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Assessment of Edema

Method to Assess Ankle Edema

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  1. Start distal to the lateral malleolus; go medial, just distal to navicular tuberosity

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  2. Under the arch to the proximal aspect of the head of the 5th metatarsal

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  3. Across the anterior tibialis tendon to the distal aspect of the medial malleolus

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  4. Over the Achilles tendon back to the lateral malleolus

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Method to Assess Hand Edema (Palmar Surface)

  1. Start distal to the lateral styloid process; go medial across the palm of the hand to the 5th MCP joint

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  2. Over the knuckles to the 2nd MCP joint

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  3. Across the palm to the medial styloid process

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  4. Around the back of the wrist to the lateral styloid process

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Method to Assess Hand Edema (Dorsal Surface)

  1. Start distal to the medial styloid process; go lateral across the back of the hand to the 2nd MCP joint

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  2. Over the palmar aspect of the MCP joints to the 5th MCP joint

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  3. Across the back of the hand to the lateral styloid process

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  4. Around the front of the wrist to the medial styloid process

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Modalities

Effects of Short-Term Application of Heat & Cold

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  Heat Cold
Skin capillaries Dilated Constricted
Skin texture Smooth Rough
Skin color Pink, then red White, then red
Skeletal muscle Relaxed Shiver
Cell tissue size Expanded Little change
Tissue metabolism
Pulse rate
Stroke volume
Blood pressure
Pain sensation

Contraindications to Heat & Cold

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Heat Cold
  • Acute inflammation

  • Acute bleeding

  • Fever

  • Malignancy (relative)

  • Thermoregulation px (relative)

  • Absent sensation (relative)

  • Cold hypersensitivity

  • Cryoglobulinemia

  • Arterial insufficiency

  • Thermoregulation px (relative)

  • Absent sensation (relative)

Ultrasound

Clear all of the following contraindications prior to treatment

  • Malignancy (relative)

  • TB

  • Pregnancy

  • Epiphyseal plates (relative)

  • Hemophilia

  • Over genitals, brain, eyes, pacemaker, carotid sinus, thrombi

  • Absent sensation (relative)

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Ultrasound Parameters:
Frequency
  • 1 MHz target tissue depth is 3–5 cm deep

  • 3 MHz target tissue depth is 2–3 cm deep

Mode
  • Continuous to achieve thermal effects

  • Pulsed to achieve mechanical effects

Beam

Nonuniformity

Ratio (BNR)

  • <5:1

Intensity = seek athlete's feedback to determine if warmth is perceived for thermal effects vs. mechanical effects
  • At 1 w/cm2, 1 MHz US heats muscle at 0.2°C per minute & 3 MHz US heats muscle at 0.6°C per minute

  • Vigorous heating requires >4°C tissue temperature

Treatment area
  • 2–3x effective radiating area (ERA)

Applicator mov't
  • Circular pattern 3–4 cm/sec

Duration of heating effect, i.e., stretching window
  • Tissue temperature remains elevated for 4–5 minutes

  • Tissue temperature returns to baseline within 15–18 minutes

Source: Draper DO (1998); Draper DO & ...

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