Tim Lei

MSAT 6401
Analysis Paper US
03/06/2014

US Tendonitis: Patellar, Bicep, & Achilles

The parameters for ultrasound (US) provided by the clinical site at Weber High School
for Achilles, Biceps, and Patella tendonitis are shown in table 1. The parameters that I produced
from what I learned from class are shown on table 2. Assumed sound head size is 5cm 2 and
effective radiating area is 2x the sound head size. The major difference between the
parameters is the frequency, which determines the depth of penetration. Therefore the
purpose of this analysis is to determine the most clinically significant parameters for the above
mentioned pathologies with an Ultrasound therapeutic modality.
Table 1
Patella
Achilles
Bicep

Frequency
1.0 Mhz
1.0 Mhz
1.0 Mhz

Power Intensity
1.4 w/cm2
1.2 w/cm2
1.2-1.4 w/cm2

Duty Cycle
100%
100%
100%

Time (min)
4
7
7

Table 2
Patella
Achilles
Bicep

Frequency
3.3 Mhz
3.3 Mhz
1.0 Mhz

Power Intensity
.84 w/cm2
.84 w/cm2
1.32 w/cm2

Duty Cycle
100%
100%
100%

Time (min)
4
4
3

Assume pain reduction

A study conducted by Draper looking over the effectiveness of varying thickness of gel
pads presented the gel only group had the highest clinically significant temperature increase
(42.6 O C)and temperature change (13.3o C), F2,43=22.06, P<.001. The randomized single factorial
study used 48 subjects with no lower extremity injury in the past 6 months were split evenly
between males and females and the treatment site was the Achillies, specifically the largest

Tim Lei
MSAT 6401
Analysis Paper US
03/06/2014

area determined by a caliper measurement. The study started with a baseline measurement
and immediately after the baseline measure, the study protocol began. The parameters for the
US pad study are as follows: 3 Mhz, 1 w/cm2, 100%, 10min. The authors took a temperature
reading every 30 seconds until the end of the 10 minute treatment (Draper 2010). With these
parameters, the site is receiving thermal effects because the temperature increase lies between
40-45oC. Within the range of 40-45oC for the length of at least 5 minutes, the physiological
effects are: decreased muscle spasm, increased blood flow, increased collagen extensibility, and
aid the inflammatory phase. However temperatures over 45oC will cause tissue damage
through unstable cavitation (Speed 2001). On the opposite end non-thermal effects of US can
aid in tissue healing by stimulating fibroblast activity, increased protein synthesis, increased
blood flow, tissue regeneration, and bone healing (Speed 2001).
A study was conducted to determine the rate and magnitude of temperature change with the
patellar tendon using US treatment for two different treatment sizes. The authors speculated tendons
will be more effective in absorbing energy due to its collagenous properties. Sixteen college age
students split evenly between male and female. All of which were screened and excluded for any type of
injury, swelling, and or infection. The US parameters are as follows: 3 Mhz, 1 w/cm2 , 100%, 4 minutes.
The authors recorded temperature every 30 seconds until the end of the 4 minute treatment. A
thermostat was inserted between the apex of the patella and the tibial tuberosity. Two treatments
were conducted one with a 2 ERA treatment site and the other with a 4 ERA treatment site. There was a
20 minute cool down before the 2nd treatment. The independent variables were treatment area and
time. The dependent variable was temperature. The results show a significant (F4,60 = 90.58, P < .001)
difference in temperature increase between the 2 and 4 ERA treatment areas. The 2 ERA (+8.3o C) site

Tim Lei
MSAT 6401
Analysis Paper US
03/06/2014
had a significant temperature increase over the 4 ERA (+5.0o) site. With the given results the protocol
was unable to reach the thermal effect range of 40-45 o C, however the parameters were able to raise
tissue temperature past the vigorous heating of 4 o C (Chan 1998). A study conducted by draper
involving muscles stated, a temperature increase 4 o C will elicit vigorous heating (Draper, 1995). With a
4o temperature increase or more, the tissue will have physiological effects of collagen extensibility and
increased blood flow.
There is little to no research that has been conducted with the biceps tendinitis pathology.
However I was able to find a study that was conducted to treat sub acromial impingement syndrome.
The study evaluated the difference between treatment times with US therapy and how it affected the
patients level of pain. Patients were evaluated by pain score, UCLA score, and the constant shoulder
score. The pain score looked at pain during rest, sleep, or activities of daily living, The UCLA score looked
at pain, function, patient satisfaction, and strength of forward flexion. The constant shoulder score
looked at pain, activity level, active range of motion, and strength. There were 100 subjects included in
the study who were split into two groups evenly. The subjects were screened and diagnosed with sub
acromial impingement pathology. The first group received 15 US treatment sessions with the following
parameters: 1.5 W/cm2, 5cm2 soundhead, continuous, 4 minute treatment time. The second group
received the exact same parameters except for the treatment time was 8 minutes. The treatment
groups also received the following modalities/ exercises along with the US treatment: TENS unit for 30
minutes, infrared therapy 20 minutes, and physical therapy exercises. The frequency or depth of
penetration was not included in the article. Results of the study show significant decrease in pain score
from pre to post treatment in both groups (p<.001). There was also significant increase in scores of both
UCLA score and constant scores with both treatment groups (p<.001); higher scores represent an
increased level of satisfaction with what was mentioned earlier. Comparing between groups, there were

Tim Lei
MSAT 6401
Analysis Paper US
03/06/2014
no significant differences between constant daily living, constant external rotation, and constant
strength. However there were significant differences with all other values including, constant pain,
constant flexion, abduction, internal rotation, force, and UCLA score. The significant p-value was set at
p<.05. In this study it shows US treatment among other modalities and exercises can significantly help
decrease pain with activities of daily living, ROM, strength, and level of satisfaction. The study does lack
in there frequency for depth of penetration chosen, the independence of the US therapy, and lack of
control and placebo (Yildirim, 2013). Another study looked at adhesive capsulitis with the shoulder and
how US can affect ROM and pain with motion. There parameters included: 3 Mhz, 1.5 W/cm2,
continuous, and 10 min treatment time. Two groups were designed, one received the parameters
above and the other received a sham US where the on mechanism of US was left off. The results of
range of motion are significantly increased (p<.001). The pain and motion results show significant
improvements with a p-valuse of .0001 (Dogru, 2008). From these two studies we can hypothesize the
parameters used from these studies may aid in the biceps tendinitis pathology.
The parameters for patellar and achilles tendonitis shown on table 3 are able to achieve at least
a 4oC temperature increase. With a 4 oC temperature increase collagen extensibility is achieved.
However the purpose of the articles was not in line with the purpose of this paper. For example the
Achilles with the gel pad article wanted to find out which type of pad thickness achieved a higher
thermal or temperature increase. Therefore the drawbacks are the parameters are not exactly for the
tendonitis pathologies. The biceps tendonitis pathology US parameters are not clear. Therefore there is
a need for research with US parameters for biceps tendonitis.
Table 3
Patella
Achilles
Bicep

Frequency
3 Mhz
3 Mhz
3 Mhz

Power Intensity
1 w/cm2

Duty Cycle
100%

Time (min)
4 min

1 w/cm2
1.5 w/cm2

100%

10min

100%

4 min

Tim Lei
MSAT 6401
Analysis Paper US
03/06/2014