Mettler Electronics Sonicator 706 User manual

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I
A
UAL
. .. .' . '
SONICATOR 706

FCC Fr equ en cy Int er ference
State m en t
Wa rnin g:
This e qu ipme nt ge ne rates and uses ra dio fre quenc y en er gy an d ,
if not installed an d operate d in s trict accor ance with th e
manu facturer's instructions, may ca u se radio frequ ency
interfe re nce.
Notice 1:
T his equipment has been veri fied to comply wi th th e
specifi
ca tions in P art 18 of FCC Ru les, which ar e desi gned to
provide
re aso nable p ro te ction against radio fre qu ency interferenc e.
H
ow ver, the re is no gu ar an tee th at inte rference will not occur in a
p
arti cul ar in s tall ation.
Notice 2:
If th is equi pment is f ou nd to be the so ur ce of radio frequency
interfere nce, w hich can be determined by t urning th equipment
off and on, th e user shou ld try to correct th e interfe re nce by on e or
more of th e fo llowing measures :
• R
eorient the receiving an t enna (as applicable).
• Relo ca te the So nicator with re sp ect to th e receiver.
• Move the
So nicator away f ro m the receiver.
• Plug
the So ni cat or i nt o a differe nt outlet th an the re ceiv er .
•
If necess ary , th e us er shoul consu lt with the deal er or
manufa ctu r er for ad diti on al su gg es ti on s. (The user ma y find
FCC's "Inte rf erence Hand bo ok" h lpful. It is available from the
U.S. Gove rnm e nt Pri n tin g Office, Wa sh in gt on , D.C. 20 4 02,
Stock No. 00 4-0 00 -00 450-7.)
Notice 3:
The m anu fa cturer is not respon sible for any int erference caused
by u nautho riz ed modifi ca tion to th is equipm ent.
M ettler Electronics Corp.
1333 S. Claudina St.
An ah eim , CA 9 28 05
Toll Fre e: (800) 854- 9305
Or (71 4) 533- 222 1

LIMITED WARRANTY
This Product iswarranted against defects in materials and workmanship for a
period of
one year from the date of purchase. During the warranty period
Mettler Electronics Corp.
will, at its discretion, either repair or replace the
Product without charge for these types of defects. For service under this
warranty, the Product must be returned within the warranty period to Mettler
Electronics Corp.
Shipping charges to and from Mettler Electronics
Corp. under this warranty must be paid by the buyer. The buyer must
also include a copy of the sales receipt or other proof of the date of
purchase. If the Product is returned without proof of the date of
purchase, it will be serviced as an out-of-warranty product at Mettler
Electronics Corp.'s prevailing service rates.
This warranty shall not be effective unless the Warranty
Registration card included with the Product is returned to Mettler
Electronics Corp. within thirty (30) days of the date of purchase.
Alteration or misuse or neglect of the Product voids the warranty.
Except as specifically set forth above, Mettler Electronics Corp.
makes no warranties, expressed or implied, including without
limitation any implied warranty of merchantability or fitness for a
particular
purpose, with respect to the Product. If any implied
warranties apply as a matter of law, they are limited in duration to
one year.
Mettler
Electronics Corp. shall not be liable for any indirect,
special, consequential or incidental damages resulting from any
defect in or use of the Product.
Any suit brought by the buyer relating to this warranty must be commenced
within one year from the date any claim arises and must be brought only in the
State or Federal courts located in Orange County, California.
Some states do not allow limitations on how long an implied warranty lasts,
or the exclusion or limitation of incidental or consequential damages, so the
above limitations or exclusions may not apply to the buyer. This warranty gives
the buyer specific legal rights,
and the buyer may also have other rights which
vary from state to state.
Copyright © 1986 by Mellier Electronics -Anaheim, CA

TABLE OF CONTENTS
Table of Contents ii
Introduction 1
Safety Precautions
Cleaning Instrucitons
Guarantee
Shipping
Unpacking and Installation
Wall Mounting
Caution
Specifications 2 & 3
Control Panel Description 4
Operating Instructions 5
Operator Troubleshooting Guide " . " " 6
General Application Information 7
About Ultrasound
Neurotrophic Approach
Output Levels
Continuous
and Pulsed Waves
Combination Therapy
Phonophoresis
Common Conditions Encountered in Athletics Treated by Ultrasound as an
Adjunctive Therapy
List of General Conditions Treated by Ultrasound as an Adjunctive Therapy
Contraindications to Ultrasonic Therapy
References
ii

INTRODUCTION
SAFETY PRECAUTIONS:
This unit operates with high voltages. Servicingofthe SonicatorME706shouldbe referred
to qualified service technicians or returned directly to the factory. To assure continued
compliance with FDA, 21 CFR 1050.10 standards, the ME 706 should be factory calibrated
and safety
tested at least once each year. Mettler Electronics recommends that all service
work be performed at the factory. However, a service manual
can be obtained by writingthe
factory for those who are qualified to service the device and are
fully aware of their
responsibilities.
CLEANING INSTRUCTIONS:
To clean the molded plastic enclosure of the Sonicator ME 706 generator housing or
applicator handle, use a mild detergent with a damp soft cloth. Use of any other cleaning
agent or solvent is not warranted or recommended.
SHIPPING:
The instrument isshipped complete in one carton containing the unit itself,a wallmounting
plate with three screws, guarantee card, operating instructions
and one tube of Sonigel
coupling agent. We recommend
that you retain the shipping carton in the event you need to
return the unit for factory servicing.
UNPACKING AND INSTALLATION:
Upon receipt of the unit, check for visible and hidden damage. If any damage is apparent
upon opening
the case, hold all shipping materials including the case and call the shipping
agency which delivered
the unit. They are responsible for alldamage in transit; therefore, all
claims should be fileddirectly with them.
The factory will not be responsible for any damage in
shipment, nor allow any adjustment unless proper formal claim has beenfiledby the receiver
against the carrier.
The unit
operates on 120volts, 60 hertz alternatingcurrent. (Othervoltages areavailable.)
Unless your voltage
and frequency are as above, DO NOT CONNECT THE UNIT TO
YOUR SUPPLY. If only direct
current (DC) is available use a converter that provides 120
volts AC, 60 hertz with a capacity of 100 watts.
WALL MOUNTING:
To fasten the mounting plate on a wooden surface, use the three screws included with the
unit. On a dry wall or plaster surface, use two "well-nuts". Position
the plate with the slot
facing upward
and angled out from the wall.Lower the mountingscrew(locatedon the upper
back of the unit) firmly into the mounting plate slot.
CAUTION:
Federal law restricts this device to sale or on the order of a physician, dentist, veterinarian,
or any other practitioner licensed by the law of the state in which he practices to use or order
the use of this device.
Use of controls or adjustments or performance of procedures
other than those specified
herein may result in hazardous exposure to ultrasonic energy.
Electric treatment tables or whirlpools which may come in contact with the patient during
a treatment with
the Sonicator ME 706, should be adequately grounded and safety tested
to insure safe operation with
the Sonicator ME 706.
1

SPECIFICA TIONS
ULTRASONIC GENERATOR:
Input: 120VAC,60Hz, 0.5 amperesmaximum. (Othervoltages are available.)
Frequency: 1.0 MHz ± 5%
Pulse repetition rate: 100 Hz ± 20% (PULSE MODE)
Pulse duration: 2 msec ±20% (PULSE MODE)
Temporal Peak/Average intensity ratio: 5 ± 20%
Indication accuracy: ± 20% (for any level above 10% of maximum.)
Output:
The output waveform incontinuousor pulsedas programmed bythe
front panel control. In the pulse mode the 1.0 MHz is square wave
pulse modulated.
The power level is adjusted by varying the pulse
amplitude.
The pulse waveform is shown below:
In
the continuous mode the power is on allthe time the timer is running. The
continuous mode waveform is shown below:
i
, I
ULTRASONIC APPLICATOR:
Piezoelectric disc: The output transducer utilizes a barium titanate
piezoelectric disc with an especially
coated face.
Frequency: 1.0 MHz ± 5%
Effective Radiating Area: 10 em" ± 20%
Beam type: Collimating
Maximum
beam non-uniformity ratio: 6:1
Spatial Pattern: The applicator produces a collimated (cylindrical) beam
with an area of 10cm2 as measured 5 mm from the ceramic disc surface
when the radiation is emitted into the equivalent of an infinitemedium of
distilled, degassed water 300 C,
and with line voltage variations in the
range of ±10%of the rated value.
2

The beam of the applicator is circular in all planes parallel to the
applicator face. If a cross section is taken through the axis of the beam,
the pattern varies with distance from the face. A few inches from the
face, It is a single smooth bell-shaped curve. Nearer
the face the pattern
varies more due to phase cancellations. A sample curve as measured 5
mm from the surface is shown below.
OUTPUT INTENSITY -%
100
..
40
20
: .... --- DISTANCE FOR A 0 cm2 APPLICATOR --- .....
10
20 15 10 5 CENTER
DISTANCE FROM CENTER OF APPLICATOR IN mm
TREATMENT TIMER:
Indicator: The timer digital indicator indicates set time in minutes and
seconds prior to the start of treatment and treatment time
remaining during the treatment.
The timer also indicates the
remaining treatment time during the "hold" period.
Accuracy: ± 1 second at all settings
Maximum treatment time: 29 minutes
CERTIFICATION:
The Sonicator ME 706 complies with the ultrasound performance
standards
set forth in the Code of Federal Regulations, Title 21 (Food and
Drugs), Part 1050.10.
LABEL ABBREVIATIONS USED:
SIN -Serial Number Coll - Collimating
Gen - Generator ern- - Square centimeter
Freq -Frequency MHz - Megahertz
BNR - Beam Non-uniformity Ratio
A
OTHER ABBREVIATIONS:
W - Watts CW - Continuous-waveform
W/cm2 -Watts per square centimeter LED - Light Emitting Diode
3
5 10 15 20

POWER
~
001%21
0
,.......--1·IMER---.,
Minutes Seconds
(10) I
SONICATOR CONTROL PANEL
CONTROL PANEL DESCRIPTION
Refer to the control panel drawing. The number
associated with each control and indicator described
below corresponds with the number shown on the
Sonicator ME 706 control panel drawing.
(1) Main Power Control -A rocker-type
ON/OFF
selector -depress left = ON, right = OFF.
(2)
Power Level Control -Determines the
output level as indicated on the power
output
indicator.
(3) Mode Selector -Selects either continuous-
wave (CW), or pulse-modulated (PULSE)
operation. Initial turn-on is in
CW mode.
(4)
Indicator Function Selector -Determines
one of two types of indication provided by the
power output indicator (W or W
/cm
2) . Initial
turn-on is in W mode.
(5)
Treatment Time Selector -Allows selection
of treatment times from zero to 29 minutes as
indicated on the treatment time indicator.
(6)
'GO' Switch -Selecting this function activates
the timer (which counts down in one
second
intervals) and the ultrasonic power.
(7)
'HOLD' Switch -Selecting this function stops
the timer (which remains in a hold state at the
indicated time remaining)
and turns off the
ultrasonic power.
o[ cw IlpUlSf) 0
(8)
(2)
(8)
ON OFF
D
(1)
(8)
Indicator Lights - Green LED (light emitting
diode) indicators for each power
output
indicator function (Wand W/cm
2) and for
each
mode (CW and PULSE). Two of these
indicators
are lit during Sonicator operation, one
each for indicator function
and mode selected.
.(9) Power Output Indicator -Provides indication
of ultrasonic power output.
I
(9)
(4)
(3)
W -
W
/cm
2 -
In CW mode the indicator displays
average ultrasonic power in watts.
In PULSE mode it displays peak
pulse ultrasonic power in watts.
In CW mode the indicator displays
average effective intensity in watts
per
square centimeter. In PULSE
mode it displays peak pulse effective
intensity in watts per
square
centimeter.
(10)
Treatment Time Indicator -Indicates
treatment time selected and displays remaining
time when the timer is activated. (Power output
automatically drops to zero watts at
the end of
the selected treatment time.)
4
~
-
~---------------------------.

Sonicator ME 706 Indicator Lights
..
..
®~I~o
Average ultrasonic power In watts, continuous-wave
® [~~] PULSE I° mode.
®[~]~2Io
Peak pulse ultrasonic power in watts, pulse-modulated
°EJlpULSEI®
mode.
O~I~®
Average effective intensity in watts per
square
®~~JULSEIO
centimeter, continuous-wave mode.
O~I~®
Peak pulse effective intensity in watts per square
O[ cw IlpULSEI®
centimeter, pulse-modulated mode.
This symbol (as used above) indicates lighted LED's at each of the
e four output settings.
OPERATING INSTRUCTIONS
Refer to the control panel drawing. Numbers in the following operating
procedures, for example (1), indicate
the control or indicator number shown
in the drawing.
1. Connect the unit to an appropriately grounded 120VAC, 60Hz
receptacle.
2. Energize the unit by pressing the MAIN POWER SWITCH (1) to the left.
3. Enter
the treatment time using the TREATMENT TIME SELECTOR (5).
The treatment time must be entered using two digits.
a.
For times up to 9 minutes, enter '0' followed by the second digit.
Example:
For 9 minutes, enter a '0' then a '9'.
b.
For 10 to 29 minutes, enter a '1' or '2' followed by the second digit.
Example:
For 15 minutes, enter a '1' then a'S'.
c. If an incorrect time is entered accidentally, cycle the MAIN POWER
CONTROL (1) and reselect the desired treatment time.
4. Select continuous-wave (CW) or pulse-modulated (PULSE) mode by
pressing the appropriate MODE SELECTOR (3) function.
5. Select
the desired power output indication by pressing the appropriate
INDICATOR
FUNCTION SELECTOR (4) switch (W or W/cm
2) .
6. Coat the area to be treated with Sonigel and couple the applicator to the
patient.
7.
Press the 'GO' SWITCH (6) to initiate treatment time and power output.
8. Adjust the POWER LEVEL
CONTROL (2) to the desired output levelas
indicated on the POWER
OUTPUT INDICATOR (9).
a.
Treatment can be stopped at any time by pressing the 'HOLD'
SWITCH (7). The power will stop and the timer will hold its running
time.
b. Restart the
treatment by pressing the 'GO' SWITCH (6).
c. A single long buzz sounds at the end of treatment time.
d. Several
short buzzes sound if treatment time is interrupted.
5

OPERATOR TROUBLESHOOTING GUIDE
Sympton
Action/Check
1. No lights when MAIN POWER Line
cord properly connected to
SWITCH is depressed.
AC outlet.
2. TIMER indicates a
number between Cycle
the MAIN POWER SWITCH
01
and 29 (or 88.88, 98.88, or 64.88), (OFF & ON)
and program the
but
the unit will not start when GO
TIMER with TWO digits as per
is pressed.
the operating instructions
(page 5).
3. After starting,
the unit stops with
Check for adequate transducer
the TREATMENT TIME INDICA- coupling
and use of recom-
TOR showing time left and the mended couplant such as Sonigel,
buzzer sounds five short buzzes. then press the GO SWITCH.
(Read
the paragraph below.)
The Sonicator ME 706 has a special feature, a no-load sensor, that limits
and cuts off power automatically if contact between the transducer and the
patient's skin is interrupted for a period of time. The buzzer will buzz for
several (aboutfive)
short buzzes when the automatic no-load sensor shuts off
the unit. Thisfeature adds another dimension of protection against excessive
heat build-up on the ceramic disc. Initial dis-contact produces a drop in the
amount of current flowing to the disc and within about 3 to 5 seconds, energy
is totally
cut off.
Should this feature activate frequently, it may be an indication
that
coupling is either insufficient in quantity, or inefficient in performance. The
lack of good coupling may be caused by not using a good coupling agent such
as Sonigel, not usingsufficient amounts of the couplingagent (you cannot use
too much), or contact with a very small area such as at the extremities (hands
and feet) without the use of copious amounts of a coupling agent. When
treatingan
area such as a hand or foot, you may treat under water as indicated
in
the illustration on page 8. You may also use a cushion filled with the
couplant to treat an irregular surface.
Selectingthe
proper couplant insures properenergy transmission, thereby
enhancing
the efficiency of treatment while discouraging energy reflection
back to the disc, causing eventual damage and possible depolarization.
NOTE: If unable to resolve a problem with
the unit, contact your dealer,
or
communicate directly with the manufacturer.
6

GENERAL APPLICATION INFORMATION
ABOUT ULTRASOUND:
Ultrasound is a form of acoustical vibration occuring at frequencies too
high to be perceived by the human ear. The limit for the audible range is at
about 20 KHz. Frequencies above this level are considered ultrasound.
The
range from 700KHz to 1.1MHz appeared during early investigative work, to
be best suited to clinical applications. Most domestic units
operate at
frequencies within this range.
The physics of ultrasound and audible
sound bear certain similarities with
frequency being the exception. Bothtravel as longitudinal compressedwaves
through a conducting medium. Ultrasound waves
can be propagated in a
gaseous, liquid, or solid medium, but not in air.
High frequency
sound waves are
formed by
areas of compression and
rarefaction of the molecules. It is not
within the scope ofthis manual to discuss
this subject in depth. The
reader can
choose his own leveloffamiliarity through
reading the articles offered as references.
However, it is important to know ultra-
sound exhibits certain beaming proper-
ties: It
can be reflected, refracted, scatteredand absorbed. Inpassingthrough
media, it is attenuated
and the absorbed energy is transformed into heat. The
attenuation coefficient for longitudinal waves in liquid and soft tissues is high,
producing the phenomenon at bone surfaces known as selective heating.
Clinical ultrasound is produced through the reverse piezoelectric effect.
Electricity is carried from a radio frequency
source to an electrode in contact
with the surface of an especially cut crystal. The electrical charges applied to
the crystal surface produce mechanical vibrations, or the so-called reverse
piezoelectric effect. Ultrasound waves need a medium for their transmission
and that is accomplished by using a propercoupling agent. This coupling layer
between the transducer
and body surface should assist in the propagation of
the mechanical vibrations and prevent loss of transmission.
r
7

The crystal may be natural or synthetic and may be salt, quartz, poly-
crystalline or ceramic. When this crystal is in resonance with the driving
oscillator, optimum conversion from electrical to mechanical energy is
achieved. A disadvantage of quartz is
that it requires extremely high voltages
of the applicator (3000 - 4000V) to energize it for an intensity of 3
W/cm
2•
Ceramic crystals require less (30 -40V), thus allowing use of longer, thinner,
and more flexiblecoaxial cables.
The Sonicator ME 706 usesa barium titanate
cobalt ceramic.
Ultrasonic energy is expressedinwatts (W), or watts per square centimeter
(W/crn''). Average intensity is obtained by measuring the total output of the
applicator (in watts)
and then dividing it by the size of the effective radiating
area of the applicator. The effective radiating area isdifferent from the overall
dimension of the applicator face.
Once the coupling agent is applied to the body surface, the applicator
placed in
contact and the desired output selected in total watts, or watts per
square centimeter,
the technique of applicaton is by means of circular or
stroking movement.
In the circularmethod, the soundheadof the applicatoris
moved in slow
and circular overlapping movements. In the stroking,or "paint-
brush" method, slow to-and-fro
strokes are used, again with slight
overlapping. Motion with either technique should be slow enough to insure
proper energy absorption yet fast enough to eliminate excessive amounts of
absorption which could produce periosteal pain.
On occasion, irregular surfaces of the body
are treated (hands) and may
offer a
poor surface for proper soundhead contact. The underwater
technique may be used for these applications.
The part to-be-treated and the
soundhead are submerged in water and the soundhead is moved over the
area, keeping the head
Y2 to 1 inch away from the area of treatment. As air
bubbles
appear on the surface ofthe soundheadthey shouldbe wiped away to
insure proper transmission of energy.
8

I
1
r
NEUROTROPHIC APPROACH:
It is most important that the neurotrophic (nerve root) approach be used
because it generally produces an analgesic effect on the sensory nerves to the
involved tissues. Most physicians recommend that the
area ofinvolvement be
treated first.
Astrip slightly wider thanthe diameterof the applicatorshouldbe treated in
the cervical section. In the dorsal region, the
area should be about two inches
wide. The strip should be increased from two to four inches as you render
treatment through the lumbar
and sacral areas. These strips should reach to,
but not include, the spinal process.
The first area is from the cervical through the first dorsal. This areacontrols
nerve roots leading to the lower neck, upper section of the back, shoulders,
arms, hands
and fingers. The second is the thoracic area, which extendsfrom
the first dorsal through the first lumbar. This section controls the uppertrunk
of the body.
The third and last isthe lower lumbar and sacral, startingfrom the
first lumbar through the coccyx. This section controls the nerve roots to the
hips and legs. (The above is not an exact outline, but it should suffice for
ultrasonic treatment. Since
such a large group of nerve roots are always
treated at one time, care need not be taken to locate the specific nerve roots
that are indicated.)
ANTERIOR
POSTERIOR
3W55M
3104W
C,rvlc.1
=-"""'--1 5M
5wa 5M
5W55M
4W
5M Rib
If II
Dorll'
3104W
6wa 5M
410 5W 5M
5M
5M
5W
lumb.r
IIl;r.1
5W 6Wa 5M 6Wa 5M
5M 3 to 4W
5M
5W
5M
5WJ-------/T-
5M L-_---I+-
5wa5M
4105W
5M
t===f-4wa 5M
-~-=_-----J ~~. 4W
Note:W=lotal watts output. and M=minutes
An
average of treatment lime and output
levelsusedby presentday therapists.
POSTERIOR TREATMENT
(Where not marked.use
output level shownon
the anterior chart.)
9

-------------------------
r
Dosage in total watts, or watts per square centimeter, and treatment time
may vary from patient-to-patient
and with areas to be treated. Generally, the
transducer (applicator) is moved ina slow, steadyrotaryor strokingmotionat
the approximate rate of 24
square inches (l55cm
2)
per minute. Most
treatments require repetition over this area for a period of fiveminutes. For a
few
hours duration after ultrasonic treatment, the pain may increase. If this
occurs,
treatments should be continued but with a slight reduction intime and
power. Frequency of treatment varies from
once daily to three times per
week.
OUTPUT LEVELS:
The differences between transducers of varying radiating areas are shown
below.
The chart is a calculation of power output for three transducer crystals
with different radiating areas.
Intensity Setting Crystal Effective Effective
Watts
(W/cm
2) Radiating Area
Produced
1.5 5 ern- 7.5 W
1.5 6 em?
9.0W
1.5 10 ern- 15.0 W
You
will note, though the intensity setting remained constant, the amount of
energy delivered varied
... appreciably. We cautionyou to consider this since
units of different manufacture
are available in many departments. Ifwatts per
square centimeter is used as the prescribed intensity setting, the effective
watts delivered
will not remain constant.
For this reason, we suggest that using average power, or WATTS, as the
intensity setting insures the
amount delivered by any unit and any sized
crystal remains
constant as desired.
10
;, ....

I
CONTINUOUS AND PULSED WAVES:
[
Ultrasound may be applied in either continuous or pulsed waveform.
Advocates of pulsed beam applications suggest the approach reduces the
thermal effects while accenting the mechanical. Wulff in his
paper titled,
"Reduction of Thermic Effect of Ultrasound Dosages by the Use of Pulsed
Ultrasound Energy" reported, ". . . the use of pulsed ultrasound energy
permits accurately controlled reduction of total ultrasound intensities
employed in therapy." He recommended the use of rectangular pulses and
stated, "The biologic response reactions of the sonated tissue seems to
continue during the
sound free intervals provided that a ratio between pulse
duration and free interval of 1:4 is maintained."
The ME 706 provides both continuous and pulse wave capabilities.
Continuous is a
100% duty cycle and an unmodulatd wave which orginates
from a filtered DC power source. The pulse setting has a pulse frequency of
100Hz with a pulse width of2milliseconds and8 milliseconds betweenpulses.
On time to total time is 1:5. The duty cycle is 20%and on time to offtime is a
ratio of 1:4. In the pulse mode, the meter reads peak power.
COMBINATION THERAPY:
Combination therapy may be performed by plugging the Sys·Stim@
muscle stimulator active lead wire (black
and negative) into the black col-
lared
phone jack located on the bottom of the Sonicator 705/706. The
phone jack is identified by the symbol A
When output is generated by the stimulator, it will be passed to the
metal ring
on the transducer head by means of this connection. The timer
on the Sonicator will control the length of time ultrasound is delivered.
The Sys" Stirn timer is placed into timer bypass during combination
therapy.
When the selected time has elapsed on the Sonicator, indicating
the
end of treatment, press hold on the Sys"Stirn to stop stimulation output
through
the transducer.
(
11

----------------------------------------
"TRIGGER-POINTS" are small areas of localized sensiti-
vity and pain found in muscles and connective tissue.
They may be produced by trauma, can be a result of
chronic strain or may be developed as a result of stress
from functional daily activities or postural habits. Though
local in nature, reports in the literature indicate the
discomfort may be referred through the autonomic nerve
fibers to other areas of the body (so-called "referred
pain").
These areas may be palpated with finger-tip pressure,
located by using the eraser end of a pencil, or by meansof
~- SCALENl
vxsrus MEDIAUS
LONG EXTENSORS
MIDDLE F1NCiER
EXTENSOR
C.4PiTlS
electrical currents. It has been suggested the combina-
tion of electrical stimulation and ultrasound is beneficial
in both locating and treating those involved areas. A
tetanizing current within comfortable intensity range of
the
patient is normally used for both location and
treatment, offering "massage-like" contraction to the
muscles where it is applied. Articles of reference are
listed.
The application is widespread and successful
treatments have been reported in both acute and chronic
conditions.
MASSETEH
ZDNE
REFFRRf!J PAIN
iRA,PEZiU~)
THtGGER POiNT
MULPflDlJS
GUJTEUS MiNIMUS
PEnONEUS
1-
lNFHASPINATUS
•
S TERNOMA5 roiu U:::VAlOR POSTERIOR
ADDUCTOR POLllCUS HRST INTEROSSEOuS ADDU(:TO~t LONGUS /\8DUCTOn HALLUC;;::;
SCAPULAE
CERV'CAL
REFERENCES:
Travel, J. and Rinzier, S.H.
"The Myofascial Genesis Sola, A.E. "Myofascial Trigger Point Pain in the Neck
of Pain," POSTGRADUATE MEDICINE, Vol. II,
No.5,
and Shoulder Girdle," NORTHWEST MEDICINE, Vol.
May, 1952. 54, pp. 980-984 September, 1955.
12
""'" .....

PHONOPHORESIS:
Phonophoresis, or sonophoresis, has been described as the use of
ultrasonic waves for the percutaneous transport of drugs.
Since the technique was first introduced, it has grown in popularity
and to
many authors,
seems to be a method of choice for driving topically applied
medication into
deep layers of soft tissues. The effect of ultrasound energy in
increasing membrane permeability appears to be part of the reason for
improvement in pain relief.
The coupling material contains medication in variable strengthsfrom 0.5 to
10%-
and both the moving and stationary head techniques have been used.
According to the literature, settings
of. 1-2 W/ern- for moving head and 0.1 -
0.2
W/cm
2 for stationary techniques have been applied.
COMMON CONDITIONS ENCOUNTERED IN ATHLETICS
TREATED BY ULTRASOUND AS AN ADJUNCTIVE THERAPY
Charley horse, contusions, edema, trauma, synovitis, adhesions, myositis
ossificans, pulled muscles, sprains, neuritis, sacro-iliac strain, wry neck,
bursitis, sciatica, shin splints, pulled tendons, strains, arthritis, stone bruise,
tenosynovitis,
scar tissue, dislocations, sacro-lumbar strain, separations.
LIST OF GENERAL CONDITIONS TREATED BY ULTRASOUND
AS AN ADJUNCTIVE THERAPY
Arthrosis (large articulations), (small articulations), coccygodynia,
lumbago, neuralgia intercostal, periostotis, sciatica,
Sudeck's Atrophy,
coxitis, myalgia, neuritis, plantar warts, sinusitis frontal, syndrome scalenus,
bursitis, Dupuytren's Contracture, myelitis, osteitis, postoperative pain,
radiculitis, sinusitis maxillary, tenovaginitis, claudication intermittent, herpes
zoster, neuralgia, periarthritis humeroscapular, Raynaud's diseases,
Spondylitis Deforman's, periarthritis chronic,
stump (phantom pains).
CONTRAINDICATIONS TO ULTRASOUND THERAPY
Over malignant tumors, over epiphysis of growing bone, over acute
infections,
acute thrombophlebitis or phlebothrombosis, over pregnant
uterus, over the eyeball, over areas of impaired sensation, over brain or
bulbar
area of spinal cord, over areas of inadequate circulation, over the
heart, over reproductive organs, in patients with hemorrhagic diatheses. In
addition, authors have recommended special precautions to dosage when an
area of the spinal
cord is to be treated following a laminectomy.
It has also been reported that ultrasound should not be given over
pacemakers or over pacemaker leads.
13
I

r
REFERENCES:
We recognize the reader's interest in clinical ultrasound may extend
beyond the levelof information we are able to provide inthis manual. To assist
you in
your search, we are including the titles of text books and selected
articles. Each of them in turn will offer additional sources for reference.
1. Griffin, J.E. & Karselis,
T.e.: PhysicalAgentsfor PhysicalTherapists, e.C.
Thomas, Springfield, Ill., 1978, pp. 225-227.
2. Griffin, J.E. &
Touchstone, J.: Effects of Ultrasonic Frequency of Phono-
phoresis of Cortisol into Swine Tissues, Am. J. Phys, Med. 51:62, 1972.
3. Kleinkort, J.A. &
Wood, F.: Phonophoresis With One Per Cent Versus
Ten Percent Hydrocortisone. Phys. Ther., 55:1320, 1975.
4. Travel, J.
and Rinzier, S.H., "The Myofascial Genesis of Pain," POST-
GRADUATE MEDICINE, Vol. II,
No.5. May, 1952.
5. Sola, A.E., "Myofascial Trigger Point Pain in the
Neck and Shoulder
Girdle," NORTHWEST MEDICINE, Vol. 54, pp, 980-984 Sept., 1955.
TEXT
BOOKS - 1. Handbook of Physical Medicine and Rehabilitation,
second edition, F.H. Krusen, M.D., F.J. Kottke, M.D., P.M. Ellwood, Jr. M.D.,
W.B.
Saunders Co.,Phila. 2. Physical Agentsfor PhysicalTherapists,Griffin,
J.E.
and Karselis, T.e., e.C. Thomas, Springfield, Ill., pp. 225-227.
ARTICLES - 1. Advantages
and Limitationsof Ultrasonics in Medicine, H.P.
Schwan, Ph.D. & E.L.
Carstensen, M.S., JAMA 5.52 Vol. 149, PP 121-125.
2. Non-surgical Management of
the Pain-Dysfunction Syndrome -W.H. Bell,
D.D.S., JADA, Vol. 79, July 69. 3. Interaction of Ultrasound & Biological
Tissues,
Workshop Proceedings, Batalle Memorial Inst., U.S. Dept. of Health,
Sept. 72.
In addition, we have a
packet of information available which includes selected
reprints, ultrasound technique
and trigger point charts, etc. For your free
copy, write: Educational Dept., Mettler Electronics
Corp., 1333 S. Claudina
St., Anaheim, California 92805
Printed in U.S.A. 1~95
14 IR6-17

USER
A
UAL
N\.E T T L ER :E L EC T R O N IC S il!i
c or p .
Additional copies of this chart are available upon
request by writing:
Mettler Electronics Corp.
1333 So. Claudina St., Anaheim, Calif. 92805 U.S.A.
Telephone: [phone] • [phone] U.S.A.
FAX [phone]