顯示具有 Therapeutic 標籤的文章。 顯示所有文章
顯示具有 Therapeutic 標籤的文章。 顯示所有文章

2012年8月29日 星期三

The Use of Therapeutic Home Ultrasound to Treat Arthritis


As we age, our once lubricated joints can become less efficient at absorbing shocks and protecting our bones. This condition, known as arthritis, can be both mentally and physically crippling and affects approximately 50% of adults 65 years and older. Arthritis can significantly reduce a person's ability to enjoy life because it effects major joints of the body, such as knees, elbows and hands, which are vital for daily functioning.

Types of Arthritis: Arthritis is an inflammation of a joint, usually accompanied by pain, swelling, and stiffness. It comprises more than 100 different rheumatic diseases and conditions. It results from severe infection, traumas, degenerative changes (osteoarthritis, hypertrophic arthritis, senescent arthritis), metabolic disruptions, autoimmune disorders (lupus erythematous) or other causes. It occurs in various forms, such as bacterial arthritis, osteoarthritis, or rheumatoid arthritis.

Rheumatoid arthritis, an autoimmune disorder, is considered a chronic disease and patients with rheumatoid arthritis develop chronic arthritis pain. Osteoarthritis, also known as degenerative joint disease, is the most common form of arthritis, especially among older populations, affecting over 20 million Americans. Two types of arthritis are Rheumatoid arthritis &osteoarthritis, both of which cause arthritic joint pain that can significantly impair a person's quality of life.

Causes: Daily activities such as getting out of bed and even walking can be affected by a painful joint. This arthritic joint pain is occurs when the lubricant, known as synovial fluid, present in the joints and cartilage becomes damaged. Because this fluid acts as a shock absorber and ensures that the ends of our bones are protected, when it is comprised, our bones can grind against each other, causing significant pain in our joints.

Painful joints and joint inflammation and stiffness typically characterize the disease. Some causes of arthritics include overuse, basic wear and tear, pseudogout, infections, autoimmune disorders, bone diseases or fractures, and bone tumors or cancer. In addition, medications, such as penicillin, and the common cold or flu often cause sore aching joints or stiff joints.

Treatments: While there is no known cure for a chronic condition like arthritis, there are treatments for inflamed, arthritic joints that really work and help sufferers manage their pain to lead normal healthy lives. Most often, a doctor, chiropractor or physical therapist will prescribe a medication program of prescription medicines and nonsteroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen (Advil, Motrin) to treat an injured joint. These medications aim to reduce the pain and inflammation of sore arthritic joints. However, they are associated with a number of bad side effects, such as drowsiness, constipation, nausea, diarrhea, vomiting, headache and rash. Anti-inflammatory drugs are not your best treatment option because they do not heal your joints, they only mask the arthritis pain. A stiff injured joint is also sometimes managed with splints or braces of various types which allow the joint to rest.

Many Arthritis sufferers have found relief with natural supplementation of Chondroitin Sulfate and Glucosamine. Chondroitin is a building block of the human connective tissue in bones and cartilage and glucosamine is the major constituent of joint cartilage. Other herbs to try might be curcumin, MSM, and boswellia.

Alternative treatments such as acupuncture, homeopathic medicines and yoga, a weight-bearing exercise that strengthens bones, have helped some arthritis sufferers find relief.

The intense flare-ups of arthritis pain can be best managed through conservative, regular treatments. Patient education on how to treat arthritis and self-care are critical components in healing painful joints. Patience is also key, as an inflamed joint can we slow to heal. Often the combination of therapeutic modalities, such as an herbal supplementation regime and, can offer the most arthritis pain relief.

Ultrasound Therapy: RICE (rest, ice, compress, elevate) can we a very useful procedure for managing arthritis pain, however, using therapeutic ultrasound prior to RICE treatment is best because the ultrasonic waves efficiently decrease inflammation and relive pain.

Joints have limited blood flow and as a result, they recover from arthritis flare-ups very slowly. In addition, inflammation and waste matter build-up due to the decreased blood flow causing extreme pain to arthritis sufferers. A personal, therapeutic ultrasound device acts as a blood flow stimulation therapy to increase circulation in the inflamed joint and decrease arthritic pain. People suffering from osteoarthritis pain or chronic Rheumatoid arthritis can perform rehabilitation at home now with the advent of portable ultrasound machines. The ultrasound therapy utilized by these devices can be used as an advanced treatment of arthritis and the chronic pain that accompanies the condition. Therapeutic ultrasound can be used to reduce pain, stimulate blood flow and injuries twice as fast.

Ultrasound physical therapy not only helps alleviate pain, but speeds up healing process as well. Ultra sound waves generate deep tissue vibrations that provide gentle heating to decrease pain and inflammation. The most rehabilitation benefits can be gained by utilizing therapeutic ultrasound at home.

Case Study: In a study by Casimiro et al, 2002 investigating the use of therapeutic ultrasound for the treatment of rheumatoid arthritis (RA), it was found that continuous ultrasound benefits grip strength when applied to the hands of RA sufferers. Ultrasound has both analgesic & anti-inflammatory effects, which is why its so widely prescribed for arthritis by qualified health care professionals. In two randomized trials, it was proven that continuous ultrasound applied to the hand increased grip strength and wrist dorsal flexion, as well as decreased morning stiffness and the number of swollen painful joints as compared with placebo.

Home Ultrasound Machines: A home ultrasound unit works the same way as bigger machines, found in physical therapist and chiropractor practices, but is more compact and priced reasonably so home users can afford to purchase. Portable ultrasound machines are also safe for use by the general public because they utilize pulsed, instead of continuous, ultrasound waves, which are just as effective when used on a daily basis. Physical therapy involving ultrasound for plantar fasciitis will provide users with immediate relief and continual healing over a 3-4 week period.

Because arthritis involves joint and bone inflammation, a specific kind of home ultrasound machine is required for treatment. A home ultrasound physical therapy machine should emit 1Mhz ultrasound waves. It is also important to purchase an FDA approved ultrasound unit that is quality manufactured. The portable therapeutic ultrasound device should also be covered with at least a 1 year warranty. And best of all, with a portable therapeutic ultrasound machine, on a daily basis you can treat your arthritis only when it's most convenient for you.

Conclusion: Studies have shown that people who receive early treatment for arthritis feel better sooner and more often, are more likely to lead an active life, and are less likely to experience chronic arthritis pain, and the type of joint damage that leads to joint replacement.

Arthritis sufferers can lead a more normal active life by reducing pain & swelling in their joints fast with a home ultrasound machine. If you would like to reduce or eliminate you intake of harmful pain-killers and improve your arthritic symptoms and chronic joint pain, a portable ultrasound unit would be a great, affordable option for managing your arthritis.




---------------------------------------------------------------------------------------------------------------------------
Christine Beggs is the founder and CEO of EZUltrasound.com, the leading provider of portable home ultrasound machines to relieve pain and speed healing. Over the past 2 years, Christine has strived to deliver affordable, therapeutic ultrasound machines to anyone who needs them. Working closely with doctors and physical therapists, Christine has first hand knowledge of ultrasound therapy, its benefits and applications, and has a passion for sharing this knowledge in her articles. She developed EZUltrasound.com to relay her continual dedication to improving the quality of people's lives through the use of therapeutic ultrasound. To find out more, please visit www.EZUltrasound.com.





This post was made using the Auto Blogging Software from WebMagnates.org This line will not appear when posts are made after activating the software to full version.

張貼者： 於 0 意見
標籤： , , ,

2012年8月24日 星期五

Ultrasound Guidance For Therapeutic Interventions


Duplex ultrasound sonography is the best choice for evaluation of venous reflux in the lower extremities. It is inexpensive, noninvasive, and generally acceptable to the patient. It provides direct visualization, localization and quantitation of venous reflux with a surprisingly high sensitivity (95%) and specificity (100%). Duplex ultrasound findings have been confirmed by angioscopic observation of incompetent vein valves in advanced chronic venous insufficiency. Yamaki has demonstrated that high peak reflux velocities (>30 cm/s), reflux duration greater than 3 s and an enlarged valve annulus measured by duplex ultrasonography at the saphenofemoral junction are all closely related to angioscopically deformed and incompetent terminal valves (types III and IV of Hoshino).

Foam sclerotherapy actually began before the development of ultrasound imaging. Phlebologists of the 1950s developed ways of producing foamed sclerosants and observed the distribution of therapeutic foam by sensing crepitus. However, all credit for the origination of foam sclerotherapy, as we know it today, goes to Juan Cabrera of Granada, Spain. It was he who combined the manufacture of fine foam with administration of the agent under ultrasound guidance.

Pretreatment assessment

The evaluation should always begin with confirmation of the medical history. A family and personal venous history are of great importance. In the personal history, the reasons for the treatment should be confirmed. The patient's view of the objectives of the procedure should

be recorded. Symptoms such as aching heaviness, limb fatigue, itching and burning pain are typically present and these should be recorded. Similarly, a detailed recording of previous treatments and their failure will be of importance in seeking insurance coverage for the intervention. History of pregnancies and their number, as well as the number of deliveries and abortions, are of importance. Any limb trauma, fractures and confining illnesses should be recorded. A history of deep venous thrombosis and treatment must be paired with its method of diagnosis. A detailed description of previous venous treatments must be a part of the treatment record. Comorbidities, allergies and pharmacologic history must be documented. The body mass index is calculated from the patient's height and weight and should be recorded.

If a proper, standing, duplex reflux examination has not been done or is not part of the patient's record, it should be accomplished before treatment is initiated. The patient should be examined in a standing position for procedural planning, identification of the venous access site, and its relation to perforating veins, varicosities, and areas of tortuosity, stenosis or dilation.

In this preparatory phase, some anatomic landmarks should be clearly recognizable, including the femoral vein, saphenofemoral junction, saphenous compartment, great saphenous vein (GSV) and the variable small saphenous junction anatomy. This should be supplemented by cold light transillumination of the skin with a bright white light such as the "vein light," to identify reticular veins. A hand-held Doppler can serve to perform a confirmatory screening examination if a proper pretreatment reflux examination is part of the record.

Three levels of pathologic veins are evaluated using the methods just mentioned. Telangiectasias in the skin are visually inspected, reticular veins are transilluminated with the vein light, and varicosities and the saphenous veins with ultrasound. Clinical data should be integrated into the CEAP classification.

Equipment

The duplex ultrasound scanner should be able to detect blood flow rates as low as 6 cm/s. Dedicated high-resolution vascular scanners with color and/or power Doppler functions as well as the continuous-wave Doppler are available. Linear transducers in the range of 4-7 MHz are used for the pretreatment as well as the definitive examination. The inferior vena cava, pelvic veins and deep veins of the limbs in obese patients may be imaged with lower-frequency, 3 MHz transducers. Linear hockey-stick transducers in the range of 5-12 MHz will provide detailed imaging of smaller veins and perforating veins.

After the year 2000, advances in technology allowed duplex ultrsound scanners to become smaller, more transportable, and more operator friendly. These miniaturized devices feature transducers designed with advanced architecture that allow a single probe to image across a greater range of depths within an application and across applications. Thus, in many ways, the portable ultrasound instrument supplements the stethoscope in patient evaluation. The transducer for peripheral vascular examinations operates from 5 to 10 MHz and provides resolution from the skin surface to 7 cm in depth. The technology incorporates power Doppler sonography, tissue harmonic imaging and direct connectivity to a personal computer. The overall performance of miniaturized ultrasound devices is comparable to that of the more traditional and much larger ultrasound equipment that allowed establishment and growth of the vascular laboratory.

Venous testing and mapping

Not only is a detailed duplex ultrasound study of the normal and pathologic venous anatomy essential, but a map should be created to guide therapy. A detailed verbal description of the examination and its findings is useful for record purposes, but the map is most useful during therapy. A clear and illustrative graphic notation of significant vein diameters, anomalous anatomy, superficial venous aneurysms, perforating veins, and presence and extent of reflux should always be recorded during the examination.

As mentioned, the ultrasound examination is conducted with the patient standing. This position has been found to maximally dilate leg veins, and challenges vein valves. Sensitivity and specificity in detecting reflux are increased in examinations performed with patient standing rather than when the patient is supine. Supine examinations for reflux are unacceptable.

The veins are scanned by moving the probe vertically up and down along their course. Transverse scans are most informative, but a mental reconstruction must be created to record the venous map. Duplicated segments, sites of tributary confluence, large perforating veins and their deep venous connections are identified, as well as the very common superficial venous aneurysms. Location of abnormalities as measured in "centimeters from the floor" assists in preparing a therapeutic guide. Measurements from the medial malleolus are commonly recorded, but are not as precise. Transverse and longitudinal scans combined with continuous scanning provide a clear mapping of the venous system.

Patency of peripheral veins is usually assessed by compression of the vein with the transducer. Residual ancient thrombus, partial patency and extrinsic compression should all be noted in the verbal description of find-ings. Reflux is detected by flow augmentation with compression and release maneuvers of the thigh and calf. The Valsalva maneuver is used only at the saphenofemoral junction, because presence of a competent proximal valve negates the value of the examination.

Automated rapid inflation and deflation cuffs have been used, but are cumbersome. However, they do offer the advantage of a standardized stimulus, which allows timing of reflux. Although reflux greater than 500 ms is considered pathologic, this is only precisely accurate when a standard stimulus is applied.

The diameter of the saphenofemoral junction and femoral vein are recorded in preparation for radiofrequency VNUS Closure® and endovenous laser ablation. Important information is also gained from diameters of the GSV at mid-thigh and distal thigh (Figure 6.2a). Radiofrequency ablation is commonly used to treat veins from 2 to 12 mm in diameter, although diameters recorded with the patient standing do not apply when treatment is given with the patient supine.

The supragenicular, infragenicular or immediate subgenicular GSVs are often the access point for introduction of sclerosant foam. Therefore the depth of the GSV in these regions should be recorded.

Accessory saphenous veins by definition run parallel to the GSV in the thigh. It is imperative to map their course accurately and to note their communication with varices and eventual communication with GSVs, as well as their presence or absence of reflux with relationship to varicosities. The accessory veins are easily confused with the GSV during continuous longitudinal scanning when the saphenous vein appears to leave the saphenous compartment. This error is avoided when transverse scans are done. The GSV is scanned throughout the leg and the thigh so that its tributaries are identified.

The diameters of the popliteal vein and the small saphenous vein (SSV) are recorded at the junction, as well as diameters of the SSV along its course in the leg. Intersaphenous veins should be identified and the extreme variability of the SSV termination carefully recorded.

The pretreatment venous reflux examination also includes the mapping of exit and re-entry perforating veins (PVs), wherever they are identified. PV reflux is detected as outward flow duration greater than 350 ms during the release phase of the flow augmentation maneuver (distal compression has higher sensitivity in detecting PV reflux;. PVs should be accu-rately mapped in their different locations in the leg, and their positions should be measured as distances (cm) from the floor.

Ultrasound monitoring during sclerofoam treatment

The advent of foam sclerotherapy has added a powerful tool for treatment of chronic venous insufficiency. Endo thermic coagulation is caused by the generation of heat, which is applied to the endothelial surface of targeted veins. Sclerosant foam has a similar end result: stripping

off the endothelium. Foam agents provoke endothelial damage by several mechanisms. They change the surface tension of the plasma membrane (detergents) and/or the intravascular pH and osmolarity. The final result is a chemical fibrosis of the treated vessel.

The endovenous techniques accomplish this by heat. It is been suggested that the coagulation process is related to the intravascular vaporization of blood (steam) during laser therapy, with intimal denudation and collagen fiber contraction. Vein wall thickening and rapid reorganization of the vessel to form a fibrotic cord follows. If the endothelium is destroyed, the targeted vein is closed permanently. Venous occlusion is usually visualized within 10-20 s of the electromagnetic or chemical stimulus. Both thermal and the chemical techniques have been proven to be safe and effective. Percutaneous introduction of foam, laser fiber and the RF catheter have made surgical intervention obsolete because of elimination of post-treatment pain, absence of cutaneous incisions and prevention of postprocedural disability Sclerosing foams, as described elsewhere in the book, are mixtures of gas and a liquid solution with surfactant properties. One of the intrinsic limits of liquid sclerosants in treatment of varicose veins is their dilution by blood, with reduction of their efficacy. Also, they are rapidly cleared by the moving blood stream. Sclerosing foams do not mix with blood, and instead remain in the vessel, where they strip off the endothelium. Persistence of the agent in the vessel causes an increased contact time with the intimal surface. Foam preparation is remarkably simple. The Tessari method is the most commonly used, but there is an increasing use of physiological gases as a substitute for room air.

As with endovenous ablation, the treatment starts with clear ultrasound mapping as described above. The GSV or the SSV can then be directly cannulated with an angiocath, an echogenic Cook needle or a butterfly needle. Nearly all descriptions of the technique explain direct ultrasound-guided access to the saphenous vein. In contrast, many experienced operators achieve a satisfactory and rapid obliteration of the GSV and SSV by cannulating a peripheral varicosity. Although the saphenous vein cannot be cannulated with a catheter by way of a varicosity, because of its angle of connection, there is no such obstacle to the flow of foam.

Foam functions as an efficient ultrasound contrast medium because of its air content. Its injection is easily monitored. Its ultrasound appearance is that of a solid hyperechogenic core with an accompanying acoustic shadow.

Foam is introduced into a varix or the saphenous vein with the patient supine. As the foam reaches the saphenofemoral junction as monitored by ultrasound, compression of the saphenofemoral or the saphenopopliteal junctions may be done in order to preserve foam in the limb. Such a maneuver does not prevent foam from reaching the systemic circulation, however.

Vasoconstriction and vasospasm in foam-filled veins can be induced by intermittent compression of the veins by the ultrasound transducer and by elevating the limb. This minimizes the blood content of the treated veins. Foam will be seen by ultrasound to flow distally in the elevated limb. As mentioned, it flows selectively through incompetent valves and is blocked by competent valves. Femoral vein compression and leg elevation have the effect of prolonging the action of the foamed sclerosant on the distal intima, improving the efficacy of the entire treatment. In addition, leg elevation for 5-10 minutes allows the foam to revert to its liquid state, so that foam particles will not reach the right atrium or a patent foramen ovale.

The femoral, popliteal and deep veins of the leg are scanned intermittently throughout the entire procedure. Foam particles are washed out of deep veins such as the gastrocnemius or tibial veins by flexion-extension maneuvers of the foot. Repetitive dorsiflexion of the foot completely clears the deep veins of any foam particles.

Despite much consternation, major thrombotic events have rarely been described with the use of sclerofoam. In a study of over 12 000 sclerotherapy sessions by Guex, over half of which involved foam, only a single femoral vein thrombus was encountered. Thromboses of the gastrocnemius, tibial and peroneal veins have been reported occasionally, and intra-arterial injections are even rarer.

Ultrasound sonography has confirmed the presence of the tangled network of small varicose veins, reticular varices and incompetent perforating veins under lipodermatosclerotic plaques and under venous ulcers. Ultrasound monitoring should confirm the fact that these vessels are filled with foam during treatment.

Ultrasound guidance is also used in treatment of incompetent perforating veins. Direct cannulation and controlled injection can be done easily if the primary treatment has failed to heal an ulcer or improve the condition of lipodermatosclerosis.6 Often, superficial peripheral veins can be directly injected with the objective of obliterating the attached perforator and its network of the incompetent veins.

As other adverse events have been eliminated, skin discoloration remains a major deterrent to acceptance of foam sclerotherapy. It is usually accompanied by patent venous channels as shown here. These should be closed by repeat injections under ultrasound guidance Post-treatment assessment.

Post-treatment assessment

Early post-treatment duplex scanning should be performed. This is best done at 1 and 7 days postprocedure, looking for deep venous thrombosis. Many have eliminated the 1-day examination because deep venous thrombosis is uncommon. Successful obliteration of the saphenous vein is confirmed by its contraction to a residual diameter of




For more information, please visit http://www.SDVeinInstitute.com

Van Cheng, MD
Medical Director, San Diego Vein Institute
1011 Devonshire Dr. Ste B
Encinitas, CA 92024
760.944.9263
http://www.SDVeinInstitute.com





This post was made using the Auto Blogging Software from WebMagnates.org This line will not appear when posts are made after activating the software to full version.

張貼者： 於 0 意見
標籤： , , ,

2012年8月23日 星期四

Treating Bursitis With a Therapeutic Home Ultrasound Machine


The bursa is a tough, flat, membranous sac enclosing any joint between bones in our body. This sac contains a lubricating fluid and lies close to the tendons that attach the muscles to the joint. The fluid in the bursa keeps the ends of the bones in a joint well lubricated and in good condition.

Bursitis is a very painful condition resulting from an excessive accumulation of fluid in the bursa, causing it to swell up and press on the neighboring tissues. Bursitis may be acute, occurring suddenly as a result of injury or trauma. It may be chronic, occurring frequently. When any one of the joints in the body is stressed by being frequently, repeatedly and/or overused for a sustained period of time, the bursa responds by producing excess fluid and becomes painfully inflamed.

There are many other causes for bursitis. These are: staphylococcal or some bacterial infection; deposits of calcium or uric acid crystals; abnormal joints because of difference in leg lengths; arthritis; bone spurs; rheumatoid arthritis; psoriatic arthritis; tuberculosis; thyroid diseases; diabetes; or gout.

The type of bursitis you have depends on which of the joints in your body is affected. Shoulder and elbow bursitis are often associated with excessive physical activity that stress these joints. Bursitis of the hip joint may be due to infection or injury. Runners and ballet dancers are subject to hip bursitis. Sitting for a long time in the same position may cause ischial bursitis. The knee joints could be affected by frequent kneeling in upright position, obesity in conjunction with diseases like diabetes or osteoporosis. Young athletes who do not take care to wear well fitting shoes may develop calcaneal bursitis of the heel or ankle.

There are several options for treatment of bursitis. Very often treatment for bursitis may involve simple procedures of bursitis physical therapy like R.I.C.E, which is resting, icing, compression and elevation of the affected joint. Other bursitis physical therapy procedures are stretching and muscle strengthening exercises, and soft tissue manipulation.

Bursitis treatment may also utilize therapeutic ultrasound. Ultrasound physical therapy reduces pain and inflammation in the bursa because the ultra sound waves increase blood circulation and oxygen to the injury site. In short, ultrasound therapy causes micro-vibrations in the soft tissues beneath the skin's surface to increase blood supply and subsequently decrease local swelling and chronic inflammation. The vibrations also help to speed healing and relieve pain associated with bursitis.

Home ultrasound machines are now available for ultrasound bursitis treatment and rehabilitation. Such ultrasonic treatments are more affordable and convenient than chiropractor and physical therapist visits. Previously, ultrasound therapy treatments have only be available for professional athletes, but it is now possible to rehab bursitis, and many other chronic injuries, in the comfort of your own home.

Soft tissue injuries, such as bursitis, require a specific kind of home ultrasound machine. A home ultrasound physical therapy machine should emit 1Mhz ultrasound waves. It is also important to purchase an FDA approved ultrasound unit that is quality manufactured. Your portable therapeutic ultrasound device should also be covered with at least a 1 year warranty.

Because these home ultrasound machines utilize pulsed ultrasound waves, they are very safe for use by the general public. Pulse ultrasound also is just as effective as continuous wave ultrasound that is used by doctors, but in home treatments will just be more often. With a portable therapeutic ultrasound machine, you can treat your bursitis daily in the comfort of your own home.




Christine Beggs is the founder and CEO of EZUltrasound.com, the leading provider of portable home ultrasound machines to relieve pain and speed healing. Over the past 2 years, Christine has strived to deliver affordable, therapeutic ultrasound machines to anyone who needs them. Working closely with doctors and physical therapists, Christine has first hand knowledge of ultrasound therapy, its benefits and applications, and has a passion for sharing this knowledge in her articles. She developed EZUltrasound.com to relay her continual dedication to improving the quality of people's lives through the use of therapeutic ultrasound. To find out more, please visit www.EZUltrasound.com.





This post was made using the Auto Blogging Software from WebMagnates.org This line will not appear when posts are made after activating the software to full version.

張貼者： 於 0 意見
標籤： , , , ,

2012年8月21日 星期二

The Healing Benefits of Therapeutic Ultrasound


Over the past several years, therapeutic ultrasound has been used by professional athletes as a preventative measure to protect against injury and to quickly relieve pain and accelerate the healing process. Professional athletes typically suffer injuries to muscles, tendons and ligaments making ultrasound therapy the best choice for reducing swelling which is the source of pain. It also increases blood flow in the affected areas which reduces healing time.

Fortunately, weekly and weekend warriors alike can receive the same benefits as professional athletes by using a home ultrasound device. Home ultrasound devices are rapidly changing the lives of many people who require ultrasound treatments. Home ultrasound devices are compact, lightweight, portable safe and very easy to operate. They are also very affordable providing a low cost way to give regular treatments to yourself and others.

Therapeutic professionals are also providing their patients home ultrasound kits to take home and use for the duration of the healing process. What this means to the patient is getting treatments several times per day, every day instead of once or twice a week at the therapist's office. This translates into a quicker recovery. Because of daily treatments, there is a decrease in the chances of recurring injuries by eliminating scar tissue.

Exactly what does therapeutic ultrasound do? Let's first explore what ultrasound is. Ultrasound is a method of stimulating tissue beneath the skin's surface using sound waves. Ultrasound waves travel at an extremely high frequency undetectable by the human ear. Typically, the sound waves travel between 800,000Hz and 2,000,000Hz whereby the human ear can detect sounds up to about 20,000Hz. These high frequency waves penetrate the body about five inches below the skin causing the molecules of the affected tissue to move. This physical stimulation of the molecules enhances cell repair. Also, power output is a significant factor. The power of an ultrasound unit is measured in watts per square centimeter. The higher the power, the more energy is transferred into the body. For example, using higher power usually speeds up treatment although it is actually more effective to use a lower power setting for a longer period of time.

The benefits of therapeutic ultrasound are many. However, the heating and massaging effects of therapeutic ultrasound have 3 primary benefits:

• Increases blood flow in the treated area which speeds the healing process.

• Reduces swelling and edema, the main sources of pain.

• The gentle massaging effects of the ultrasound waves stimulate the affected muscles, tendons and ligaments. The cell of the damaged tissue are repaired without adding strain, and softens any scar tissue that may be present in the injured area.

Another important benefit of therapeutic ultrasound is that it can be used to administer therapeutic medicines into the body. This is a process known as phonophoresis. During this process a naturally medicated gel containing anti-inflammatory and pain relieving ingredients is applied with the ultrasound unit by massaging it deep into the affected area. The combination of the medicated gel and regular ultrasound therapy provide incredible pain relief and speed the healing process.

Home therapeutic ultrasound units are becoming extremely popular among active people because they see the great benefits these units provide in the relief of pain and treatment for chronic ailments. It is a powerful tool to have in your medical arsenal.




Anthony Pica is a writer who provides helpful information about Therapeutic Ultrasound Technology.
You can check out his latest website at
Therapeutic Ultrasound.





This post was made using the Auto Blogging Software from WebMagnates.org This line will not appear when posts are made after activating the software to full version.

張貼者： 於 0 意見
標籤： , , ,

2012年8月19日 星期日

Using Therapeutic Home Ultrasound to Treat Plantar Fasciitis


Plantar fasciitis is a common, persistent foot injury that requires proper treatment. Plantar fascitis results in acute inflammation and severe pain in the fibrous band of tissue running across the bottom of the foot. Because the ligaments, tendons, and tissue in the foot move every time the foot is flexed, when they are inflamed, every movement hurts, making daily activities very painful. Once the plantar fascia tissue is injured, 100% recovery is difficult and re-injury occurs frequently. But, therapies such as ultrasound can hold the key to complete plantar fascia healing. And luckily, ultrasound technologies are advancing and new affordable and portable ultrasound machines are becoming available for home users.

Causes:

Because the plantar fascia can only stretch 102% of its length without tearing, the stress of an extremely active lifestyle can be too much. This condition of the foot is caused primarily from overloading and overuse in jobs that require a person to be on their feet all day, such as teachers and waitresses, to push heavy loads, such as shippers and construction workers, and to participate in vigorous sports, such as running, dancing, football and basketball. Plantar fasciitis is one of the top five most common foot and ankle injuries among professional athletes.

Poor biomechanics, foot muscle and/or ligament imbalances, and faulty foot structures can also contribute to the development of plantar fasciitis. Other causes include obesity and poorly supported shoes.

The inflammation in the arch of the foot experienced by plantar fasciitis suffers can also lead to an intense stabbing pain in the heel and eventually, heel spurs. For this reason, it is critical to properly treat an inflamed plantar fascia at the onset of the condition with ultrasound therapy or another modality.

Treatments:

The intense flare-ups of pain in the arch of the foot associated with plantar fascitis can be best managed through conservative, regular treatments. Patient education on how to treat plantar fasciitis and self-care are critical components in healing from plantar fasciitis. Patience is also key, as an inflamed plantar fascia can take six months to a year to completely recover.

By modifying daily activities and exercise, wearing properly fitting shoes, taping the feet, and massaging the foot arch, the acute inflammation of plantar fasciitis can be minimized. After strenuous activities, RICE (rest, ice, compress, elevate) is generally the prescribed procedure for plantar fascitis sufferers. However, for 100% injury recovery, using therapeutic ultrasound prior to RICE treatment is best because the ultrasonic waves efficiently decrease inflammation and relive pain for diagnosed or chronic plantar fasciitis within the first 48 hours of a flare-up. Daily ultrasound physical therapy can be a very effective way to manage and heal plantar fasciitis and heel spurs and is best accomplished with a personal, therapeutic ultrasound device.

For those suffering from chronic plantar fasciitis, foot and tendon rehabilitation at home is now possible with the advent of portable ultrasound machines. The ultrasound therapy utilized by these devices can be used as an advanced treatment of plantar fasciitis and the chronic tendon pain that accompanies the condition. Therapeutic ultrasound can be used to reduce pain and heal foot and ankle injuries twice as fast.

Ultra sound waves provide gentle deep tissue heating that decreases pain and inflammation to speed healing by penetrating the skin and causing vibrations in the tendons and soft tissues of the foot. Ultrasound therapy relaxes muscles and decreases swelling by increasing blood flow and oxygen to tendons and ligaments. Ultrasound deep tissue stimulation can be used as a pain therapy system to control plantar fasciitis flare-ups and can now be used in the comfort of your very own home.

A home ultrasound unit works the same way as bigger machines, found in physical therapist and chiropractor practices, but is more compact and priced reasonably so home users can afford to purchase. Portable ultrasound machines are also safe for use by the general public because they utilize pulsed, instead of continuous, ultrasound waves, which are just as effective when used on a daily basis. Plantar fasciitis physical therapy involving ultrasound will provide users with immediate relief and continual healing over a 3-4 week period.

Because plantar fascist involves soft tissue and tendon inflammation, a specific kind of home ultrasound machine is required for treatment. A home ultrasound physical therapy machine should emit 1Mhz ultrasound waves. It is also important to purchase an FDA approved ultrasound unit that is quality manufactured. The portable therapeutic ultrasound device should also be covered with at least a 1 year warranty. And best of all, with a portable therapeutic ultrasound machine, you can treat your plantar fasciitis daily when it is most convenient for you.




Christine Beggs is the founder and CEO of EZUltrasound.com, the leading provider of portable home ultrasound machines to relieve pain and speed healing. Over the past 2 years, Christine has strived to deliver affordable, therapeutic ultrasound machines to anyone who needs them. Working closely with doctors and physical therapists, Christine has first hand knowledge of ultrasound therapy, its benefits and applications, and has a passion for sharing this knowledge in her articles. She developed EZUltrasound.com to relay her continual dedication to improving the quality of people's lives through the use of therapeutic ultrasound. To find out more, please visit www.EZUltrasound.com.





This post was made using the Auto Blogging Software from WebMagnates.org This line will not appear when posts are made after activating the software to full version.

張貼者： 於 0 意見
標籤： , , , , ,

2012年8月1日 星期三

What is Therapeutic Ultrasound and How Does it Work to Help Decrease Pain and Increase Healing?


Many patients receive ultrasound therapy in the clinic, outpatient ER, or doctor's office yet do not know how or why it works, or doesn't work. This is a general discussion of what is ultrasound and how does ultrasound work.

Ultrasound units operate on production of sound waves that can produce heat in one mode yet in another mode create physiological change on a cellular level. Sounds good but what does that mean?

If you take your hands and rub them together very rapidly you will create friction which produces heat. When ultrasound is used on the patient in the clinic on "continuous" mode the same type physiological occurrence is happening, except on a deeper level within the structure being treated such as elbow, low back, leg etc. The ultrasonic energy is moving the cells back and forth deeper inside the tissue and creating heat. From heat flows other therapeutic benefits such as increased blood flow which often reduces pain during the treatment and for some residual or carryover pain relief post treatment.

Most ultrasound machines can also be set on "pulsed" mode which is when the unit is turning off and on automatically. As an example on continuous the ultrasound machine is constantly on and moving molecules, but on pulsed it may be on for short periods of time such as on 20% of the time the continuous treatment is. The ultrasound is administered to the treatment area for short time period, then turns off and comes back on later for short bursts of ultrasonic energy. The "pulsed" mode does not produce heat.

Generally speaking most treatments are applied on "continuous" mode simply because ultrasound treatments are initiated with the desired effects of producing heat within the damaged tissues. Continuous mode is not indicated in acute injury that may have occurred within the past 24 - 48 hours. At that point in time the body is in an inflammatory process and additional heat is not beneficial to healing, and can actually irritate. During the acute stage "pulsed" mode may be used to increase the physiological responses occurring due to the injury.

After the initial injury, when heat is beneficial, continuous mode is indicated for pain relief. Generally speaking the patient does not "feel the ultrasound" and this is always true on pulsed mode. The ultrasound head needs to be moving at all times on continuous mode as there is a danger of harming the patient if the head, with the crystal inside, is not constantly moving to avoid heat build up in the underlying tissues.




Bob Johnson is owner/founder of MedFaxx, Inc. and has multiple patents for non pharmacological treatment of chronic pain, decubitus ulcers, using electrotherapy and ultraviolet F.D.A. approved medical devices.

More information on renting, buying ultrasound units for home or clinical use at:

http://www.painreductiontherapy.com/ult.php?cat=20





This post was made using the Auto Blogging Software from WebMagnates.org This line will not appear when posts are made after activating the software to full version.

張貼者： 於 0 意見
標籤： , , , ,

2012年7月29日 星期日

Therapeutic Ultrasound And Pain Management


In recent years, a new form of pain relief management and treatment has emerged called "therapeutic ultrasound" or at times "ultrasound therapy." Although first tried in the 1940's, only in the past decade or so has it grown in popularity as a form of pain management.

One of the most common ways ultrasound therapy is used today is to manage lower back pain. There are two primary ways to acquire this treatment: either by seeing a physiotherapists who specializes in this treatment at a clinic, or by using a portable home device developed for this treatment.

There are two main types of ultrasound therapy: thermal and mechanical. Thermal relies on providing a continual stream of sound waves, while mechanical relies on sound pulses.

Most therapeutic ultrasound treatments only last between five to ten minutes in length, and completely painless. The therapy relies on the use of sound waves and is really a form of deep tissue therapy. Not only can it be used to treat chronic pain conditions such as lower back pain, but many sufferers of conditions such as arthritis and fibromyalgia and found the treatment to be of use as well.

Therapeutic ultrasound is generally much preferred to surgical options for pain management. Given the advent of home ultrasound machines, it is also quite convenient for many to use as well. Home machines usually consist of a hand held "transducer" that in conjunction with a gel will allow an individual to treat many different body pains easily at home. Many of these devices cost under $200, although you should shop carefully and make sure the model you select has good customer reviews and is FDA approved.

If you prefer to see a physiotherapists for the procedure, you may want to ask your regular physician for a recommendation and for his or her opinion on the treatment. A physiotherapist may be able to more accurately treat your pain condition. They should be able to tell whether your specific condition is more appropriately treated via thermal or mechanical ultrasound therapy, and make sure that it is administered effectively.

There have been several scientific studies that have supported the use of ultrasound therapy, but others have not, so at best the scientific community is mixed on the benefits of this treatment. Still, given that there is little chance of harm using this method to treat pain compared to surgical options, it may be worth at least trying out for many.




If you are interested in ultrasound technology more generally, you may want to look into ultrasound technician training and various ultrasound technician schools.





This post was made using the Auto Blogging Software from WebMagnates.org This line will not appear when posts are made after activating the software to full version.

張貼者： 於 0 意見
標籤： , ,

2012年7月8日 星期日

Treating Bursitis With a Therapeutic Home Ultrasound Machine


The bursa is a tough, flat, membranous sac enclosing any joint between bones in our body. This sac contains a lubricating fluid and lies close to the tendons that attach the muscles to the joint. The fluid in the bursa keeps the ends of the bones in a joint well lubricated and in good condition.

Bursitis is a very painful condition resulting from an excessive accumulation of fluid in the bursa, causing it to swell up and press on the neighboring tissues. Bursitis may be acute, occurring suddenly as a result of injury or trauma. It may be chronic, occurring frequently. When any one of the joints in the body is stressed by being frequently, repeatedly and/or overused for a sustained period of time, the bursa responds by producing excess fluid and becomes painfully inflamed.

There are many other causes for bursitis. These are: staphylococcal or some bacterial infection; deposits of calcium or uric acid crystals; abnormal joints because of difference in leg lengths; arthritis; bone spurs; rheumatoid arthritis; psoriatic arthritis; tuberculosis; thyroid diseases; diabetes; or gout.

The type of bursitis you have depends on which of the joints in your body is affected. Shoulder and elbow bursitis are often associated with excessive physical activity that stress these joints. Bursitis of the hip joint may be due to infection or injury. Runners and ballet dancers are subject to hip bursitis. Sitting for a long time in the same position may cause ischial bursitis. The knee joints could be affected by frequent kneeling in upright position, obesity in conjunction with diseases like diabetes or osteoporosis. Young athletes who do not take care to wear well fitting shoes may develop calcaneal bursitis of the heel or ankle.

There are several options for treatment of bursitis. Very often treatment for bursitis may involve simple procedures of bursitis physical therapy like R.I.C.E, which is resting, icing, compression and elevation of the affected joint. Other bursitis physical therapy procedures are stretching and muscle strengthening exercises, and soft tissue manipulation.

Bursitis treatment may also utilize therapeutic ultrasound. Ultrasound physical therapy reduces pain and inflammation in the bursa because the ultra sound waves increase blood circulation and oxygen to the injury site. In short, ultrasound therapy causes micro-vibrations in the soft tissues beneath the skin's surface to increase blood supply and subsequently decrease local swelling and chronic inflammation. The vibrations also help to speed healing and relieve pain associated with bursitis.

Home ultrasound machines are now available for ultrasound bursitis treatment and rehabilitation. Such ultrasonic treatments are more affordable and convenient than chiropractor and physical therapist visits. Previously, ultrasound therapy treatments have only be available for professional athletes, but it is now possible to rehab bursitis, and many other chronic injuries, in the comfort of your own home.

Soft tissue injuries, such as bursitis, require a specific kind of home ultrasound machine. A home ultrasound physical therapy machine should emit 1Mhz ultrasound waves. It is also important to purchase an FDA approved ultrasound unit that is quality manufactured. Your portable therapeutic ultrasound device should also be covered with at least a 1 year warranty.

Because these home ultrasound machines utilize pulsed ultrasound waves, they are very safe for use by the general public. Pulse ultrasound also is just as effective as continuous wave ultrasound that is used by doctors, but in home treatments will just be more often. With a portable therapeutic ultrasound machine, you can treat your bursitis daily in the comfort of your own home.




Christine Beggs is the founder and CEO of EZUltrasound.com, the leading provider of portable home ultrasound machines to relieve pain and speed healing. Over the past 2 years, Christine has strived to deliver affordable, therapeutic ultrasound machines to anyone who needs them. Working closely with doctors and physical therapists, Christine has first hand knowledge of ultrasound therapy, its benefits and applications, and has a passion for sharing this knowledge in her articles. She developed EZUltrasound.com to relay her continual dedication to improving the quality of people's lives through the use of therapeutic ultrasound. To find out more, please visit www.EZUltrasound.com.





This post was made using the Auto Blogging Software from WebMagnates.org This line will not appear when posts are made after activating the software to full version.

張貼者： 於 0 意見
標籤： , , , ,

2012年6月4日 星期一

The Healing Benefits of Therapeutic Ultrasound


Over the past several years, therapeutic ultrasound has been used by professional athletes as a preventative measure to protect against injury and to quickly relieve pain and accelerate the healing process. Professional athletes typically suffer injuries to muscles, tendons and ligaments making ultrasound therapy the best choice for reducing swelling which is the source of pain. It also increases blood flow in the affected areas which reduces healing time.

Fortunately, weekly and weekend warriors alike can receive the same benefits as professional athletes by using a home ultrasound device. Home ultrasound devices are rapidly changing the lives of many people who require ultrasound treatments. Home ultrasound devices are compact, lightweight, portable safe and very easy to operate. They are also very affordable providing a low cost way to give regular treatments to yourself and others.

Therapeutic professionals are also providing their patients home ultrasound kits to take home and use for the duration of the healing process. What this means to the patient is getting treatments several times per day, every day instead of once or twice a week at the therapist's office. This translates into a quicker recovery. Because of daily treatments, there is a decrease in the chances of recurring injuries by eliminating scar tissue.

Exactly what does therapeutic ultrasound do? Let's first explore what ultrasound is. Ultrasound is a method of stimulating tissue beneath the skin's surface using sound waves. Ultrasound waves travel at an extremely high frequency undetectable by the human ear. Typically, the sound waves travel between 800,000Hz and 2,000,000Hz whereby the human ear can detect sounds up to about 20,000Hz. These high frequency waves penetrate the body about five inches below the skin causing the molecules of the affected tissue to move. This physical stimulation of the molecules enhances cell repair. Also, power output is a significant factor. The power of an ultrasound unit is measured in watts per square centimeter. The higher the power, the more energy is transferred into the body. For example, using higher power usually speeds up treatment although it is actually more effective to use a lower power setting for a longer period of time.

The benefits of therapeutic ultrasound are many. However, the heating and massaging effects of therapeutic ultrasound have 3 primary benefits:

• Increases blood flow in the treated area which speeds the healing process.

• Reduces swelling and edema, the main sources of pain.

• The gentle massaging effects of the ultrasound waves stimulate the affected muscles, tendons and ligaments. The cell of the damaged tissue are repaired without adding strain, and softens any scar tissue that may be present in the injured area.

Another important benefit of therapeutic ultrasound is that it can be used to administer therapeutic medicines into the body. This is a process known as phonophoresis. During this process a naturally medicated gel containing anti-inflammatory and pain relieving ingredients is applied with the ultrasound unit by massaging it deep into the affected area. The combination of the medicated gel and regular ultrasound therapy provide incredible pain relief and speed the healing process.

Home therapeutic ultrasound units are becoming extremely popular among active people because they see the great benefits these units provide in the relief of pain and treatment for chronic ailments. It is a powerful tool to have in your medical arsenal.




Anthony Pica is a writer who provides helpful information about Therapeutic Ultrasound Technology.
You can check out his latest website at
Therapeutic Ultrasound.





This post was made using the Auto Blogging Software from WebMagnates.org This line will not appear when posts are made after activating the software to full version.

張貼者： 於 0 意見
標籤： , , ,

2012年6月3日 星期日

The Use of Therapeutic Home Ultrasound to Treat Arthritis


As we age, our once lubricated joints can become less efficient at absorbing shocks and protecting our bones. This condition, known as arthritis, can be both mentally and physically crippling and affects approximately 50% of adults 65 years and older. Arthritis can significantly reduce a person's ability to enjoy life because it effects major joints of the body, such as knees, elbows and hands, which are vital for daily functioning.

Types of Arthritis: Arthritis is an inflammation of a joint, usually accompanied by pain, swelling, and stiffness. It comprises more than 100 different rheumatic diseases and conditions. It results from severe infection, traumas, degenerative changes (osteoarthritis, hypertrophic arthritis, senescent arthritis), metabolic disruptions, autoimmune disorders (lupus erythematous) or other causes. It occurs in various forms, such as bacterial arthritis, osteoarthritis, or rheumatoid arthritis.

Rheumatoid arthritis, an autoimmune disorder, is considered a chronic disease and patients with rheumatoid arthritis develop chronic arthritis pain. Osteoarthritis, also known as degenerative joint disease, is the most common form of arthritis, especially among older populations, affecting over 20 million Americans. Two types of arthritis are Rheumatoid arthritis &osteoarthritis, both of which cause arthritic joint pain that can significantly impair a person's quality of life.

Causes: Daily activities such as getting out of bed and even walking can be affected by a painful joint. This arthritic joint pain is occurs when the lubricant, known as synovial fluid, present in the joints and cartilage becomes damaged. Because this fluid acts as a shock absorber and ensures that the ends of our bones are protected, when it is comprised, our bones can grind against each other, causing significant pain in our joints.

Painful joints and joint inflammation and stiffness typically characterize the disease. Some causes of arthritics include overuse, basic wear and tear, pseudogout, infections, autoimmune disorders, bone diseases or fractures, and bone tumors or cancer. In addition, medications, such as penicillin, and the common cold or flu often cause sore aching joints or stiff joints.

Treatments: While there is no known cure for a chronic condition like arthritis, there are treatments for inflamed, arthritic joints that really work and help sufferers manage their pain to lead normal healthy lives. Most often, a doctor, chiropractor or physical therapist will prescribe a medication program of prescription medicines and nonsteroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen (Advil, Motrin) to treat an injured joint. These medications aim to reduce the pain and inflammation of sore arthritic joints. However, they are associated with a number of bad side effects, such as drowsiness, constipation, nausea, diarrhea, vomiting, headache and rash. Anti-inflammatory drugs are not your best treatment option because they do not heal your joints, they only mask the arthritis pain. A stiff injured joint is also sometimes managed with splints or braces of various types which allow the joint to rest.

Many Arthritis sufferers have found relief with natural supplementation of Chondroitin Sulfate and Glucosamine. Chondroitin is a building block of the human connective tissue in bones and cartilage and glucosamine is the major constituent of joint cartilage. Other herbs to try might be curcumin, MSM, and boswellia.

Alternative treatments such as acupuncture, homeopathic medicines and yoga, a weight-bearing exercise that strengthens bones, have helped some arthritis sufferers find relief.

The intense flare-ups of arthritis pain can be best managed through conservative, regular treatments. Patient education on how to treat arthritis and self-care are critical components in healing painful joints. Patience is also key, as an inflamed joint can we slow to heal. Often the combination of therapeutic modalities, such as an herbal supplementation regime and, can offer the most arthritis pain relief.

Ultrasound Therapy: RICE (rest, ice, compress, elevate) can we a very useful procedure for managing arthritis pain, however, using therapeutic ultrasound prior to RICE treatment is best because the ultrasonic waves efficiently decrease inflammation and relive pain.

Joints have limited blood flow and as a result, they recover from arthritis flare-ups very slowly. In addition, inflammation and waste matter build-up due to the decreased blood flow causing extreme pain to arthritis sufferers. A personal, therapeutic ultrasound device acts as a blood flow stimulation therapy to increase circulation in the inflamed joint and decrease arthritic pain. People suffering from osteoarthritis pain or chronic Rheumatoid arthritis can perform rehabilitation at home now with the advent of portable ultrasound machines. The ultrasound therapy utilized by these devices can be used as an advanced treatment of arthritis and the chronic pain that accompanies the condition. Therapeutic ultrasound can be used to reduce pain, stimulate blood flow and injuries twice as fast.

Ultrasound physical therapy not only helps alleviate pain, but speeds up healing process as well. Ultra sound waves generate deep tissue vibrations that provide gentle heating to decrease pain and inflammation. The most rehabilitation benefits can be gained by utilizing therapeutic ultrasound at home.

Case Study: In a study by Casimiro et al, 2002 investigating the use of therapeutic ultrasound for the treatment of rheumatoid arthritis (RA), it was found that continuous ultrasound benefits grip strength when applied to the hands of RA sufferers. Ultrasound has both analgesic & anti-inflammatory effects, which is why its so widely prescribed for arthritis by qualified health care professionals. In two randomized trials, it was proven that continuous ultrasound applied to the hand increased grip strength and wrist dorsal flexion, as well as decreased morning stiffness and the number of swollen painful joints as compared with placebo.

Home Ultrasound Machines: A home ultrasound unit works the same way as bigger machines, found in physical therapist and chiropractor practices, but is more compact and priced reasonably so home users can afford to purchase. Portable ultrasound machines are also safe for use by the general public because they utilize pulsed, instead of continuous, ultrasound waves, which are just as effective when used on a daily basis. Physical therapy involving ultrasound for plantar fasciitis will provide users with immediate relief and continual healing over a 3-4 week period.

Because arthritis involves joint and bone inflammation, a specific kind of home ultrasound machine is required for treatment. A home ultrasound physical therapy machine should emit 1Mhz ultrasound waves. It is also important to purchase an FDA approved ultrasound unit that is quality manufactured. The portable therapeutic ultrasound device should also be covered with at least a 1 year warranty. And best of all, with a portable therapeutic ultrasound machine, on a daily basis you can treat your arthritis only when it's most convenient for you.

Conclusion: Studies have shown that people who receive early treatment for arthritis feel better sooner and more often, are more likely to lead an active life, and are less likely to experience chronic arthritis pain, and the type of joint damage that leads to joint replacement.

Arthritis sufferers can lead a more normal active life by reducing pain & swelling in their joints fast with a home ultrasound machine. If you would like to reduce or eliminate you intake of harmful pain-killers and improve your arthritic symptoms and chronic joint pain, a portable ultrasound unit would be a great, affordable option for managing your arthritis.




---------------------------------------------------------------------------------------------------------------------------
Christine Beggs is the founder and CEO of EZUltrasound.com, the leading provider of portable home ultrasound machines to relieve pain and speed healing. Over the past 2 years, Christine has strived to deliver affordable, therapeutic ultrasound machines to anyone who needs them. Working closely with doctors and physical therapists, Christine has first hand knowledge of ultrasound therapy, its benefits and applications, and has a passion for sharing this knowledge in her articles. She developed EZUltrasound.com to relay her continual dedication to improving the quality of people's lives through the use of therapeutic ultrasound. To find out more, please visit www.EZUltrasound.com.





This post was made using the Auto Blogging Software from WebMagnates.org This line will not appear when posts are made after activating the software to full version.

張貼者： 於 0 意見
標籤： , , ,

2012年6月2日 星期六

Using Therapeutic Home Ultrasound to Treat Plantar Fasciitis


Plantar fasciitis is a common, persistent foot injury that requires proper treatment. Plantar fascitis results in acute inflammation and severe pain in the fibrous band of tissue running across the bottom of the foot. Because the ligaments, tendons, and tissue in the foot move every time the foot is flexed, when they are inflamed, every movement hurts, making daily activities very painful. Once the plantar fascia tissue is injured, 100% recovery is difficult and re-injury occurs frequently. But, therapies such as ultrasound can hold the key to complete plantar fascia healing. And luckily, ultrasound technologies are advancing and new affordable and portable ultrasound machines are becoming available for home users.

Causes:

Because the plantar fascia can only stretch 102% of its length without tearing, the stress of an extremely active lifestyle can be too much. This condition of the foot is caused primarily from overloading and overuse in jobs that require a person to be on their feet all day, such as teachers and waitresses, to push heavy loads, such as shippers and construction workers, and to participate in vigorous sports, such as running, dancing, football and basketball. Plantar fasciitis is one of the top five most common foot and ankle injuries among professional athletes.

Poor biomechanics, foot muscle and/or ligament imbalances, and faulty foot structures can also contribute to the development of plantar fasciitis. Other causes include obesity and poorly supported shoes.

The inflammation in the arch of the foot experienced by plantar fasciitis suffers can also lead to an intense stabbing pain in the heel and eventually, heel spurs. For this reason, it is critical to properly treat an inflamed plantar fascia at the onset of the condition with ultrasound therapy or another modality.

Treatments:

The intense flare-ups of pain in the arch of the foot associated with plantar fascitis can be best managed through conservative, regular treatments. Patient education on how to treat plantar fasciitis and self-care are critical components in healing from plantar fasciitis. Patience is also key, as an inflamed plantar fascia can take six months to a year to completely recover.

By modifying daily activities and exercise, wearing properly fitting shoes, taping the feet, and massaging the foot arch, the acute inflammation of plantar fasciitis can be minimized. After strenuous activities, RICE (rest, ice, compress, elevate) is generally the prescribed procedure for plantar fascitis sufferers. However, for 100% injury recovery, using therapeutic ultrasound prior to RICE treatment is best because the ultrasonic waves efficiently decrease inflammation and relive pain for diagnosed or chronic plantar fasciitis within the first 48 hours of a flare-up. Daily ultrasound physical therapy can be a very effective way to manage and heal plantar fasciitis and heel spurs and is best accomplished with a personal, therapeutic ultrasound device.

For those suffering from chronic plantar fasciitis, foot and tendon rehabilitation at home is now possible with the advent of portable ultrasound machines. The ultrasound therapy utilized by these devices can be used as an advanced treatment of plantar fasciitis and the chronic tendon pain that accompanies the condition. Therapeutic ultrasound can be used to reduce pain and heal foot and ankle injuries twice as fast.

Ultra sound waves provide gentle deep tissue heating that decreases pain and inflammation to speed healing by penetrating the skin and causing vibrations in the tendons and soft tissues of the foot. Ultrasound therapy relaxes muscles and decreases swelling by increasing blood flow and oxygen to tendons and ligaments. Ultrasound deep tissue stimulation can be used as a pain therapy system to control plantar fasciitis flare-ups and can now be used in the comfort of your very own home.

A home ultrasound unit works the same way as bigger machines, found in physical therapist and chiropractor practices, but is more compact and priced reasonably so home users can afford to purchase. Portable ultrasound machines are also safe for use by the general public because they utilize pulsed, instead of continuous, ultrasound waves, which are just as effective when used on a daily basis. Plantar fasciitis physical therapy involving ultrasound will provide users with immediate relief and continual healing over a 3-4 week period.

Because plantar fascist involves soft tissue and tendon inflammation, a specific kind of home ultrasound machine is required for treatment. A home ultrasound physical therapy machine should emit 1Mhz ultrasound waves. It is also important to purchase an FDA approved ultrasound unit that is quality manufactured. The portable therapeutic ultrasound device should also be covered with at least a 1 year warranty. And best of all, with a portable therapeutic ultrasound machine, you can treat your plantar fasciitis daily when it is most convenient for you.




Christine Beggs is the founder and CEO of EZUltrasound.com, the leading provider of portable home ultrasound machines to relieve pain and speed healing. Over the past 2 years, Christine has strived to deliver affordable, therapeutic ultrasound machines to anyone who needs them. Working closely with doctors and physical therapists, Christine has first hand knowledge of ultrasound therapy, its benefits and applications, and has a passion for sharing this knowledge in her articles. She developed EZUltrasound.com to relay her continual dedication to improving the quality of people's lives through the use of therapeutic ultrasound. To find out more, please visit www.EZUltrasound.com.





This post was made using the Auto Blogging Software from WebMagnates.org This line will not appear when posts are made after activating the software to full version.

張貼者： 於 0 意見
標籤： , , , , ,

2012年6月1日 星期五

Ultrasound Guidance For Therapeutic Interventions


Duplex ultrasound sonography is the best choice for evaluation of venous reflux in the lower extremities. It is inexpensive, noninvasive, and generally acceptable to the patient. It provides direct visualization, localization and quantitation of venous reflux with a surprisingly high sensitivity (95%) and specificity (100%). Duplex ultrasound findings have been confirmed by angioscopic observation of incompetent vein valves in advanced chronic venous insufficiency. Yamaki has demonstrated that high peak reflux velocities (>30 cm/s), reflux duration greater than 3 s and an enlarged valve annulus measured by duplex ultrasonography at the saphenofemoral junction are all closely related to angioscopically deformed and incompetent terminal valves (types III and IV of Hoshino).

Foam sclerotherapy actually began before the development of ultrasound imaging. Phlebologists of the 1950s developed ways of producing foamed sclerosants and observed the distribution of therapeutic foam by sensing crepitus. However, all credit for the origination of foam sclerotherapy, as we know it today, goes to Juan Cabrera of Granada, Spain. It was he who combined the manufacture of fine foam with administration of the agent under ultrasound guidance.

Pretreatment assessment

The evaluation should always begin with confirmation of the medical history. A family and personal venous history are of great importance. In the personal history, the reasons for the treatment should be confirmed. The patient's view of the objectives of the procedure should

be recorded. Symptoms such as aching heaviness, limb fatigue, itching and burning pain are typically present and these should be recorded. Similarly, a detailed recording of previous treatments and their failure will be of importance in seeking insurance coverage for the intervention. History of pregnancies and their number, as well as the number of deliveries and abortions, are of importance. Any limb trauma, fractures and confining illnesses should be recorded. A history of deep venous thrombosis and treatment must be paired with its method of diagnosis. A detailed description of previous venous treatments must be a part of the treatment record. Comorbidities, allergies and pharmacologic history must be documented. The body mass index is calculated from the patient's height and weight and should be recorded.

If a proper, standing, duplex reflux examination has not been done or is not part of the patient's record, it should be accomplished before treatment is initiated. The patient should be examined in a standing position for procedural planning, identification of the venous access site, and its relation to perforating veins, varicosities, and areas of tortuosity, stenosis or dilation.

In this preparatory phase, some anatomic landmarks should be clearly recognizable, including the femoral vein, saphenofemoral junction, saphenous compartment, great saphenous vein (GSV) and the variable small saphenous junction anatomy. This should be supplemented by cold light transillumination of the skin with a bright white light such as the "vein light," to identify reticular veins. A hand-held Doppler can serve to perform a confirmatory screening examination if a proper pretreatment reflux examination is part of the record.

Three levels of pathologic veins are evaluated using the methods just mentioned. Telangiectasias in the skin are visually inspected, reticular veins are transilluminated with the vein light, and varicosities and the saphenous veins with ultrasound. Clinical data should be integrated into the CEAP classification.

Equipment

The duplex ultrasound scanner should be able to detect blood flow rates as low as 6 cm/s. Dedicated high-resolution vascular scanners with color and/or power Doppler functions as well as the continuous-wave Doppler are available. Linear transducers in the range of 4-7 MHz are used for the pretreatment as well as the definitive examination. The inferior vena cava, pelvic veins and deep veins of the limbs in obese patients may be imaged with lower-frequency, 3 MHz transducers. Linear hockey-stick transducers in the range of 5-12 MHz will provide detailed imaging of smaller veins and perforating veins.

After the year 2000, advances in technology allowed duplex ultrsound scanners to become smaller, more transportable, and more operator friendly. These miniaturized devices feature transducers designed with advanced architecture that allow a single probe to image across a greater range of depths within an application and across applications. Thus, in many ways, the portable ultrasound instrument supplements the stethoscope in patient evaluation. The transducer for peripheral vascular examinations operates from 5 to 10 MHz and provides resolution from the skin surface to 7 cm in depth. The technology incorporates power Doppler sonography, tissue harmonic imaging and direct connectivity to a personal computer. The overall performance of miniaturized ultrasound devices is comparable to that of the more traditional and much larger ultrasound equipment that allowed establishment and growth of the vascular laboratory.

Venous testing and mapping

Not only is a detailed duplex ultrasound study of the normal and pathologic venous anatomy essential, but a map should be created to guide therapy. A detailed verbal description of the examination and its findings is useful for record purposes, but the map is most useful during therapy. A clear and illustrative graphic notation of significant vein diameters, anomalous anatomy, superficial venous aneurysms, perforating veins, and presence and extent of reflux should always be recorded during the examination.

As mentioned, the ultrasound examination is conducted with the patient standing. This position has been found to maximally dilate leg veins, and challenges vein valves. Sensitivity and specificity in detecting reflux are increased in examinations performed with patient standing rather than when the patient is supine. Supine examinations for reflux are unacceptable.

The veins are scanned by moving the probe vertically up and down along their course. Transverse scans are most informative, but a mental reconstruction must be created to record the venous map. Duplicated segments, sites of tributary confluence, large perforating veins and their deep venous connections are identified, as well as the very common superficial venous aneurysms. Location of abnormalities as measured in "centimeters from the floor" assists in preparing a therapeutic guide. Measurements from the medial malleolus are commonly recorded, but are not as precise. Transverse and longitudinal scans combined with continuous scanning provide a clear mapping of the venous system.

Patency of peripheral veins is usually assessed by compression of the vein with the transducer. Residual ancient thrombus, partial patency and extrinsic compression should all be noted in the verbal description of find-ings. Reflux is detected by flow augmentation with compression and release maneuvers of the thigh and calf. The Valsalva maneuver is used only at the saphenofemoral junction, because presence of a competent proximal valve negates the value of the examination.

Automated rapid inflation and deflation cuffs have been used, but are cumbersome. However, they do offer the advantage of a standardized stimulus, which allows timing of reflux. Although reflux greater than 500 ms is considered pathologic, this is only precisely accurate when a standard stimulus is applied.

The diameter of the saphenofemoral junction and femoral vein are recorded in preparation for radiofrequency VNUS Closure® and endovenous laser ablation. Important information is also gained from diameters of the GSV at mid-thigh and distal thigh (Figure 6.2a). Radiofrequency ablation is commonly used to treat veins from 2 to 12 mm in diameter, although diameters recorded with the patient standing do not apply when treatment is given with the patient supine.

The supragenicular, infragenicular or immediate subgenicular GSVs are often the access point for introduction of sclerosant foam. Therefore the depth of the GSV in these regions should be recorded.

Accessory saphenous veins by definition run parallel to the GSV in the thigh. It is imperative to map their course accurately and to note their communication with varices and eventual communication with GSVs, as well as their presence or absence of reflux with relationship to varicosities. The accessory veins are easily confused with the GSV during continuous longitudinal scanning when the saphenous vein appears to leave the saphenous compartment. This error is avoided when transverse scans are done. The GSV is scanned throughout the leg and the thigh so that its tributaries are identified.

The diameters of the popliteal vein and the small saphenous vein (SSV) are recorded at the junction, as well as diameters of the SSV along its course in the leg. Intersaphenous veins should be identified and the extreme variability of the SSV termination carefully recorded.

The pretreatment venous reflux examination also includes the mapping of exit and re-entry perforating veins (PVs), wherever they are identified. PV reflux is detected as outward flow duration greater than 350 ms during the release phase of the flow augmentation maneuver (distal compression has higher sensitivity in detecting PV reflux;. PVs should be accu-rately mapped in their different locations in the leg, and their positions should be measured as distances (cm) from the floor.

Ultrasound monitoring during sclerofoam treatment

The advent of foam sclerotherapy has added a powerful tool for treatment of chronic venous insufficiency. Endo thermic coagulation is caused by the generation of heat, which is applied to the endothelial surface of targeted veins. Sclerosant foam has a similar end result: stripping

off the endothelium. Foam agents provoke endothelial damage by several mechanisms. They change the surface tension of the plasma membrane (detergents) and/or the intravascular pH and osmolarity. The final result is a chemical fibrosis of the treated vessel.

The endovenous techniques accomplish this by heat. It is been suggested that the coagulation process is related to the intravascular vaporization of blood (steam) during laser therapy, with intimal denudation and collagen fiber contraction. Vein wall thickening and rapid reorganization of the vessel to form a fibrotic cord follows. If the endothelium is destroyed, the targeted vein is closed permanently. Venous occlusion is usually visualized within 10-20 s of the electromagnetic or chemical stimulus. Both thermal and the chemical techniques have been proven to be safe and effective. Percutaneous introduction of foam, laser fiber and the RF catheter have made surgical intervention obsolete because of elimination of post-treatment pain, absence of cutaneous incisions and prevention of postprocedural disability Sclerosing foams, as described elsewhere in the book, are mixtures of gas and a liquid solution with surfactant properties. One of the intrinsic limits of liquid sclerosants in treatment of varicose veins is their dilution by blood, with reduction of their efficacy. Also, they are rapidly cleared by the moving blood stream. Sclerosing foams do not mix with blood, and instead remain in the vessel, where they strip off the endothelium. Persistence of the agent in the vessel causes an increased contact time with the intimal surface. Foam preparation is remarkably simple. The Tessari method is the most commonly used, but there is an increasing use of physiological gases as a substitute for room air.

As with endovenous ablation, the treatment starts with clear ultrasound mapping as described above. The GSV or the SSV can then be directly cannulated with an angiocath, an echogenic Cook needle or a butterfly needle. Nearly all descriptions of the technique explain direct ultrasound-guided access to the saphenous vein. In contrast, many experienced operators achieve a satisfactory and rapid obliteration of the GSV and SSV by cannulating a peripheral varicosity. Although the saphenous vein cannot be cannulated with a catheter by way of a varicosity, because of its angle of connection, there is no such obstacle to the flow of foam.

Foam functions as an efficient ultrasound contrast medium because of its air content. Its injection is easily monitored. Its ultrasound appearance is that of a solid hyperechogenic core with an accompanying acoustic shadow.

Foam is introduced into a varix or the saphenous vein with the patient supine. As the foam reaches the saphenofemoral junction as monitored by ultrasound, compression of the saphenofemoral or the saphenopopliteal junctions may be done in order to preserve foam in the limb. Such a maneuver does not prevent foam from reaching the systemic circulation, however.

Vasoconstriction and vasospasm in foam-filled veins can be induced by intermittent compression of the veins by the ultrasound transducer and by elevating the limb. This minimizes the blood content of the treated veins. Foam will be seen by ultrasound to flow distally in the elevated limb. As mentioned, it flows selectively through incompetent valves and is blocked by competent valves. Femoral vein compression and leg elevation have the effect of prolonging the action of the foamed sclerosant on the distal intima, improving the efficacy of the entire treatment. In addition, leg elevation for 5-10 minutes allows the foam to revert to its liquid state, so that foam particles will not reach the right atrium or a patent foramen ovale.

The femoral, popliteal and deep veins of the leg are scanned intermittently throughout the entire procedure. Foam particles are washed out of deep veins such as the gastrocnemius or tibial veins by flexion-extension maneuvers of the foot. Repetitive dorsiflexion of the foot completely clears the deep veins of any foam particles.

Despite much consternation, major thrombotic events have rarely been described with the use of sclerofoam. In a study of over 12 000 sclerotherapy sessions by Guex, over half of which involved foam, only a single femoral vein thrombus was encountered. Thromboses of the gastrocnemius, tibial and peroneal veins have been reported occasionally, and intra-arterial injections are even rarer.

Ultrasound sonography has confirmed the presence of the tangled network of small varicose veins, reticular varices and incompetent perforating veins under lipodermatosclerotic plaques and under venous ulcers. Ultrasound monitoring should confirm the fact that these vessels are filled with foam during treatment.

Ultrasound guidance is also used in treatment of incompetent perforating veins. Direct cannulation and controlled injection can be done easily if the primary treatment has failed to heal an ulcer or improve the condition of lipodermatosclerosis.6 Often, superficial peripheral veins can be directly injected with the objective of obliterating the attached perforator and its network of the incompetent veins.

As other adverse events have been eliminated, skin discoloration remains a major deterrent to acceptance of foam sclerotherapy. It is usually accompanied by patent venous channels as shown here. These should be closed by repeat injections under ultrasound guidance Post-treatment assessment.

Post-treatment assessment

Early post-treatment duplex scanning should be performed. This is best done at 1 and 7 days postprocedure, looking for deep venous thrombosis. Many have eliminated the 1-day examination because deep venous thrombosis is uncommon. Successful obliteration of the saphenous vein is confirmed by its contraction to a residual diameter of




For more information, please visit http://www.SDVeinInstitute.com

Van Cheng, MD
Medical Director, San Diego Vein Institute
1011 Devonshire Dr. Ste B
Encinitas, CA 92024
760.944.9263
http://www.SDVeinInstitute.com





This post was made using the Auto Blogging Software from WebMagnates.org This line will not appear when posts are made after activating the software to full version.

張貼者： 於 0 意見
標籤： , , ,

2012年5月20日 星期日

Using Therapeutic Home Ultrasound to Treat Plantar Fasciitis


Plantar fasciitis is a common, persistent foot injury that requires proper treatment. Plantar fascitis results in acute inflammation and severe pain in the fibrous band of tissue running across the bottom of the foot. Because the ligaments, tendons, and tissue in the foot move every time the foot is flexed, when they are inflamed, every movement hurts, making daily activities very painful. Once the plantar fascia tissue is injured, 100% recovery is difficult and re-injury occurs frequently. But, therapies such as ultrasound can hold the key to complete plantar fascia healing. And luckily, ultrasound technologies are advancing and new affordable and portable ultrasound machines are becoming available for home users.

Causes:

Because the plantar fascia can only stretch 102% of its length without tearing, the stress of an extremely active lifestyle can be too much. This condition of the foot is caused primarily from overloading and overuse in jobs that require a person to be on their feet all day, such as teachers and waitresses, to push heavy loads, such as shippers and construction workers, and to participate in vigorous sports, such as running, dancing, football and basketball. Plantar fasciitis is one of the top five most common foot and ankle injuries among professional athletes.

Poor biomechanics, foot muscle and/or ligament imbalances, and faulty foot structures can also contribute to the development of plantar fasciitis. Other causes include obesity and poorly supported shoes.

The inflammation in the arch of the foot experienced by plantar fasciitis suffers can also lead to an intense stabbing pain in the heel and eventually, heel spurs. For this reason, it is critical to properly treat an inflamed plantar fascia at the onset of the condition with ultrasound therapy or another modality.

Treatments:

The intense flare-ups of pain in the arch of the foot associated with plantar fascitis can be best managed through conservative, regular treatments. Patient education on how to treat plantar fasciitis and self-care are critical components in healing from plantar fasciitis. Patience is also key, as an inflamed plantar fascia can take six months to a year to completely recover.

By modifying daily activities and exercise, wearing properly fitting shoes, taping the feet, and massaging the foot arch, the acute inflammation of plantar fasciitis can be minimized. After strenuous activities, RICE (rest, ice, compress, elevate) is generally the prescribed procedure for plantar fascitis sufferers. However, for 100% injury recovery, using therapeutic ultrasound prior to RICE treatment is best because the ultrasonic waves efficiently decrease inflammation and relive pain for diagnosed or chronic plantar fasciitis within the first 48 hours of a flare-up. Daily ultrasound physical therapy can be a very effective way to manage and heal plantar fasciitis and heel spurs and is best accomplished with a personal, therapeutic ultrasound device.

For those suffering from chronic plantar fasciitis, foot and tendon rehabilitation at home is now possible with the advent of portable ultrasound machines. The ultrasound therapy utilized by these devices can be used as an advanced treatment of plantar fasciitis and the chronic tendon pain that accompanies the condition. Therapeutic ultrasound can be used to reduce pain and heal foot and ankle injuries twice as fast.

Ultra sound waves provide gentle deep tissue heating that decreases pain and inflammation to speed healing by penetrating the skin and causing vibrations in the tendons and soft tissues of the foot. Ultrasound therapy relaxes muscles and decreases swelling by increasing blood flow and oxygen to tendons and ligaments. Ultrasound deep tissue stimulation can be used as a pain therapy system to control plantar fasciitis flare-ups and can now be used in the comfort of your very own home.

A home ultrasound unit works the same way as bigger machines, found in physical therapist and chiropractor practices, but is more compact and priced reasonably so home users can afford to purchase. Portable ultrasound machines are also safe for use by the general public because they utilize pulsed, instead of continuous, ultrasound waves, which are just as effective when used on a daily basis. Plantar fasciitis physical therapy involving ultrasound will provide users with immediate relief and continual healing over a 3-4 week period.

Because plantar fascist involves soft tissue and tendon inflammation, a specific kind of home ultrasound machine is required for treatment. A home ultrasound physical therapy machine should emit 1Mhz ultrasound waves. It is also important to purchase an FDA approved ultrasound unit that is quality manufactured. The portable therapeutic ultrasound device should also be covered with at least a 1 year warranty. And best of all, with a portable therapeutic ultrasound machine, you can treat your plantar fasciitis daily when it is most convenient for you.




Christine Beggs is the founder and CEO of EZUltrasound.com, the leading provider of portable home ultrasound machines to relieve pain and speed healing. Over the past 2 years, Christine has strived to deliver affordable, therapeutic ultrasound machines to anyone who needs them. Working closely with doctors and physical therapists, Christine has first hand knowledge of ultrasound therapy, its benefits and applications, and has a passion for sharing this knowledge in her articles. She developed EZUltrasound.com to relay her continual dedication to improving the quality of people's lives through the use of therapeutic ultrasound. To find out more, please visit www.EZUltrasound.com.





This post was made using the Auto Blogging Software from WebMagnates.org This line will not appear when posts are made after activating the software to full version.

張貼者： 於 0 意見
標籤： , , , , ,

The Healing Benefits of Therapeutic Ultrasound


This post was made using the Auto Blogging Software from WebMagnates.org This line will not appear when posts are made after activating the software to full version.
張貼者： 於 0 意見
標籤： , , ,

2012年5月9日 星期三

Ultrasound Guidance For Therapeutic Interventions


Duplex ultrasound sonography is the best choice for evaluation of venous reflux in the lower extremities. It is inexpensive, noninvasive, and generally acceptable to the patient. It provides direct visualization, localization and quantitation of venous reflux with a surprisingly high sensitivity (95%) and specificity (100%). Duplex ultrasound findings have been confirmed by angioscopic observation of incompetent vein valves in advanced chronic venous insufficiency. Yamaki has demonstrated that high peak reflux velocities (>30 cm/s), reflux duration greater than 3 s and an enlarged valve annulus measured by duplex ultrasonography at the saphenofemoral junction are all closely related to angioscopically deformed and incompetent terminal valves (types III and IV of Hoshino).

Foam sclerotherapy actually began before the development of ultrasound imaging. Phlebologists of the 1950s developed ways of producing foamed sclerosants and observed the distribution of therapeutic foam by sensing crepitus. However, all credit for the origination of foam sclerotherapy, as we know it today, goes to Juan Cabrera of Granada, Spain. It was he who combined the manufacture of fine foam with administration of the agent under ultrasound guidance.

Pretreatment assessment

The evaluation should always begin with confirmation of the medical history. A family and personal venous history are of great importance. In the personal history, the reasons for the treatment should be confirmed. The patient's view of the objectives of the procedure should

be recorded. Symptoms such as aching heaviness, limb fatigue, itching and burning pain are typically present and these should be recorded. Similarly, a detailed recording of previous treatments and their failure will be of importance in seeking insurance coverage for the intervention. History of pregnancies and their number, as well as the number of deliveries and abortions, are of importance. Any limb trauma, fractures and confining illnesses should be recorded. A history of deep venous thrombosis and treatment must be paired with its method of diagnosis. A detailed description of previous venous treatments must be a part of the treatment record. Comorbidities, allergies and pharmacologic history must be documented. The body mass index is calculated from the patient's height and weight and should be recorded.

If a proper, standing, duplex reflux examination has not been done or is not part of the patient's record, it should be accomplished before treatment is initiated. The patient should be examined in a standing position for procedural planning, identification of the venous access site, and its relation to perforating veins, varicosities, and areas of tortuosity, stenosis or dilation.

In this preparatory phase, some anatomic landmarks should be clearly recognizable, including the femoral vein, saphenofemoral junction, saphenous compartment, great saphenous vein (GSV) and the variable small saphenous junction anatomy. This should be supplemented by cold light transillumination of the skin with a bright white light such as the "vein light," to identify reticular veins. A hand-held Doppler can serve to perform a confirmatory screening examination if a proper pretreatment reflux examination is part of the record.

Three levels of pathologic veins are evaluated using the methods just mentioned. Telangiectasias in the skin are visually inspected, reticular veins are transilluminated with the vein light, and varicosities and the saphenous veins with ultrasound. Clinical data should be integrated into the CEAP classification.

Equipment

The duplex ultrasound scanner should be able to detect blood flow rates as low as 6 cm/s. Dedicated high-resolution vascular scanners with color and/or power Doppler functions as well as the continuous-wave Doppler are available. Linear transducers in the range of 4-7 MHz are used for the pretreatment as well as the definitive examination. The inferior vena cava, pelvic veins and deep veins of the limbs in obese patients may be imaged with lower-frequency, 3 MHz transducers. Linear hockey-stick transducers in the range of 5-12 MHz will provide detailed imaging of smaller veins and perforating veins.

After the year 2000, advances in technology allowed duplex ultrsound scanners to become smaller, more transportable, and more operator friendly. These miniaturized devices feature transducers designed with advanced architecture that allow a single probe to image across a greater range of depths within an application and across applications. Thus, in many ways, the portable ultrasound instrument supplements the stethoscope in patient evaluation. The transducer for peripheral vascular examinations operates from 5 to 10 MHz and provides resolution from the skin surface to 7 cm in depth. The technology incorporates power Doppler sonography, tissue harmonic imaging and direct connectivity to a personal computer. The overall performance of miniaturized ultrasound devices is comparable to that of the more traditional and much larger ultrasound equipment that allowed establishment and growth of the vascular laboratory.

Venous testing and mapping

Not only is a detailed duplex ultrasound study of the normal and pathologic venous anatomy essential, but a map should be created to guide therapy. A detailed verbal description of the examination and its findings is useful for record purposes, but the map is most useful during therapy. A clear and illustrative graphic notation of significant vein diameters, anomalous anatomy, superficial venous aneurysms, perforating veins, and presence and extent of reflux should always be recorded during the examination.

As mentioned, the ultrasound examination is conducted with the patient standing. This position has been found to maximally dilate leg veins, and challenges vein valves. Sensitivity and specificity in detecting reflux are increased in examinations performed with patient standing rather than when the patient is supine. Supine examinations for reflux are unacceptable.

The veins are scanned by moving the probe vertically up and down along their course. Transverse scans are most informative, but a mental reconstruction must be created to record the venous map. Duplicated segments, sites of tributary confluence, large perforating veins and their deep venous connections are identified, as well as the very common superficial venous aneurysms. Location of abnormalities as measured in "centimeters from the floor" assists in preparing a therapeutic guide. Measurements from the medial malleolus are commonly recorded, but are not as precise. Transverse and longitudinal scans combined with continuous scanning provide a clear mapping of the venous system.

Patency of peripheral veins is usually assessed by compression of the vein with the transducer. Residual ancient thrombus, partial patency and extrinsic compression should all be noted in the verbal description of find-ings. Reflux is detected by flow augmentation with compression and release maneuvers of the thigh and calf. The Valsalva maneuver is used only at the saphenofemoral junction, because presence of a competent proximal valve negates the value of the examination.

Automated rapid inflation and deflation cuffs have been used, but are cumbersome. However, they do offer the advantage of a standardized stimulus, which allows timing of reflux. Although reflux greater than 500 ms is considered pathologic, this is only precisely accurate when a standard stimulus is applied.

The diameter of the saphenofemoral junction and femoral vein are recorded in preparation for radiofrequency VNUS Closure® and endovenous laser ablation. Important information is also gained from diameters of the GSV at mid-thigh and distal thigh (Figure 6.2a). Radiofrequency ablation is commonly used to treat veins from 2 to 12 mm in diameter, although diameters recorded with the patient standing do not apply when treatment is given with the patient supine.

The supragenicular, infragenicular or immediate subgenicular GSVs are often the access point for introduction of sclerosant foam. Therefore the depth of the GSV in these regions should be recorded.

Accessory saphenous veins by definition run parallel to the GSV in the thigh. It is imperative to map their course accurately and to note their communication with varices and eventual communication with GSVs, as well as their presence or absence of reflux with relationship to varicosities. The accessory veins are easily confused with the GSV during continuous longitudinal scanning when the saphenous vein appears to leave the saphenous compartment. This error is avoided when transverse scans are done. The GSV is scanned throughout the leg and the thigh so that its tributaries are identified.

The diameters of the popliteal vein and the small saphenous vein (SSV) are recorded at the junction, as well as diameters of the SSV along its course in the leg. Intersaphenous veins should be identified and the extreme variability of the SSV termination carefully recorded.

The pretreatment venous reflux examination also includes the mapping of exit and re-entry perforating veins (PVs), wherever they are identified. PV reflux is detected as outward flow duration greater than 350 ms during the release phase of the flow augmentation maneuver (distal compression has higher sensitivity in detecting PV reflux;. PVs should be accu-rately mapped in their different locations in the leg, and their positions should be measured as distances (cm) from the floor.

Ultrasound monitoring during sclerofoam treatment

The advent of foam sclerotherapy has added a powerful tool for treatment of chronic venous insufficiency. Endo thermic coagulation is caused by the generation of heat, which is applied to the endothelial surface of targeted veins. Sclerosant foam has a similar end result: stripping

off the endothelium. Foam agents provoke endothelial damage by several mechanisms. They change the surface tension of the plasma membrane (detergents) and/or the intravascular pH and osmolarity. The final result is a chemical fibrosis of the treated vessel.

The endovenous techniques accomplish this by heat. It is been suggested that the coagulation process is related to the intravascular vaporization of blood (steam) during laser therapy, with intimal denudation and collagen fiber contraction. Vein wall thickening and rapid reorganization of the vessel to form a fibrotic cord follows. If the endothelium is destroyed, the targeted vein is closed permanently. Venous occlusion is usually visualized within 10-20 s of the electromagnetic or chemical stimulus. Both thermal and the chemical techniques have been proven to be safe and effective. Percutaneous introduction of foam, laser fiber and the RF catheter have made surgical intervention obsolete because of elimination of post-treatment pain, absence of cutaneous incisions and prevention of postprocedural disability Sclerosing foams, as described elsewhere in the book, are mixtures of gas and a liquid solution with surfactant properties. One of the intrinsic limits of liquid sclerosants in treatment of varicose veins is their dilution by blood, with reduction of their efficacy. Also, they are rapidly cleared by the moving blood stream. Sclerosing foams do not mix with blood, and instead remain in the vessel, where they strip off the endothelium. Persistence of the agent in the vessel causes an increased contact time with the intimal surface. Foam preparation is remarkably simple. The Tessari method is the most commonly used, but there is an increasing use of physiological gases as a substitute for room air.

As with endovenous ablation, the treatment starts with clear ultrasound mapping as described above. The GSV or the SSV can then be directly cannulated with an angiocath, an echogenic Cook needle or a butterfly needle. Nearly all descriptions of the technique explain direct ultrasound-guided access to the saphenous vein. In contrast, many experienced operators achieve a satisfactory and rapid obliteration of the GSV and SSV by cannulating a peripheral varicosity. Although the saphenous vein cannot be cannulated with a catheter by way of a varicosity, because of its angle of connection, there is no such obstacle to the flow of foam.

Foam functions as an efficient ultrasound contrast medium because of its air content. Its injection is easily monitored. Its ultrasound appearance is that of a solid hyperechogenic core with an accompanying acoustic shadow.

Foam is introduced into a varix or the saphenous vein with the patient supine. As the foam reaches the saphenofemoral junction as monitored by ultrasound, compression of the saphenofemoral or the saphenopopliteal junctions may be done in order to preserve foam in the limb. Such a maneuver does not prevent foam from reaching the systemic circulation, however.

Vasoconstriction and vasospasm in foam-filled veins can be induced by intermittent compression of the veins by the ultrasound transducer and by elevating the limb. This minimizes the blood content of the treated veins. Foam will be seen by ultrasound to flow distally in the elevated limb. As mentioned, it flows selectively through incompetent valves and is blocked by competent valves. Femoral vein compression and leg elevation have the effect of prolonging the action of the foamed sclerosant on the distal intima, improving the efficacy of the entire treatment. In addition, leg elevation for 5-10 minutes allows the foam to revert to its liquid state, so that foam particles will not reach the right atrium or a patent foramen ovale.

The femoral, popliteal and deep veins of the leg are scanned intermittently throughout the entire procedure. Foam particles are washed out of deep veins such as the gastrocnemius or tibial veins by flexion-extension maneuvers of the foot. Repetitive dorsiflexion of the foot completely clears the deep veins of any foam particles.

Despite much consternation, major thrombotic events have rarely been described with the use of sclerofoam. In a study of over 12 000 sclerotherapy sessions by Guex, over half of which involved foam, only a single femoral vein thrombus was encountered. Thromboses of the gastrocnemius, tibial and peroneal veins have been reported occasionally, and intra-arterial injections are even rarer.

Ultrasound sonography has confirmed the presence of the tangled network of small varicose veins, reticular varices and incompetent perforating veins under lipodermatosclerotic plaques and under venous ulcers. Ultrasound monitoring should confirm the fact that these vessels are filled with foam during treatment.

Ultrasound guidance is also used in treatment of incompetent perforating veins. Direct cannulation and controlled injection can be done easily if the primary treatment has failed to heal an ulcer or improve the condition of lipodermatosclerosis.6 Often, superficial peripheral veins can be directly injected with the objective of obliterating the attached perforator and its network of the incompetent veins.

As other adverse events have been eliminated, skin discoloration remains a major deterrent to acceptance of foam sclerotherapy. It is usually accompanied by patent venous channels as shown here. These should be closed by repeat injections under ultrasound guidance Post-treatment assessment.

Post-treatment assessment

Early post-treatment duplex scanning should be performed. This is best done at 1 and 7 days postprocedure, looking for deep venous thrombosis. Many have eliminated the 1-day examination because deep venous thrombosis is uncommon. Successful obliteration of the saphenous vein is confirmed by its contraction to a residual diameter of




For more information, please visit http://www.SDVeinInstitute.com

Van Cheng, MD
Medical Director, San Diego Vein Institute
1011 Devonshire Dr. Ste B
Encinitas, CA 92024
760.944.9263
http://www.SDVeinInstitute.com





This post was made using the Auto Blogging Software from WebMagnates.org This line will not appear when posts are made after activating the software to full version.

張貼者： 於 0 意見
標籤： , , ,
較舊的文章 首頁
訂閱： 文章 (Atom)