electrophysical agents
TRANSCRIPT
Electrophysical Agents
Case Study
Question
• A patient presents with a chronic injury to the tendon of supraspinatus following a fall onto the point of shoulder several months earlier.
Supraspinatus• A muscle that connects the scapula to the
humerus• Origin: Supraspinous fossa of the scapula• Insertion: Greater tuberosity of humerus• Action:
– Abduction of the arm (early range & following that is done by anterior fibers of deltoid)
– Also stabilizes shoulder joint as it is part of the rotator cuff muscles
Supraspinatus as aRotator cuff Muscle
• Tendon fuse into the underlying capsule of the shoulder joint
• Plays an important role in stabilizing the shoulder joint
• Tone of muscle assists in holding the head of humerus in the glenoid cavity of scapula during shoulder joint movements
Subjective Assessment
How long has the pain been Onset- Months
What movements trigger pain To confirm that the movement is abduction of
arm as it is the specific movement carried out What daily activities trigger pain
To find out what ADL(s) it affects Find out if patient plays sports and if it is
swimming or throwing sports Pain Intensity
To plan out type of exercise and treatment
Questions to ask the patient/
Complaints
Objective Assessment
1. Look out for Swelling or Oedema2. AROM/PROM- AROM first, then
PROM. Assess if movement inhibited by pain, impingement, tightness etc
3. Pain Rating4. Muscle Strength5. Palpation- Check for painful spots,
muscle tightness, muscle wasting
Goals
• Short-term goal– Increase range of motion (abduction);
active range– Pain relief
• Long-term goal– Restore to full range of motion
(abduction)– Permanent pain relief
Treatment
Possible Modalities
•Ultrasound•Shortwave Diathermy•Heat Pack•Paraffin Wax•Microwave Diathermy•Infra-red radiation
Selection of Modalities
Cryotherapy VS Heat Therapy• Injury is chronic• Cryotherapy is more suited for acute and sub-
acute stage• Heat therapy is more suited for chronic stage
as…Useful for pain relief, swelling and
inflammation in the chronic stageTherefore, heat modalities are recommended
Advantages of thermal effects
– Promotes relaxation– Relief pain– Increase blood flow– Facilitate healing– Prepare stiff joints and tight muscles
for exercise
Modalities Temperature Change
Penetration Depth
Heat pack 2-5 Degrees 1-2 cm (Max)
Paraffin Wax 2-5 Degrees 1-2cm (Max)
Infra-red 5-6 Degree 1-2mm3mm on sole and palm
SWD Condensor- 5 DegreesInductor- 7-8 Degrees
Depend onarrangement
MWD 5-7 Degrees 3 cm
Ultrasound 8 Degrees 3MHZ- 16mm1MHZ- 50mm
Possible modalitiesUltrasound Short wave
DiathermyMicrowave
Nature of modality
Conversive heat modalities
Penetration Depth
Depth of 5cm or more
4cm is the greatest absolute heating of deep tissues
More superficial than SW; 3-4cm
Temperature change
Up to 8 deg 5 (condensor)7-8 (inductor)
5-7 deg
Duration of Temperature Change
about 30-45 minutes for alll
Physiological effects
Reduce pain & muscle spasm
Reduce pain, muscle spasm, stiffness, oedema
Reduce pain, muscle spasm, soften tissues, accelerate healing
Best Modality of Choice
• Ultrasound– Thermal effect as patient presents
chronic injury– Has deep penetration depth – Long Duration of temp change– High absorption by tendons– Easy to be match contours of shoulder– Provides sufficient coverage for a small
tissue like a tendon
List of Contraindications
• Cardiac pacemakers• Patient is expecting• Area is ischemic• Thrombosis• Phlebitis• Metallic implants in treatment area• Metallic effects on or near treatment
area
Before treatment• Hot/Cold Test and sharp/blunt test• Give patient standard warning
– During treatment, all you should feel is a mild comfortable warmth. If you feel, any thing hotter, if you feel the heat concentrating in one area, or a sharp pain, you are in danger of being burnt. Alert me when this occurs and during treatment, don’t move, don’t fall asleep and don’t touch anything. Got it?
Method of Application
• Direct Contact using ultrasound gel as a coupling medium– Soundhead is in contact with skin– Suitable for treating area where surface
being treated is larger than soundhead– Not using immersion technique as it is not
convenient to be used on the shoulders– Not using gel pads (as another medium)
as effects are superficial.
Area applied
• As tendon of supraspinatus is at the greater tuberosity of humerus, the area of modality applied will be at that area.
Duration & Dosage
• As it is a chronic condition,
– 0.8-3.0 W/cm2– 1mHz (for deep penetration)– Continuous– for 7 minutes– mild to comfortable warmth.
Desired Physiological effects
• Increase vasodilatation; promotes blood flow and facilitate healing
• Decrease pain; by decreasing nerve conduction velocity
Progression of Treatment
• Recommend patient to come on a weekly basis
• Each visit, we’ll take note of patient’s ROM and pain rating
• If shows improvement, we’ll continue with treatment.
Progression of Treatment
• Encourage mobility exercises (targeting the shoulder abduction) to the limit of motion before onset of pain
– Prevent further decrease in active range of motion.
Progression of Treatment
• Once pain subsides, we will recommend stretching and strengthening exercises
– to increase ROM as much as possible and restore functional strength
• Ie. Using therapy bands and light weights for shoulder abduction
Bibliography
• http://emedicine.medscape.com/article/93095-overview
• http://www.ehow.com/about_5531020_supraspinatus-tendinosis-treatment.html