Comparative efficacy of analgesic gel phonophoresis and ultrasound in the treatment of temporomandibular joint disorders

Aim: The aim of this study is to determine the efficacy of phonophoresis in patients with temporomandibular disorders. Objective: To prove that phonophoresis could be an effective treatment modality in in patients with temporomandibular disorders. Procedure: Fifty patients diagnosed clinically and radiographically as temporomandibular disorder were randomly assigned into either of the two groups, namely, (Group A) plain ultrasound and (Group B) phonophoresis. Acoustic gel containing no pharmacological agent was applied in the ultrasound group, whereas a gel containing aceclofenac was applied in the phonophoresis group. Each group was treated three times a week for 2 weeks. The assessment of pain and inflammation both before and after treatment were done using the visual analog scale (VAS) and Creactive protein (CRP). Results: Intergroup comparison was done and analyzed statistically using independent ttest. Intragroup comparison was done using paired ttest. A significant difference in VAS scores and CRP levels before and after treatment were seen within both ultrasound phonophoresis PH groups. No significant difference was noted statistically between ultrasound and phonophoresis group. Conclusion: The results of this study suggests that though plain ultrasound as well as phonophoresis with aceclofenac gel are effective in the management of temporomandibular disorders. Phonophoresis was found be slightly superior as evident in VAS scores and CRP levels though not statistically significant.

Efeitos do ultrassom terapêutico no ingurgitamento mamário: estudo piloto / Effects of therapeutic ultrasound in mammary engagement: pilot study

INTRODUÇÃO: A amamentação constitui uma importante etapa no processo reprodutivo, oferecendo benefícios tanto para mãe como para a criança. O Ingurgitamento mamário é uma complicação que ocorre do terceiro ao quinto dia de pós-parto. O Ultrassom Terapêutico (UST) é amplamente utilizado, e consiste em um aparelho capaz de produzir energia acústica de alta frequência. OBJETIVO: verificar o efeito agudo do ultrassom no processo terapêutico do ingurgitamento mamário. METODOLOGIA: Estudo transversal, que avaliou a mama e classificou o ingurgitamento, além de realizar avaliação da dor e da percepção subjetiva das mamas. Foi administrado o protocolo com ultrassom terapêutico na frequência de 1Mh, modo pulsado, intensidade/ dose de 0,5w/cm2, ciclo ativo de 20% com tempo de aplicação de 02 minutos por área de radiação efetiva (ERA). Após aplicação, a lactente foi submetida à amamentação e realizada nova avaliação das mamas. RESULTADOS: A amostra foi composta por 4 mulheres entre 20 e 30 anos com quadro de ingurgitamento mamário. O valor inicial do ingurgitamento mamário foi de 2 a mediana e a final foi de 1 a mediana. Em relação à dor mamária, inicialmente foi de 5 mediana e a final 2 a mediana. Em todos os casos analisados houve melhora na dor, na disponibilidade do leite e no aspecto de ingurgitamento da mama. CONCLUSÃO: O ultrassom terapêutico se mostrou eficaz na redução da dor, no aumento da disponibilidade do leite e na melhora do enrijecimento característico do ingurgitamento mamário.

INTRODUCTION: Breastfeeding is an important step in the reproductive process, providing benefits for both mother and child. Breast engorgement is a complication that occurs from the third to the fifth postpartum day. Therapeutic Ultrasound (UST) is widely used, and consists of an apparatus capable of producing high frequency acoustic energy. OBJECTIVE: to verify the acute effect of ultrasound in the therapeutic process of breast engorgement. METHODOLOGY: Cross-sectional study, which evaluated the breast and classified the engorgement, besides evaluating the pain and the subjective perception of the breasts. The protocol with therapeutic ultrasound was administered at a frequency of 1Mh, pulsed mode, intensity / dose of 0.5w / cm2, active cycle of 20% with application time of 02 minutes per effective Radiation Area (ERA). After application, the infant was submitted to breastfeeding and a new breast evaluation was performed. RESULTS: The sample consisted of 4 women between 20 and 30 years of age with breast engorgement. The initial value of breast engorgement was 2 the median and the final value was 1 to median. Regarding breast pain, it was initially 5 median and the final 2 median. In all the analyzed cases there was improvement in pain, milk availability and breast engorgement aspect. CONCLUSION: Therapeutic ultrasound has been shown to be effective in reducing pain, increasing milk availability and improving the stiffness characteristic of breast engorgement.

Evaluation of gloves as a water bag coupling agent for therapeutic ultrasound

Abstract Introduction Therapeutic ultrasound (TUS) is a widespread modality in physiotherapy, and the water bag technique is a coupling method employed in the presence of anatomical irregularities in the treatment area. The aim of the present study is to evaluate the acoustic attenuation of the water bag and its effectiveness as a TUS coupling agent. Methods The rated output powers (ROPs) of the TUS equipment were evaluated based on IEC 61689. Then, a radiation force balance was used to measure ROP with and without a water bag (latex and nitrile gloves filled with deionized water) between a TUS transducer and the cone-shaped target of the balance. Each experiment was performed five times for each nominal power (0.5, 1.0, 2.0, 3.0, 4.0, 5.0, 6.0, and 7.0 W) and in the following configurations: without the water bag (A), with nitrile gloves and with (B) and without (C) a height controller, and latex gloves with (D) and without (E) height controller. ROPs obtained in different media were compared. Results The highest relative error of ROP was 16.72% for 0.5 W. Although the power values of the equipment were within the range recommended by IEC, there was a significant difference between the ROP values measured with A and with B, C and D. Conclusion As intensity differences below 0.5 W/cm2 are considered clinically not relevant, conditions A, B, C, D, or E can be used interchangeably.

Estudio comparativo entre dos intensidades de ultrasonido continuo en la reparación del nervio espinal lesionado por compresión / Comparative study between two intensities of continuous ultrasound in the repair of the spinal nerve injured by compression

El ultrasonido continuo fundamenta su efectividad en la energía térmica que genera, favoreciendo la reparación nerviosa. Es por esto que surge la interrogante de que si al aplicar diferentes intensidades de ultrasonido continuo sobre el nervio espinal lesionado, la respuesta reparativa será igual o distinta. Para ello se utilizaron 12 ratas de sexo masculino a las que se les aisló quirúrgicamente el nervio isquiático, el cual fue pinzado durante 45 segundos con una fuerza constante de 40N. La compresión se realizó a 10mm sobre la bifurcación, luego se desinfectó y suturó. Inmediatamente después de la operación las ratas fueron agrupadas de a 3: A) control sano, B) control lesionado, C) aplicación de ultrasonido terapéutico de 0,5w/cm2 y D) aplicación de ultrasonido terapéutico de 1w/cm2. El grupo A se utilizó como control sano y no recibió irradiación. Las ratas del grupo B fueron lesionadas y no recibieron irradiación y las del grupo C y D fueron lesionadas e irradiadas transcutáneamente en la región correspondiente al recorrido del nervio isquiático utilizando intensidades de 0,5w/cm2 y 1w/cm2, 3 MHZ de frecuencia, un cabezal de 0,5cm2, durante 1 minuto y 10 días consecutivos. 28 días post operatorio se extrajeron los nervios isquiáticos y fueron sometidos a técnicas de tinción de H-E y Van Gieson. Se realizó el diagnóstico histopatológico y la morfometría: se midió el Grosor del Perineuro, Perímetro del núcleo del Schwannocito, Perímetro del Axón Mielínicoy Perímetro de la Mielina. Los resultados revelan que el ultrasonido continuo es efectivo en la reparación del nervio espinal, siéndolo más con 1w/cm2 que con 0,5w/cm2.

The continuous ultrasound bases its efficiency on the heat energy it generates, favoring the nervous repair. Therefore, the question arises whether the reparative response will be equal or different under varying intensities of continuous ultrasound application on the disabled spinal nerve. For the study we used 12 male rats; the ischiatic nerve was surgically isolated and compressed during 45 seconds with a constant force of 40N. The compression was realized at 10 mm on the bifurcation, and was subsequently disinfected and sutured. Immediately following the operation the rats were separated in groups of 3: A) Healthy control, B) Injured control, C) Application of therapeutic ultrasound of 0.5 w/cm2 and D) Application of therapeutic ultrasound of 1 w/cm2. Group A was used as healthy control and did not receive irradiation. The rats in group B were injured and did not receive irradiation and those of groups C and D were injured and were transcutaneously irradiated in the area corresponding to the ischiatic nerve using intensities of 0.5 w/cm2 and 1 w/cm2, 3 MHZ of frequency. We used a compress of 0.5 cm2, during 1 minute and for 10 consecutive days. 28 days post operative ischiatic nerves were removed and submitted to technologies of H.E and VG stain. Histopathological and morphometrical diagnosis was realized: Thickness of the Perineurium, schwannocyte perimeter, Myelin Axon and Myelin perimeters were measured. The results revealed that the continuous ultrasound is effective in the repair of the spinal nerve, more so with 1 w/cm2 than with 0.5 w/cm 2.

Treatment time of ultrasound therapy interferes with the organization of collagen fibers in rat tendons

BACKGROUND: The application time of therapeutic ultrasound is an infrequently studied dosimetric variable that affects tissue repair. OBJECTIVES: The aim of this study was to evaluate the effects of different treatment times of therapeutic ultrasound (US) on the organization of collagen fibers in the tendons of rats. METHOD: Forty Wistar rats were selected (300±45 g), and the rats were divided into five groups (n=8 for each group): Control, without tenotomy or any treatment; tenotomy group, with tenotomy and without treatment; US groups (US1, US2, and US3), subjected to tenotomy and treated with US for one, two, or three minutes per area of the transducer, respectively. The animals were sacrificed on the 12th post-operative day, and the tendons were surgically removed for analyses of the collagen fiber organization by means of birefringence analysis. RESULTS: The collagen fibers exhibited better aggregation and organization in the US3 group compared with the tenotomy group (p<0.05). CONCLUSIONS: The findings suggest that US applied for three minutes per treated area improves the organization of collagen fibers during rat tendon repair. .

Alteração da temperatura nos tecidos biológicos com a aplicação do ultrassom terapêutico: uma revisão / Temperature changes in biological tissue due to the application of therapeutic ultrasound: a review

INTRODUÇÃO: O ultrassom (US) terapêutico atua nos tecidos biológicos por meio da vibração, que é capaz de produzir efeitos fisiológicos térmicos e não térmicos. OBJETIVO: Discutir os parâmetros que afetam o aquecimento dos tecidos biológicos, decorrente da aplicação do US. MATERIAIS E MÉTODOS: Efetuou-se levantamento bibliográfico nas bases de pesquisa ISI WEB e SCOPUS. Foram selecionados os artigos, na língua inglesa, que tiveram como ponto central, o estudo da variação da temperatura após a aplicação do US em humanos. RESULTADOS: Foram observadas variações significativas em relação ao aumento de temperatura tecidual. Para a frequência de 3MHz, ocorre um aumento médio de 2,6 ºC nos tecidos superficiais; e para 1MHz, há um aumento médio de 1,7 ºC em tecidos profundos. Há um maior aquecimento do tecido em relação ao tamanho da ERA (área de radiação efetiva), quanto menor o tamanho maior o aquecimento. Também há um aumento da temperatura em relação às intensidades. Intensidades variando entre 0,5 a 3 W/cm² apresentam um acréscimo significativo de temperatura. Em relação à forma de aplicação, o gel proporciona melhor acoplamento, gerando maior aquecimento com um tempo de aplicação de cinco minutos - o tempo de aplicação deve ser adequado à área de tratamento e à densidade de potência. Entretanto, a velocidade de aplicação parece não modificar o aquecimento até 7-8 cm/s, mesmo que dispositivos diferentes aqueçam em níveis diferentes. CONCLUSÃO: Os parâmetros para a aplicação do US devem ser controlados e ajustados para produzir o aquecimento profundo dos tecidos considerando a variação entre dispositivos.

INTRODUCTION: The therapeutic ultrasound act in biological tissues by means of vibration can produce physiological effects of thermal and non-thermal. OBJECTIVE: To discuss the parameters that affect the heating of biological tissues by ultrasound. MATERIALS AND METHODS: We conducted a literature research based on ISI Web and SCOPUS database. We selected the articles in the English language that have studied the temperature variation after the application of ultrasound in humans. RESULTS: There are significant variations related to tissue-temperature rise. For the 3MHz ultrasound, there is an average increase of 2.6 ºC in superficial tissues, and to the 1MHz US, there is an average increase of 1.7 ºC in deep tissues. There is a higher heating of the treated tissue when an area twice the ERA (effective radiating area) size, the shorter the higher the heating, there is an increase in temperature relative intensities. Intensities ranging from 0.5 to 3 W/cm² have a significant increase in temperature. Regarding the mode of application, the gel provides an improved coupling, generating more heat with an application time of five minutes - the application time depends on the treatment area and power density. However, the speed of application appears to modify the heating up to 7-8 cm/s. Also, different commercial devices produce heat differently. CONCLUSION: Parameters for ultrasound application must be controlled and adjusted to generate deep heating of tissues considering that it may vary among devices.

Pulsed ultrasound therapy accelerates the recovery of skeletal muscle damage induced by Bothrops jararacussu venom

We studied the effect of pulsed ultrasound therapy (UST) and antibothropic polyvalent antivenom (PAV) on the regeneration of mouse extensor digitorum longus muscle following damage by Bothrops jararacussu venom. Animals (Swiss male and female mice weighing 25.0 ± 5.0 g; 5 animals per group) received a perimuscular injection of venom (1 mg/kg) and treatment with UST was started 1 h later (1 min/day, 3 MHz, 0.3 W/cm², pulsed mode). Three and 28 days after injection, muscles were dissected and processed for light microscopy. The venom caused complete degeneration of muscle fibers. UST alone and combined with PAV (1.0 mL/kg) partially protected these fibers, whereas muscles receiving no treatment showed disorganized fascicules and fibers with reduced diameter. Treatment with UST and PAV decreased the effects of the venom on creatine kinase content and motor activity (approximately 75 and 48%, respectively). Sonication of the venom solution immediately before application decreased the in vivo and ex vivo myotoxic activities (approximately 60 and 50%, respectively). The present data show that UST counteracts some effects of B. jararacussu venom, causing structural and functional improvement of the regenerated muscle after venom injury.

Tratamiento con ultrasonido continuo de alta intensidad en nervios isquiáticos de rata (Sprague Dawley) lesionados por compresión / Treatment with continuous high-intensity ultrasound on rat sciatic nerve (Sprague Dawley) and compression injuries

Actualmente las patologías compresivas de nervios espinales son de alta incidencia. Como una forma de contribuir con fundamentos morfológicos a la aplicación de ultrasonido terapéutico se realizó la presente experiencia, que se refiere a la reparación de los nervios espinales luego de una injuria compresiva. Para esto se utilizaron 9 ratas Sprague Dawley las cuales fueron separadas en tres grupos con 3 ratas cada uno: A) control sano, B) control lesionado y C) aplicación de ultrasonido terapéutico de 1w/cm2. Las ratas de los grupos B y C fueron anestesiadas y se les aisló quirúrgicamente el nervio isquiático, el cual fue pinzado durante 45 segundos con una fuerza constante de 40N. La compresión se realizó a 10mm sobre su bifurcación distal, luego se desinfectó y suturó. 24 horas después de la compresión las ratas del grupo C fueron irradiadas con un equipo de ultrasonido terapéutico, utilizando 1w/cm2 de intensidad con frecuencia de 3 MHZ y un cabezal de 0,5cm2, durante 1 minuto y en 10 días seguidos. 28 días después de la irradiación se extrajeron los nervios isquiáticos y fueron sometidos a técnicas histológicas de rutina con tinción de HE y VG. Se realizó el diagnóstico histopatológico y la morfometría donde se midió: grosor del perineuro, perímetro de los núcleos de neurilemocitos, perímetro del axón mielínico, perímetro de la mielina, ancho del núcleo del fibroblastocito y largo del núcleo del fibroblastocito. Los resultados permiten concluir que el ultrasonido de modalidad continua estimula la regeneración del nervio espinal lesionado por compresión.

Currently, the pathologies of spinal nerves are of high incidence. As a way to contribute to morphological grounds the application of therapeutic ultrasound was used in the repair of spinal nerves after a compressive injury. 9 tests were carried out using Sprague Dawley rats which were separated into three groups with 3 rats each: A) healthy control, B) injured control and C) the application of therapeutic ultrasound 1w/cm2. The rats in groups B and C were anesthetized and sciatic nerve was surgically isolated, which was clamped for 45 seconds with constant force of 40N. Compression was performed on the distal bifurcation 10mm, then disinfected and sutured. 24 hrs after compression, rats in group C were irradiated with a therapeutic ultrasound equipment, using 1w/cm2 of intensity with frequency of 3 MHz and a head of 0.5 cm2 for 1 minute, for 10 days. 28 days after irradiation sciatic nerve was removed and subjected to routine histological staining with HE and VG. Histopathological diagnosis was made and morphometry which measured: perineum thickness, perimeter of the nuclei of neurolemocyte cell, perimeter of myelinated axons, perimeter of myelin, the fibroblastocyte core width and length of the fibroblastocyte nucleus. The results show that the continuous mode ultrasound stimulates the regeneration of injured spinal nerve compression.

Problem-based learning in clinical teaching ultrasonic therapeutic application / 中华医学教育探索杂志

ObjectiveTo explore the PBL mode in training students' ability,improve the quality of teaching effect,in the teaching of Clinical therapeutic ultrasound and the teaching method based on problems with discussion method.MethodsTo 31 subjects of study who were randomly divided into five groups,each 6 people,a PBL teaching mode was used for 12 periods by proposing and study,group discussion,the whole class exchange and commenting on summary.ResultsThe survey shows that 93.6％ students think the teachers' design has gained their ends,71％ students are impressed by the knowlege and 96.8％ of the students show the good learning attitude,64.5％ of the students raised their interest in learning,which shows teaching results are effective.ConclusionPBL mode is superior to LBL teaching mode in training students' ability,improving the quality of teaching effect.

Análise histológica em tecido epitelial sadio de ratos Wistar (in vivo) irradiados com diferentes intensidades do ultrassom / Histological analysis of healthy epithelium of Wistar rats in vivo irradiated with different intensities of therapeutic ultrasound

CONTEXTUALIZAÇÃO: O Ultrassom (US) é um dos recursos físicos amplamente utilizado e pesquisado nos tratamentos de fisioterapia. Sabe-se que diante de uma escassa literatura sobre efeitos do US em tecidos sadios, muitos profissionais fisioterapeutas acabam realizando aplicações infundadas de métodos e parâmetros. OBJETIVO: Avaliar possíveis alterações histológicas e morfométricas do tecido sadio in vivo de ratos Wistar irradiados com diferentes intensidades de US. MÉTODOS: Trinta ratos da linhagem Wistar, distribuídos aleatoriamente em cinco grupos de seis animais cada foram tratados na região dorsal do lado direito numa área de 4cm². O lado esquerdo serviu como controle. O tratamento foi feito durante quatro dias com 2 minutos de irradiação. Verificou-se a intensidade de saída com dosímetro de precisão antes das aplicações. Analisou-se a histologia e a morfometria por meio do software Image Tool. RESULTADOS: Observou-se um discreto infiltrado inflamatório e adelgaçamento das fibras da derme, principalmente dos grupos irradiados com 1.5 e 2W/cm². Notou-se também um aumento na espessura da epiderme nas amostras dos animais irradiados. Para avaliar os resultados quantitativos, utilizou-se como análise estatística ANOVA one way e o teste post hoc de Tukey. Na espessura da epiderme, obtiveram-se diferenças significativas entre grupo controle e os grupos irradiados com 1.0, 1.5 e 2.0W/cm². CONCLUSÃO: Sob ação do US nas doses maiores houve alterações na epiderme e derme, respectivamente, o aumento da espessura e proliferação com adelgaçamento das fibras colágenas, o que alerta para possíveis implicações do uso do US em estética.

BACKGROUND: Ultrasound (US) is a widely used and studied resource for physical therapy treatments. Given the scarcity of studies on the effects of US on healthy tissue, many physical therapy professionals make unfounded decisions regarding its methods and parameters of application. OBJECTIVES: The possible histological and morphometric changes in the healthy tissue of Wistar rats in vivo irradiated with different intensities of US were evaluated. METHODS: Thirty Wistar rats, randomly distributed among five groups of six animals each, were treated on the right side of the dorsal region, over an area of 4 cm². The left side served as a control. The treatment was applied over a four-day period, with two mins. of daily irradiation. The output intensity was checked using a precision dosimeter before the applications. Histological and morphometric analyses were performed using the Image Tool software. RESULTS: There were slight inflammatory infiltration and thinning of the dermis fibers, particularly in the groups irradiated with 1.5 and 2 W/cm². There was also thickening of the epidermis in the samples from the irradiated animals. To evaluate the quantitative results, the statistical analyses consisted of one-way ANOVAs with the post-hoc Tukey tests. There were significant differences in epidermis thicknesses between the control group and the groups irradiated with 1.0, 1.5 and 2.0 W/cm². CONCLUSIONS: Higher doses of US produced changes in the epidermis and dermis, i.e. increased thickness and collagen fiber thinning and proliferation, respectively. These results serve as a warning of the possible implications of therapeutic ultrasound use in esthetics.

Ultra-som terapêutico e imobilização na reparação do trauma muscular / Therapeutic ultrasound and immobilization in muscular trauma repair

INTRODUÇÃO: Avaliamos os efeitos do ultra-som terapêutico (UST), adicionado ou não à imobilização gessada (IG), como forma de tratamento à lesão muscular por impacto analisando as propriedades mecânicas de alongamento e carga nos limites de proporcionalidade e máximo, rigidez (R) e resiliência do músculo gastrocnêmio. METODOLOGIA: Utilizamos 70 ratas divididas em 7 grupos:Grupo 1-Controle;Grupo 2-Sem tratamento,Grupo 3-IG por 24 horas;Grupo 4-IG por 72 horas; Grupo 5-UST sem presença de IG;Grupo 6-IG por 24 horas associada ao UST;Grupo 7-IG por 72 horas associada ao UST. RESULTADOS: As propriedades de carga no limite de proporcionalidade e carga máxima mostraram que o grupo estimulado com o UST comportou-se de modo semelhante ao grupo controle. A propriedade de alongamento no limite de proporcionalidade não diferenciou os grupos; o alongamento máximo do grupo estimulado com (UST) e dos grupos imobilizados por 72 horas foram comparáveis ao grupo controle. CONCLUSÃO: O grupo estimulado (UST) apresentou rigidez similar ao grupo controle e resiliência superior a todos os grupos. A utilização isolada do UST forneceu resultados similares àqueles considerados como normais, o mesmo não sendo observado quando o UST foi associado à IG.

INTRODUCTION: We assessed the effects of therapeutic ultrasound (TUS), either added to cast immobilization (CI) as a treatment alternative to muscular injuries caused by impact by assessing the mechanical properties of stretching and load at proportionality and maximum limit, stiffness (S) and gastrocnemius muscle resiliency. METHODS: 70 female rats were employed in the study, and the animals were divided into 7 groups: Group 1-Control; Group 2-Untreated; Group 3-CI for 24 hours; Group 4-CI for 72 hours; Group 5-TUS without CI; Group 6-CI for 24 hours combined with TUS; Group 7-CI for 72 hours combined with TUS. RESULTS: Loads at proportionality limit and maximum limit showed that the group receiving TUS behaved similarly to control group. The property of stretching at proportionality limit was not different from one group to another; the maximum stretching of the group receiving TUS and of the groups immobilized for 72 hours was comparable to controlgroup. CONCLUSION: The group receiving TUS showed similar stiffness levels compared to control group and superior resiliency compared to all remaining groups. The standalone use of TUS provided similar results to those regarded as normal, but these were not noticed when TUS was combined to CI.

High-intensity Focused Ultrasound in the Solid Tumor Treatment

High intensity focused ultrasound (HIFU) is a technique that was first introduced in the 1940s as a potential method of destroying selective regions within the brain to aid neurobehavioral studies. A beam of ultrasound can be delivered to a targeted focus at a distance from its source, and if a sufficient amount of energy is concentrated in the focus, the cells lying within this focal volume are selectively killed. This is, therefore, a non-invasive method of producing selective and "trackless" tissue destruction in deep-seated targets in the body without damage to the overlying tissues. Although it had not been in clinical use for a long time, HIFU is now widely used as a non-invasive treatment method for malignant tumors of the liver, kidney, breast, bone, uterus and pancreas, as well as for the relief of chronic pain of malignant origin. Further improvement of technology and imaging of HIFU in the near future will make it one of the most important tools in the treatment of solid tumors, further expanding its clinical applications.