Therapeutic Ultrasound

Question 1

What is therapeutic ultrasound?

Answer 1

Type of sound wave
Frequency is greater than 20,000 Hz (Cycle per second)
Exceeds the limits of normal human hearing

Question 2

What is the physical effect of ultrasound?

Answer 2

Thermal & Non-thermal

Question 3

What does the thermal effect of ultrasound do?

Answer 3

Increase tissue temp

Question 4

What does the non- thermal effect of ultrasound do?

Answer 4

Acoustic streaming
Microstreaming
Cavitation
May alter cell membrane permeability

Question 5

What type of ultrasound do you use to produce thermal effects?

Answer 5

Continuous

Question 6

What type of ultrasound do you use to produce non thermal effects?

Answer 6

Pulsed

Question 7

What are the thermal effects of ultrasound?

Answer 7

Acceleration of metabolic rate
Reduction or control of pain & muscle spasm
Alteration of nerve conduction velocity
Increased soft tissue extensibility

Question 8

True or false: Ultrasound heats tissue with a high absorption coefficient more than tissues with low absorption coefficents

Answer 8

True

Question 9

Is ultrasound ideal for heating muscles>

Answer 9

No b/c muscle has relatively low absorption coefficient & most muscle are larger than transducer

Question 10

True or False: Tissues with higher absorption coefficients generally have higher collagen content

Answer 10

True

Question 11

What factors affect the amount of temperature increase?

Answer 11

Tissue
Frequency
Intensity
Duration

Question 12

What is one big thing that does not affect the amount of temperature increase?

Answer 12

Speed does not affect temperature change

Question 13

What can happen if ultrasound intensity is too high? And what should you do?

Answer 13

Patient will most likely complain of deep ache because you are overheating the periosteum
You should reduce ultrasound intensity immediately

Question 14

What can happen if ultrasound intensity is too low>

Answer 14

Patient will not feel any increase in temperature

Question 15

What should tissue temperature be when using ultrasound?

Answer 15

40-45 *C

Question 16

What is cavitation?

Answer 16

Formation, growth, & pulsation of gas filled bubbles caused by ultrasound

Question 17

What is Microstreaming?

Answer 17

Microscope Eddying that occurs near any small vibrating ultrasound

Question 18

What is acoustic streaming?

Answer 18

Steady circular flow of cellular fluids induced by ultrasound

Question 19

What are some clinical indications for ultrasound?

Answer 19

• Soft tissue shortening
• Pain control
• Soft tissue healing
• Tendon & ligament injuries
• Bone Fx
• CTS
• Phonophoresis

Question 20

How can ultrasound aid in pain control?

Answer 20

• Stimulation of cutaneous thermal receptors
• Increased soft tissue extensibility
• Changes in nerve conduction
• Modulation of inflammation

Question 21

How can ultrasound aid in soft tissue healing?

Answer 21

May accelerate healing of vascular & pressure ulcers

Question 22

What effect does ultrasound have on tendon & ligament injures?

Answer 22

Reported to reduce tendon inflammation & to assist in healing of tendon & ligament after surgical incision

Question 23

Is ultrasound supported for neck pain?

Answer 23

No

Question 24

Is ultrasound supported for hip pain, mobility deficits, OA?

Answer 24

Moderate recommendation but therapeutic exercise is better

Question 25

Is ultrasound supported for heel pain?

Answer 25

No

Question 26

What is phonophoresis?

Answer 26

Use of ultrasound to promote transdermal drug delivery

Question 27

How does phonophoresis work?

Answer 27

Works by increasing permeability of stratum corneum through cavitation Once applied through skin the meds becomes systemic due to vascular network

Question 28

What medication is used with phonophoresis?

Answer 28

Used to deliver a corticosteroid anti-inflammatory medication (dexamethasone) for inflammatory conditions

Question 29

Can phonophoresis be useful when using an NSAID or corticosteroid?

Answer 29

More useful with NSAID but not as effective as with a corticosteroid

Question 30

What are the advantages of phonophoresis?

Answer 30

-Safe -Non invasive - Painless - Avoids GI tract (no 1st pass or GI irritation) - Can apply to specific area

Question 31

What are contraindications for ultrasound?

Answer 31

- Malignant Tumor - Pregnancy - Over central nervous system tissue - Total joint replacement - Pacemaker (within 6 months) - Thrombophlebitis - Over the eye - Over the reproductive organ

Question 32

What are the precautions to ultrasound?

Answer 32

- Acute Inflammation - Epiphyseal plates - Fractures - Breast Implants

Question 33

What are some adverse effects to ultrasounds?

Answer 33

Burn Cross Contamination

Question 34

How can you prevent someone from being burned with ultrasound?

Answer 34

Always move ultrasound head Do not apply thermal ultrasound to areas of impaired circulation or sensation

Question 35

What is the application technique for using ultrasound?

Answer 35

1. Evaluate patient clinical finding & goals of treatment 2. Determine whether ultrasound is appropriate 3. Check Contraindication & precautions 4. Apply US transmission medium to area to be treated 5. Select a sound head with ERA approx half the size of treatment area 6. Select parameters 7. Wipe sound head w/ alcohol prep pad 8. Place sound head on treatment area 9. Turn on ultrasound machine 10. Move sound head within treatment area 11. Remove everything 12. Reassess patient for changes 13. Document

Question 36

When wanting to apply heat to superficial tissue what frequency should you use of ultrasound?

Answer 36

3MHz

Question 37

When wanting to apply heat to deep tissue what frequency should use of ultrasound?

Answer 37

1MHz

Question 38

What is the duty cycle when wanting to get a thermal effect with ultrasound?

Answer 38

100% continuous

Question 39

What is the duty cycle when wanting to get non-thermal effect with ultrasound?

Answer 39

20-50% pulsed