IMMEDIATE EFFECT OF ULTRASOUND ON PAIN MANAGEMENT FOR HEALTHY INDIVIDUAL WITH TRAPEZITIS

Transcription

1

2 IMMEDIATE EFFECT OF ULTRASOUND ON PAIN MANAGEMENT FOR HEALTHY INDIVIDUAL WITH TRAPEZITIS Submitted by: SWATI S. DHRANGU (12SPTPT11025) HIRAL R. GAMDHA (12SPTPT11026) 6 th semester, JULY, 2015 Guided by: DR. PRIYANSHU V. RATHOD, PT, PhD, DIRECTOR, OF SOPT, R K University I

3 CERTIFICATE This is to certify that the project work entitled IMMEDIATE EFFECT OF ULTRASOUND ON PAIN MANAGEMENT FOR HEALTHY INDIVIDUAL WITH TRAPEZITIS has been undertaken and written under my supervision and it describes the original research work carried out by Miss. SWATI S. DHRANGU and Miss. HIRAL R. GAMDHA registered at RK University in 6 th semester Bachelors of Physiotherapy. DR. PRIYANSHU V. RATHOD, MPT, PhD DIRECTOR, SOPT, RK University II

4 DECLARATION We here by certify that we are the authors of this project work. We certify to the best of our knowledge, our project does not infringe upon anyone s copyright nor violate any proprietary rights and that any ideas, techniques, quotations, or any other material from the work of other people included in our project published or otherwise, are fully acknowledged in accordance with the standard referencing practices. We declare that this is a true copy of our project, including any final revisions, as approved by my project review committee. Ms. Swati Subhashbhai Dhrangu Ms. Hiral Rameshbhai Gamdha Enrolment no: 12sptpt11025 Enrolment no: 12sptpt11026 Date: 16/7/2015 Date: 16/7/2015 Place: Rajkot Place: Rajkot III

5 ACKNOWLEGEMENT First and foremost we would like to thank our parents Mr. Subhashbhai Dhrangu, Mrs. Rambhaben and Mr. Rameshbhai Gamdha, Mrs. Nirmalaben Gamdha who are our living Gods and my brother Mr. Nirav R. Gamdha for their valuable support and encouragement, blessing and love which has always been a source of inspiration and strength in accomplishing this academic task. Our heartfelt gratitude to almighty God who has guided us this far and to whom goes all the honor and glory for the successful completion of this study. We wish to express our regards to our Director Dr. Priyanshu V. Rathod School of Physiotherapy, RK. University for his whole hearted guidance and meticulous suggestions in the completion of this work and for all the facilities and support extended to us during this study. We are extremely thankful for his constant encouragement and inspiration during the course of this study. With due respect, we would like to express our sincere thanks to my guide Dr. Priyanshu V. Rathod director of School of Physiotherapy, RK. University, for his judicious information, expert suggestions, valuable guidance, continuous support, incessant reassurance during every stage of this work and interest shown in this dissertation without which this work would not have been possible. We would like to extend our heartfelt thanks to assistant lecturer, Dr. Shweta rakholiya and Dr. vaibhavi ved for their valuable guidance, constant help and support throughout this study and all the lecturers of our college who have taught us and gave their valuable suggestions during the course of the study. IV

6 Our sincere thanks to Dr. Shweta Rakholiya for taking keen interest in our study, guiding us through the path, giving us support and motivation during the course of study We wish to express our thanks to Mr. Harshan Anjari our librarian for their timely help in lending our books and journals for our reference all the time. We shall fail our duties if we don t acknowledge our Colleagues and Friends for their suggestions and criticism while assisting us in this study. Last but not the least we would like to thanks all the Individuals in our study without whom this task would not have been possible. Our sincere thanks to all the contributors whose names we might have missed but who truly deserve our gratitude. We would like to thank once again to all who have helped us all the while. Ms. Swati Subhashbhai Dhrangu Ms. Hiral Rameshbhai Gamdha V

7 LIST OF ABBREVIATIONS 1.NPRS :- Numerical pain rating scale 2 PPAM :- Pain pressure algometer 3 SOPT :- School of physiotherapy VI

8 ABSTRACT BACKGROUND: Ultrasound therapy is a form of physical therapy that uses high frequency sound waves. It is one of the most common instrument of electrotherapy practiced in physiotherapy for management of pain in trapezitis conditions.however, acute effect relief pain is one of the major challenges in physiotherapy practice as compared to prolong management, thus we would like to find out the acute effect of ultrasound in pain management by of trapezitis conditions. AIM: To review the scope of immediate pain management by ultrasound in trapezitis condition. To understand the Pathophysiological effect of ultrasound in acute or immediate pain relief. METHODOLOGY:- Study Design: Experimental clinical trial, Sample Size:30 Subjects,Sampling Technique :Convenient sampling, Study setting : SOPT RK University, Study Population :College students age between 18 to 25 years Inclusion criteria: subject with trapezitis Pain (acute or chronic) including soft tissue injures, trapezitis Pain and spasm, Exclusion criteria:-history of hospitalization in last six month. RESULTS: There was significant decrease value of NPRS and increase value of PPAM and decrease tenderness. CONCLUSION: Immediate effect of ultrasound must be taken into consideration in physiotherapy practice for management of trapezitis. KEY WORDS: Ultrasound, Trapezitis, pain management VII

9 TABLE OF CONTENTS Sr. No. TITLE Page No. 1. INTRODUCTION 1 2. AIMS & OBJECTIVES 6 3. REVIEW OF LITERATURE METHODOLOGY RESULTS DISCUSSION CONCLUSION SUMMARY BIBLIOGRAPHY ANNEXURES 40 VIII

10 LIST OF FIGURES SR. NO. FIGURES PAGE NO. 4.1 Ultrasound machine 4.2 Machine operating 4.3 Treatment of the study 10.1 Numerical pain rating scale 10.2 Pain pressure algometer IX

11 LIST OF TABLES Sr. NO. TABLES Page No. 5.1 Pre and post Difference in Numerical Pain Rating Scale Pre and Post Difference in Pain Pressure Algometer Pre and Post Difference in Tenderness 27 X

12 LIST OF GRAPHS SR. NO. GRAPHS PAGE NO. 5.1 Mean of pre and post difference between NPR Scale Mean of Pre and post difference between PPAM. 5.3 Mean of pre and post difference between tenderness XI

13 INTRODUCTION TRAPEZITIS 1

14 INTRODUCTION Trapezitis is an inflammatory pain arising from the trapezius muscle causing a severe neck spasm. This muscle lies at the back of the neck and helps in shrugging movement of the shoulders along with upward movement of the head. 1 The upper trapezitis is that part of the trapezius muscle extending from the occiput to the lateral third of the clavicle and acromion process of the scapula. A strain of this muscle results in pain in posterolateral region of the neck. 2 Bed posture is frequently incrimated as the cause of trapezitis. Watching television or working on a computer with an awkward posture or even use of a thick pillow can cause neck spasm. 1 There are several physiotherapy adjuncts which are proved to be effective in trapezitis. One of which is ultrasound. 3 Ultrasound refers to mechanical vibrations, which are essentially the same as sound waves but of a higher frequency. 3 Effects of ultrasound application include increased rate of tissue repair and wound healing, increased blood flow, increased tissue extensibility, breakdown of calcium deposits, reduction of pain and muscle spasm through alteration of nerve conduction velocities and changes in cell membrane permeability. 4 Ultrasound accelerates inflammatory phase of tissue healing and shown positively influence macrophage activity and to increase adhesion of leucocytes to the damaged endothelial cells. 5 Ultrasound directly influences the transmission of painful impulses by eliciting changes within the nerve fibers themselves. Cell membrane permeability to sodium ions is changed altering the electrical activity of the nerve fibers and elevating the pain threshold. 5 The length of treatment depends on the size of the area being treated, the output intensity and the therapeutics goals of the treatment. 3 TRAPEZITIS 2

15 Numerical pain rating scale: The numerical rating scale has been widely used clinically for the assessment of pain.it is used for clinical researches controversial. Physiotherapists will evaluate the outcome from physiotherapy treatment using an evidence-based outcome measure. Two measure have been recommended the for routine use: the patient specific functional scale outcome measure and the numeric pain rating scale 6 Pain pressure Algometer: Pain threshold measurement provides unique information not obtainable by any other method. This document can be used for clinical and research purposes. For patient the objective measurements give reassurance, confirming their improvement. 7 Tenderness: only after the tissue at fault has been identified is palpation for tenderness used to determine the exact extend of the lesion within that tissue, and then palpation is done only if the tissue lies superficially and within easy reach of the fingers. Palpation is an important technique that must be practiced if it is to be used effectively. Tenderness often does enable the examiner to name the affected ligament or the specific section or exact point of the tearing or bruising. 8 TRAPEZITIS 3

16 NEED OF THE STUDY TRAPEZITIS 4

17 NEED OF STUDY However, immediate effect of relief pain is one of the major challenges in physiotherapy practice as compared to prolong management, thus we would like to find out the immediate effect of ultrasound in pain management by of trapezitis conditions. TRAPEZITIS 5

18 AIM AND OBJECTIVES TRAPEZITIS 6

19 Aim To review the scope of immediate pain management by ultrasound in trapezitis condition. Objects To Understand the Pathophysiological effect of ultrasound in immediate pain relief. TRAPEZITIS 7

20 HYPOTHESIS TRAPEZITIS 8

21 Hypothesis Null hypothesis: There is no significant difference pain reduction immediately often application of ultrasound in patients with Trapezitis pain. Alternative hypothesis: There is a significant difference in reduce pain in patients with Trapezitis pain. TRAPEZITIS 9

22 REVIEW OF LITERATURE TRAPEZITIS 10

23 Review of literature Review of literature for ultrasound: Young ET. Al. studied that when ultrasound enters the body, it can exert effects on cell and tissues via thermal and non-thermal mechanism of which some are still inconclusive. Young et al. also found that there is positive effect of ultrasound on inflammatory phase of tissue healing. Marij et al. studied that ultrasound influences transmission of painful impulse and elevates pain threshold. Review of literature for trapezitis: Draper Do studied that the results of the study showed that ultrasound therapy is effective in the management of chronic trapezitis. Aarti kamath studied that the effect of ultrasound therapy with strengthening exercises for trapezitis. Review of literature for NPRS: Agency for health care policy research studied that Physiotherapists will evaluate the outcome from physiotherapy treatment using an evidence-based outcome measure. TRAPEZITIS 11

24 Review of literature for PPAM: studied that. For patient the object measurements give reassurance, confirming their improvement Review of literature for Tenderness: David j Maggie studied that tenderness often does enable the examiner to name the affected ligament or the specific section or exact point of the tearing or bruising. TRAPEZITIS 12

25 METHODOLOGY TRAPEZITIS 13

26 Methodology Study Design: - Experimental clinical trial Study setting: - SOPT RK University Sampling Technique: - Convenient sampling Study Population: - College students (Male and Female) Study Sample: - 30 Study Duration: - Training duration 5-8 min. per subject Total study duration 1 day session TRAPEZITIS 14

27 CRITERIA FOR SELECTION INCLUSION CRITERIA: 1. Male and female, 2. Trapezitis Pain (acute or chronic) including soft tissue injures, 3. Trapezitis Pain and spasm EXCLUSION CRITERIA: 1. History of hospitalization in last six month. TRAPEZITIS 15

28 MATERIALS USED IN THE STUDY 1. Ultrasound machine (electroson 709) 2. Ultrasound couplant Gel 3. Dayclofanic Gel 4. Cotton 5. Pillow 6. Chair 7. Paper 8. Pen 9. Measures (pain pressure algometer, NPR Scale) TRAPEZITIS 16

29 Method Subject will be called as volunteers following to screening with inclusive / exclusive criteria for the study, after taking ethical informed written consent from subjects study will be executed. Before starting the treatment, patient should be in comfortable butterfly position. Take the NPRS of subject. Then check the tenderness over trapezius muscle and pain pressure algometer. Apply the ultrasound over the symptoms which were acute or chronic. Instruct the subject that inappropriate sensation or excess heat or pain feels then report to the therapist. Again check the post NPRS, tenderness and pain pressure algometer. This treatment was for one day session only. Mode: - Continuous / Pulsed Frequency: - 3 MHZ (superficial) 1 MHZ (Deep) Acute condition dose: or 0.5 wt. /cm 2, Used for 5 min., for 1 day. Chronic condition dose: or 2 wt. / cm 2, Used for 8 min., for 1 day TRAPEZITIS 17

30 FIGURE 4.1 Ultrasound Machine FIGURE 4.2 Machine Operating TRAPEZITIS 18

31 FIGURE 4.3 The Therapist Giving The Treatment: TRAPEZITIS 19

32 RESULTS TRAPEZITIS 20

33 Results In present study 30 individual with trapezitis were assessed with NPR Scale, Pain pressure algometer and Tenderness grading. Outcome measures for present study were trapezitis which was effective using with ultrasound. This study was performed by pre and post NPR Scale, tenderness and pain pressure algometer. The data was analysed by Wilcoxon and paired t test. Wilcoxon is used for NPR Scale, paired t test is used for pain pressure algometer and tenderness. There is highly significant difference between pre and post in subject with NPR Scale, tenderness and pain pressure algometer. Base line characteristics No. of participants 30 No. of male 3 No. of female 27 Mean age 20 TRAPEZITIS 21

34 3 male female 27 TRAPEZITIS 22

35 Table 5.1 Table suggests pre and post difference in NPRS for immediate effect of Ultrasound with Wilcoxon test. Pre and post difference in NPR Scale Data Mean SD W value P value Significant difference Pre NPRS Post NPRS < Yes(HS) NPRS: - Numerical pain rating scale S:- Significant, HS :- Highly significant, NS :- Not significant Interpretation:-The above table shows the mean difference of pre NPRS is 4.10 and post NPRS is Result shows that there is significant difference is < TRAPEZITIS 23

36 Graph 5.1 Graphical representation is suggesting significant difference in mean values for NPRS NPRS PRE NPRS 1.83 POST NPRS NPRS: - Numerical pain rating scale TRAPEZITIS 24

37 PAIN PRESSURE ALGOMETER: Table 5.2 Table suggests pre and post difference in Pain pressure algometer (PPAM) for immediate effect of Ultrasound with paired sample Test Pre and post difference in PPAM Data Mean SD T value P value Significant difference Pre PPAM Post PPAM < Yes(HS) (PPAM: - Pain pressure algometer) S: - Significant, HS: - Highly significant, NS: - Not significant Interpretation: - The above table shows the mean difference of pre PPAM is 2.67and post PPAM is Result shows that there is significant difference is < TRAPEZITIS 25

38 Graph 5.2 Graphical representation is suggesting significant difference in mean values for Pain pressure algometer Pain Pressure Algometer PRE PPAM POST PPAM (PPAM: - Pain pressure algometer) TRAPEZITIS 26

39 Table 5.3 Table suggests pre and post difference in Tenderness grade for immediate effect of ultrasound with paired sample Test Pre and post difference in tenderness Data Mean SD T value P value Significant difference Pre Tenderness Post Tenderness < Yes(HS) S: - Significant, HS: - Highly significant, NS: - Not significant Interpretation:-The above table shows the mean difference of pre Tenderness is 1.97and post Tenderness is Result shows that there is significant difference is < TRAPEZITIS 27

40 Graph 5.3 Graphical representation is suggesting significant difference in mean values for Tenderness grade. 2.5 Tenderness PRE Tenderness POST Tenderness PRE Tenderness POST Tenderness TRAPEZITIS 28

41 DISCUSSION TRAPEZITIS 29

42 Discussion Trapezitis is an inflammatory pain arising from the trapezius muscle causing severe neck spasm. This muscle lies at the back of the neck and help in shrugging movement of the shoulders along with upward movement of the head. As the ultrasonic waves are absorbed they are converted to thermal energy(heat).the amount of heat produced depends upon factors such as the number of time per second the transducer passes over a part and on the space average intensity(watts/cm 2 ) used. Reflection of ultrasound may occur at tissue interfaces, producing a concentrated heating effect at that point. This is particularly likely at the interface between periosteum and bone. As reflection from bone occurs there is double the intensity of ultrasound in the periosteum region which may cause localized overheating and can manifest itself as periosteum pain. In practical term this means that it is best to avoid passing the ultrasonic head over subcutaneous bony point if possible. Non thermal effect is caused by the pressure changes applied to the tissue by the sound waves. It gives cavitation and micro massage effect. Chemical and biological effect produces by the ultrasonic beam. Ultrasound provide many physical benefit including reliving pain, reliving tenderness increase calcium uptake, increase secretion from cell and giving effect on micro massage and acoustic streaming. In acoustic streaming when beam of sound travelling through and absorbing medium, radiation pressure action along the beam axis is produced. There is also pressure generated on any structure which reflects the sound energy. This result in a flow or streaming. That two type s bulk and micro massage. In bulk streaming that is visible when testing output of ultrasound equipment and that can occur in any fluid being insonated. Effects of ultrasound application include increase rate of tissue repair and wound healing, increase blood flow, increase tissue extensibility, breakdown of calcium TRAPEZITIS 30

43 deposits, reduction of pain and muscle spasm through alteration of nerve conduction velocities and changes in cell membrane permeability. The study was done on the subject with trapezitis pain is selected to apply above method to reduce pain and tenderness. Pain was measured by NPR Scale and tenderness measured by grade and they also direct related to PPAM. So using this test we can to know a changes in trapezitis pain and tenderness. Subjects were taken accordingly to inclusion criteria. The single application of ultrasound was given to relevant group and reading taken. The result of this study suggested that 5to8 min duration of ultrasound is an effective amount of time sustain a trapezitis in reduce pain. Marij E Roebroect [vol.78] studied that ultrasound influence transmission of pain full impulses & elevates pain threshold. Draper Do studied that the results of the study showed that ultrasound therapy is effective in the management of chronic trapezitis. TRAPEZITIS 31

44 LIMITATIONS OF THE STUDY The machine should be calibrated. TRAPEZITIS 32

45 FURTHER RECOMMENDATION To find out the individual effect of ultrasound with or without analgesic gel. This study can be measured by other functional outcome. TRAPEZITIS 33

46 CONCLUSION TRAPEZITIS 34

47 Conclusion Immediate effect of ultrasound must be taken into consideration in physiotherapy practice for management of trapezitis. TRAPEZITIS 35

48 SUMMARY TRAPEZITIS 36

49 Summary This study was conduct on 30 subject with an aim to find out the acute effect of us in trapezitis condition. Patient were selected as per inclusion and exclusion criteria. This study was done day treatment protocol.it was given one time for 5 to 8 min. with continuous and pulse us as per patient condition. Outcome measured by the NPRS and PPAM. There was pair t test was use for statically analysis. The mean value of NPRS pretreatment(4.10)and post treatment(1.83).the mean value of pain pressure algometer are pretreatment(2.67) and Post treatment (1.83).The mean value of tenderness are pre-treatment(1.97)and post treatment(1.00)after statastical analysis the result showed that there was much significant improvement. Pain measured by NPRS and PPAM. TRAPEZITIS 37

50 BIBLOGRAPHY TRAPEZITIS 38

51 Bibliography 1. Dr. Gauresh ( symptoms and treatment) 2. Physiotherapy banglore.blogspot.com/ 3. Low j. & reed a. (2000) electrotherapy explained principle and practice, butterworth heinman oxford(a) (b) Marij e roebroect, joost dekkar, rob ab, oostendrop,physical therapy vol.78,no.5 may Young, sr & dyson, m (1990) macrophage responsiveness to therapeutic ultrasound, us.in medicine & biology 16, Aguilera F J, et al. J Manipulative physiol ther Agency for health care policy research (1992) complete acute pain management: operative or medical procedure and trauma, clinical practice guideline no.1, publication no , reliability and validity of pain pressure algometer. 9. David j Maggie, orthopedic physical assessment (fifth addition) / /09-T doc the result of study showed that ultrasound therapy is effective in the management of chronic trapezitis was done by researchers. 11. Forester & Palastanga, claytons electrotherapy (ninth edition). TRAPEZITIS 39

52 ANNEXURES TRAPEZITIS 40

53 ANNEXURES 10.1 ETHICAL INFORMED CONSENT FORM STUDY TITLE: IMMEDIATE EFFECT OF ULTRASOUND ON PAIN MANAGEMENT FOR HEALTHY INDIVIDUAL WITH TRAPEZITIS Subject s Name: Age : Years Sex: Address of the Subject I have been explained in details about IMMEDIATE EFFECT OF ULTRASOUND ON PAIN MANAGEMENT FOR HEALTHY INDIVIDUAL WITH TRAPEZITIS. I have also been explained that all the tests are non-invasive and without any side effect. I understand that my participation in the study is voluntary and that I am free to withdraw at any time, without giving any reason, without my medical care or legal right being affected. I understand that the data obtained through the study may be used for research paper publication and I also understand that my identity will not be revealed at any cost. I agree to give my consent for taking my photograph and have no objection against it. I agree to take part in the above study Signature / Thumb impression of the subject Date: Name of Witness: Signature of the Witness: Signature of Investigator Date: TRAPEZITIS 41

54 ANNEXURES 10.2 ASSESSMENT FORM Date: NO: NAME: AGE AND GENDER: OCCUPATION : ADDRESS: M: CHIEF COMPLAIN: PAIN HISTORY: SITE TYPE: DURATION: ONSET: FREQUENCY: AGGRAVATING FACTORS : RELIEVING FACTORS: TRAPEZITIS 42

55 Outcome measures / scores PRE US POST US NPR Scale PAIN PRESSURE ALGOMETER TENDERNESS ( Grade ) TRAPEZITIS 43

56 ANNEXURES 10.3 MEASUREMENT TOOL Measurement tools: The objective assessment of reducing pain with Trapezitis was done using this scale (NPRS) and Pain pressure algometer. Fig: 10.1 Pain pressure algometer Fig:10.2 TRAPEZITIS 44

57 MASTER CHART SR.NO. AGE GENDER NPR SCALE PAIN PRESSURE ALGOMETER TENDERNESS (GRADE) PRE POST PRE(KGS) POST(KGS) PRE POST 1 20 Female Female Female Female Female Female Female Female Female Female Male Female Female Female Female Female Female Female Male Male Male Female Female Female Female Female Female Female Female Male TRAPEZITIS 45 55