depth of penetration is ____ related to frequency
inversely
31
Lower frequency causes ___ penetration
deeper
32
Higher frequency causes ____ penetration | not increase/decrease; think about what layer is penetrated with a higher freq on US machine
superficial
33
Due to increased attenuation (decrease in sound energy by increased absorption/dispersion), higher frequency US is more
superficial
34
Factors affecting absorption of US waves/energy include
- attenuation - US frequency - Mode - Intensity of US wave - Tissue composition - Medium used for transmission - Angle of US beam
35
The angle of the US beam should be ____ deg from perpendicular
15
36
What are the 6 physiologic effects of US? | TM MC HN
1. Thermal 2. Mechanical 3. Muscular 4. Connective Tissue 5. Hemodynamic 6. Neurologic
37
The thermal effects of US include
deep heating increased metabolic rate, decreased muscle spasm/pain, increased blood flow, increased collagen extensibility and decreased sympathetic activity
38
What are the 2 main mechanical effects of US (non-thermal)? | hint: MC
1. Microstreaming | 2. Cavitation
39
What is microstreaming?
Small magnitude movements of ions and cellular fluids that alter cellular activity and cell membrane permeability
40
What is cavitation?
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
Rate and magnitude of mm temp depend upon (3) | IDF
- intensity - duration - frequency
42
No studies completed looked at ____ of temp elevation in human mm after US treatment
duration
43
Connective tissue heats up faster and to a higher temp than mm because connective tissue is more ____, has higher _____ content and is more __vascular
dense collagen avascular
44
The thermal mechanism of US include
Increased tissue temperature as US energy is absorbed Local blood flow then increased to area to dissipate heat
45
Non thermal mechanisms of US on hemodynamics include
1. Reflexive vasodilation | 2. Local histamine release changes vascular tone
46
Regardless of mechanism, blood flow returns to baseline less than ___ after US
1 minute
47
Motor nerve conduction velocities (MNCV) change during US can be
increased, decreased or stay the same
48
Sensory nerve conduction velocities (SNCV) appear to ____ with thermal US
increase
49
___ perception also can be altered in US
pain
50
Thermal is achieved with _____ US
continuous | 0.75-3.0 w/cm2
51
Non-thermal is achieved with ____ US or ___ intensity continuous US
pulsed; low
52
The gentle tissue temperature rise should be ___ enough not to cause pain, ____ enough for depth of penetration and ____ enough for heating to occur
low; high; long
53
What are the main clinical uses of US?
1. Inflammation a. Pain b. Edema 2. Tissue Healing
54
For tissue healing, what does US promote?
- # of tissue repair cells - collagen - protein synthesis
55
Pain is ____ and Edema is ____ effect-wise with US
thermal; non-thermal
56
US ___ circulation, ___ mobility, and ____ extensibility of collagen
increases; increases; increases
57
What are the main 5 indications for using US?
1. Contractures/scarring 2. Chronic arthritis 3. Muscle strain/spasm 4. MM Guarding/trigger pts 5. Subacute/chronic inflammation
58
What are contraindications for using US?
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
What are precautions to using US?
1. Unhealed Fx sites 2. Primary repair of tendon or ligament 3. Osteoporosis 4. Plastic implants 5. Metal implants
60
When using indirect contact, you either are doing ______ or _____
water immersion; gel pad
61
Indirect contact only delivers how much energy vs direct contact?
32%
62
Phonophoresis uses what in addition to US gel?
hydrocortisone (10%) or lidocaine
63
DON'T DRAG _____ in the gel for US
tip of gel bottle
64
If selecting pulsed US, you also have to select
the duty cycle
65
The size of the treatment area should be ____x size of the soundhead (____x ERA)
2-3; 3-4
66
Pressure on the transducer should ____ skin and be moving ______
indent; continuously
67
The appropriate time using US should be _____ minutes per site
5-10
68
Less than ____ minutes shows NO physiological effects
3
69
__ MHz takes 10 minutes to reach a therapeutic temperature, so ___ MHz is advised as it is faster
1; 3
70
What 2 motions are used with US?
Either longitudinal stoking or circular movements
71
The US Intensity should be ____ with more acute conditions and ____ with chronic conditions/CT shortening
lower; higher
72
The transducer/sound head MUST be.......when starting
in contact with skin | otherwise crystal will break with air contact

PT 6221: Therapeutic Procedures (7 decks)

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