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CHAPTER SIXTEEN: Ultrasound

Karen A. Gibbs, PT, PhD, DPT, CWS; Rose L. Hamm, PT, DPT, CWS, FACCWS

CHAPTER OBJECTIVES

At the end of this chapter, the learner will be able to:

  1. Define terms describing the use of ultrasound including cavitation, frequency, intensity, attenuation, and duty cycle; use these concepts to alter the application of ultrasound.

  2. Explain how the application of ultrasound affects human tissue during different phases of healing.

  3. Utilize the cellular and tissue effects of ultrasound to develop safe and appropriate application parameters.

  4. Select specific patient indications appropriate for the use of ultrasound in wound management.

  5. Identify precautions and contraindications for the use of ultrasound.

  6. Select safe and appropriate parameters for US application using both low-frequency and high-frequency equipment.

  7. Develop and implement a care plan involving the use of ultrasound in the treatment of a chronic wound.

INTRODUCTION

Health care providers have long utilized ultrasound (US) technology for both diagnostic and therapeutic purposes1 (FIGURE 16-1, TABLE 16-1). As a noninvasive diagnostic tool, ultrasonography is used to painlessly visualize medical images of bone fractures,2 patterns of blood flow,3 sex and physical development of a fetus,4 abscesses, hematomas, and other internal anatomical and physiological events (FIGURE 16-2). Once thought of as a hospital-or clinic-based modality, battery-powered, mobile units (Edge Ultrasound, SonoSite Inc, Bothell, WA) are now available to diagnose fractures in emergency and combat environments.2,5 US technology is also utilized in invasive diagnostic procedures such as US-guided needle aspiration and biopsy.6

Figure 16-1

Diagnostic ultrasound being used on medial thigh to detect vascular occlusion

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Table 16-1US Technology Use
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Table 16-1 US Technology Use

  • Diagnostic

  • High frequency (2-18.0 MHz)

    • Doppler/duplex scanning (tissue visualization)

  • Therapeutic

  • High frequency (1.0 or 3.0 MHz)

    • Thermotherapy, tissue repair, pain reduction, phonophoresis

    • Ablation (0.5-7.0 MHz)7

  • Low frequency

    • Noncontact (40 kHz)

      • Tissue stimulation, wound cleansing, pain reduction

    • Contact

      • Wound debridement (20-50 kHz)

      • Lithotripsy (25-150 kHz)7

      • Liposuction (20-30 kHz)7

      • Surgical incisions (55.5 kHz)43,44
Figure 16-2

Diagnostic ultrasound equipment used for peripheral vascular studies Diagnostic ultrasound is used both to detect occlusion of an artery affected by peripheral arterial disease and to confirm or rule out a deep vein thrombosis. The image created by the ultrasound waves can be visualized on the screen of the equipment.

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As a treatment modality, US technology is utilized in lithotripsy, liposuction,7 tumor ablation,8–10 enhancement of cancer treatment,11 and many general surgical procedures.7 Recently, a study was conducted examining a US-mediated oxygen delivery system to enhance local tissue oxygen levels.12 Additionally, physical therapists have long utilized US for phonophoresis,13 thermotherapy, pain reduction, and tissue repair.14 It has been documented that US may provide the ...

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