Ultrasound parameters for sprain

Transcription

1 Ultrasound parameters for sprain Hassouna H, Singh D, Taylor H, Johnson S. Ultrasound guided steroid injection in the treatment of interdigital neuralgia. Acta Orthop Belg 2007; 73:224. Gauthier G. Thomas Morton's disease: a nerve entrapment syndrome. A new surgical technique. Clin Orthop Relat Res 1979;:90. Dunn JE, Link CL, Felson DT, et al. Prevalence of foot and ankle conditions in a multiethnic community sample of older adults. Am J Epidemiol 2004; 159:491. This topic reviews the common causes of fore foot pain in the adult, including descriptions of important conditions and a discussion of how to reach a diagnosis. An overview of foot pain generally, including more detailed discussions of foot anatomy and biomechanics, and how to conduct a history and examination of the patient with foot complaints, is provided separately (see "Evaluation and diagnosis of common causes of foot pain in adults" ). A topic

2 devoted to running injuries, including footrelated problems, is also available. (See "Overview of running injuries of the lower extremity", section on 'Foot and ankle injuries'.). Glasoe WM, Coughlin MJ. A critical analysis of Dudley Morton's concept of disordered foot function. J Foot Ankle Surg 2006; 45:147. Belanger, A.-Y. (2010). Therapuetic Electrophysical Agents: Evidence Behind Practice. Philadelphia, Lippincott Williams and Wilkins. Sharp RJ, Wade CM, Hennessy MS, Saxby TS. The role of MRI and ultrasound imaging in Morton's neuroma and the effect of size of lesion on symptoms. J Bone Joint Surg Br 2003; 85:999. Kose IC, Hizal M, Bulut EG, et al. Bilateral fused os intermetatarseum presenting as dorsal foot pain: a case report. Surg Radiol Anat 2014; 36:503. Moran DS, Evans R, Arbel Y, et al. Physical and psychological stressors linked with stress fractures in recruit training. Scand J Med Sci Sports 2013; 23:443. McCormick JJ, Anderson RB. Turf toe: anatomy, diagnosis, and treatment. Sports Health 2010; 2:487. Essentially, this stimulation modality employs a monophasic pulsed current, the pulses being delivered in a doublet (hence the 'twin peak' term). Each pulse is of short duration (typically less than 200µs), but, as the name implies, at a high peak voltage (up to 500V, typically V). By virtue of the fact that each pulse is very short, the current flow through the tissue will average to a very low level - thus the links with microcurrent type therapies. This site uses cookies. By continuing to browse this site you are agreeing to our use of cookies. Stewart S, Dalbeth N, Vandal AC, Rome K. The first metatarsophalangeal joint in gout: a systematic review and meta-analysis. BMC Musculoskelet Disord 2016; 17:69. The Stralka et al (1998) study (in Oedema section below) also suggests that HVPC can make a useful contribution to pain management issues. Section Editor

3 Biomechanics, Rehabilitation, and Recovery; Sports-Related Injuries; Symptom Assessment and Physical Examination. Robertson, V. J. et al (2006). Electrotherapy Explained: Principles and Practice. Oxford, Elsevier. Support Tag: [ EFE554 - PR14 - UPT :53:22GMT]. Hsi WL, Kang JH, Lee XX. Optimum position of metatarsal pad in metatarsalgia for pressure relief. Am J Phys Med Rehabil 2005; 84:514. The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the. There has been a range of research over the years looking to see if muscle strengthening can be achieved with EStim - ranging from Interferential therapy, through Russian Stimulation to NMES based interventions. Yakut et al (2001) compared different e stim applications alongside an exercise programme, evaluating strength and pain changes. The HVPC was demonstrated to be the stimulation modality which provided best pain relief along side a strengthening effect (which was found with all groups). Thomson CE, Gibson JN, Martin D. Interventions for the treatment of Morton's neuroma. Cochrane Database Syst Rev 2004;:CD Overview of running injuries of the lower extremity. In a similar way to the pulse ratio decision, the intensity of ultrasound required at the target tissue will vary with the tissue state. The more acute the lesion, the less strong the ultrasound needs to be in order to achieve/maintain the tissue excitement. The more chronic the tissue state, the less sensitive, and hence the greater the intensity required at the lesion in order to instigate a physiological response. It is of note that it is the state of the tissue that

4 determines the most appropriate pulse ratio rather than simply the duration since the onset of the lesion. In a similar way to the clinical decision making process in manual or other therapies, tissue reactivity is the key. If the tissue in question behaves in an acute manner on assessment, then the lesion is effectively treated with an 'acute' dose. If it behaves as a chronic, less responsive tissue, then treat with a 'chronic' dose. Some patients will present several weeks after an injury or lesion onset, yet the problem exhibits 'acute behaviour' and should treated accordingly. Similarly, some lesions appear to move swiftly into chronic behaviour mode, and these are best managed with a dose estimated for chronic lesions. The key here is to treat what you find at assessment, rather than what the timescale says should be there. There is not need to measure the treatment head, it is a matter of estimating the number of time the head fits onto the target tissue rather than a millimetre by millimetre measurement. There IS a need to increase the surface dose to allow for loss of ultrasound at depth, and using the tables above, it is estimated that the required surface dose will need to be 0.75 W/cm2 (though of course this will depend on the size There is no need to increase the surface dose to allow for loss of ultrasound at depth. The greater the size of the lesion, the longer the duration of the ultrasound that will be required in order to achieve a particular effect. The most common method to take account of this factor is to estimate the number of times which the ultrasound treatment head to be utilised can be placed over the target tissue. Assuming that on examination, the primary focus of the lesion is determined to be at the anterior capsule of the glenohumeral joint, the following clinical decisions are made:. The following 'dose calculations' offer one method (by no means the only one) by which the most likely clinically effective dose can be established. There is

5 no guarantee the resulting dose will work, but it does offer a mechanism by which the dose which is most likely to work can be estimated. Ultrasound treatment for an acute lesion of the lateral collateral ligament of the knee. It is suggested that pulse ratios of 1:4 are best suited to the treatment of acute lesions, reducing this as the tissue moves towards the chronic state moving through 1:3 and 1:2 to end up with 1:1 or continuous modes. Some machines are unable to deliver the most effective treatment modes and the therapist will need to compromise the treatment dose according to the facilities that are available. THE FOLLOWING TEXT IS AN EXPLANATION OF THE FLOWCHART ABOVE, AND IF YOU WANT TO CITE IT (OTHER THAN AS A WEB REFERENCE) YOU CAN USE THE Watson (2002) REFERENCE (ON THE. Ultrasound Pulsed (Duty Cycle %) modes and their selection. There is no need to increase the surface dose to allow for loss of ultrasound at depth. Russian Stimulation and Burst Mode Alternating Current (BMAC). The final compilation of the treatment dose which is most likely to be effective is based on the principle that one needs to deliver 1 minutes worth of ultrasound energy (at an appropriate frequency and intensity) for every treatment head that needs to be covered. One important factor is that some of the ultrasound energy delivered to the tissue surface will/may be lost before the target tissue (i.e. in the normal or uninjured tissues which lie between the skin surface and the target). In order to account for this, it may be necessary to deliver more at the surface than is required, therefore allowing for some absorption before the lesion, and allowing sufficient remaining ultrasound to achieve the desired effect. To identify the appropriate dose to set on the machine, determine (a) the estimated depth of the lesion to be treated and (b) the intensity of ultrasound required at that depth to achieve the desired effect. The intensity to

6 set on the machine is that which is indicated where the two columns/rows meet. Working on the principle of 1 minutes worth of ultrasound per treatment head area, the total time taken to treat the lesion will be (1 minute) x (number of times the treatment head fits over the lesion) x (the pulse ratio) which in this instance = (1) x (2) x (3) = 6 minutes. The lesion is acute, therefore a pulse ratio of 1:4 will be most appropriate. The lesion is superficial, hence a 3MHz frequency would be most appropriate. Ultrasound treatment of a chronic lesion of the anterior capsule of the shoulder (glenohumeral joint. This page provides information about interpreting the various statistical tests utilized in journal articles, and contains other information regarding Evidence-based Practice. As the chiropractic profession delineates its role in the emerging health care marketplace, it will become increasingly important that the scope of appropriate chiropractic care is clearly defined relative to overall patient case management. Therefore, the Council on Chiropractic Guidelines and Practice Parameters engaged in a multidisciplinary consensus process addressing the terminology related to levels of care. These recommendations have been updated by the 2016 article:. Best Practices for Chiropractic Care of TEENren: A Consensus Update. This section was compiled by Frank M. Painter, D.C. Send all comments or additions to: Chiropractic wellness care (sometimes referred to as maintenance care [MC]) is accepted by the profession as an integral part of chiropractic practice. [ 16 ] The theory of MC suggests that ongoing chiropractic care may have value in maintaining and promoting health, as well as preventing disease. [ 7 ]. The findings of the CCGPP literature synthesis particularly support, although clinical practice is not limited to, the use of manual therapeutic techniques (such as manipulation and mobilization procedures), patient education regarding

7 reassurance, staying active and avoiding illness behavior, and also rehabilitative exercise as the therapeutic basis for care for low back conditions. It is also important to note that the CCGPP recommendations in support of manipulation for both acute and chronic low back pain closely mirror many other systematic reviews of the literature. For example, Bronfort et al6 have also recently concluded that manual therapeutic methods, such as spinal manipulation and mobilization methods, combined with active care/exercises have been shown to be effective in the management of chronic back pain. Chiropractic Management of Low Back Disorders: Report From a Consensus Process. This is an update of the 2010 Consensus Document titled:. Best Practices for Chiropractic Care of TEENren: A Consensus Update. By 2030, nearly 1 in 5 US residents is expected to be 65 years or older. [ 1 ] Chiropractors commonly provide care to older adults in the United States, with approximately 14% of chiropractic patients being 65 years or older. [ 2 ] With musculoskeletal conditions cited as a leading cause of disability in this population, [ 3 ] it is important that the large body of evidence for the effectiveness of chiropractic care be examined for relevance to the geriatric population. This is particularly important given the statements made by the American Geriatric Society ( AGS ) in their clinical practice guidelines for the management of chronic pain in older adults. The 1998 AGS report made the following recommendation on chiropractic (based on the single study available at that time): [ 4 ]. In North America the relentless upwards spiral of healthcare costs in the last quarter of the 20th century produced the current era of managed care. There is no question that the excessive cost of American medical care needed to be reined in. There is also no question that third party payers in managed care have been ruthless in

8 establishing rules and procedures based on financial targets rather than reasonable patient care. Money that should be going to patient care is going to a bloated administration and managed care owners. In the US the ratio of physicians to administrators is now almost 1 to 1 (1 to 0.95). ( CCGPP ) in [ 6 ] The organization sponsored and/or participated in the development of a number of best practices recommendations on various conditions. [ 2132 ] With respect to chiropractic management of LBP, a CCGPP team produced a literature synthesis [ 8 ] which formed the basis of the first iteration of this guideline in [ 9 ] In 2010, a new guideline focused on chronic spine-related pain was published, [ 12 ] with a companion publication to both the 2008 and 2010 guidelines published in 2012, providing algorithms for chiropractic management of both acute and chronic pain. [ 10 ] Guidelines should be updated regularly. [ 33, 34 ] Therefore, this article provides the clinical practice guideline (CPG) base