Modal

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

   

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

   

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

   

4. Over the Achilles tendon back to the lateral malleolus

   

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

   

2. Over the knuckles to the 2nd MCP joint

   

3. Across the palm to the medial styloid process

   

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

   

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

   

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

   

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

   

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

   

• Acute inflammation

• Acute bleeding

• Fever

• Malignancy (relative)

• Thermoregulation px (relative)

• Absent sensation (relative)

• Cold hypersensitivity

• Cryoglobulinemia

• Arterial insufficiency

• Thermoregulation px (relative)

• Absent sensation (relative)

• 1 MHz target tissue depth is 3–5 cm deep

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

• Continuous to achieve thermal effects

• Pulsed to achieve mechanical effects

Beam

Nonuniformity

Ratio (BNR)

• <5:1

• 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

• 2–3x effective radiating area (ERA)

• Circular pattern 3–4 cm/sec

• Tissue temperature remains elevated for 4–5 minutes

• Tissue temperature returns to baseline within 15–18 minutes