After several years of practicing with an emphasis on soft-tissue therapy, I finally hit a wall treating patients with shoulder tendinopathies, carpal tunnel syndrome, deep muscular pain, and extremity pain. My fingers and wrists began to hurt from performing trigger-point therapy and cross friction massage, so upon the recommendation of a chiropractic colleague in Canada, I looked into the Intelect TranSport therapeutic ultrasound unit from Chattanooga Medical Supply Inc, Chattanooga, Tenn. I remembered using Chattanooga equipment in chiropractic school, and recalled that the Chattanooga company has a great reputation in the medical instrument field.

Portable, efficient, and capable of producing continuous and pulsed waves, the Intelect TranSport was also the most affordable option for me. It occupies no more counter space than my laptop computer. It produces a 1.0 MHz frequency suitable for deeper penetration and heating applications of large joints such as the hip, shoulder, and spinal facets; and a 3.3 MHz frequency desirable for treating superficial tissues such as the rotator cuff, muscles and tendons, plantar foot pain, and the small joints of the elbow, wrist, and ankle. I don't need to change applicator heads to change waveforms; I merely press the button on the console.

Ultrasound energy is generated by the piezoelectric effect. Electrical energy passes through a crystal, causing it to vibrate at a high frequency, producing ultrasound waves that emanate from the applicator head in a collimated beam.

The ultrasound waves are absorbed and transformed into heat energy as it propagates through tissue. Heat energy is concentrated at the articular surfaces of joints.¹

The Intelect is preset to start at 7 minutes, and the operator can change the time-duration setting simply by pressing the console button. The head-warming function provides a nice feature for patients who don't like the sensation of having a cold applicator head applied to their bare skin, warming the applicator head to slightly above body temperature to increase patient comfort.

Indications for Ultrasound

Chattanooga states that ultrasound is indicated for the application of therapeutic deep heat for the treatment of selected subchronic and chronic musculoskeletal conditions, including:

• relief from pain, muscle spasms, and joint contractures that may be associated with adhesive capsulitis, bursitis with slight calcification, myositis, soft-tissue injuries, shortened tendons due to past injuries and scar tissues; and
• relief from subchronic and chronic pain and joint contractures resulting from capsular tightness and capsular scarring.²

Contraindications

Therapeutic ultrasound should not be used for symptomatic local pain relief unless the clinician has established the etiology of the patient's pain. Additional contraindications include:

• the presence of cancerous lesions or open wounds in the treatment area;
• patients suspected of carrying serious infectious disease, or febrile patients;
• the use of ultrasound over or near bone-growth centers until bone growth is complete;
• application over the thoracic area if the patient has a cardiac pacemaker;
• continuous ultrasound application over a healing fracture (pulsed ultrasound may be indicated for accelerating healing of nonunion fractures);
• application over or near the eye or over or near a gravid uterus; and
• application over or near ischemic tissues in individuals with vascular disease where the blood supply would be unable to follow the increase in metabolic demand and tissue necrosis might result.²

Additional precautions include:

• the use of therapeutic ultrasound over an area of the spinal cord following surgery such as laminectomy, in which the major covering tissues have been removed;
• application of ultrasound over anesthetic areas or areas of sensory disturbance, including patients with diabetic neuropathy; and
• application on patients with hemorrhagic diatheses.

Patients with an implanted neurostimulation device must not be treated with, or be in close proximity to, a therapeutic ultrasound device or other forms of heat-generating electrotherapy such as shortwave diathermy or laser diathermy anywhere on their body. Energy from diathermy (short-wave, microwave, ultrasound, and laser) can be transferred through the implanted neurostimulation system, causing severe injury or death. The manufacturer states that injury, damage, or death can occur during diathermy therapy even if the implanted neurostimulation system is turned off. Clinicians are urged to prescreen their patients for any underlying medical problem or medical implant device before applying a heat-generating therapy or electrotherapy.²

Potential for Burns

The Chattanooga Intelect TranSport provides an effective adjunctive treatment modality for various musculoskeletal problems.

It is possible for ultrasound therapy to cause skin burns if the power intensity is too high, if the clinician uses too low of a frequency or holds the application head in one place for too long, or if the clinician is treating an area with sensory nerve damage or the loss of normal skin sensations. The clinician may also burn or overheat desensitized areas without the patient realizing it, especially in patients with diabetes or neural damage. Bony prominences are also vulnerable to overheating or burning because they reflect sound waves and increase intensity to the periosteum.

If the movement of the sound head over the treatment region is too slow, the patient may feel periosteal pain characterized by a deep ache or pain. The recommended speed of sonation is between 2 to 8 cm per second. If the movement of the sound head is too fast, or if the sound head does not maintain sufficient contact with the skin through an appropriate ultrasound coupling medium, the therapeutic effect of the ultrasound waves will be reduced and the sound head may overheat. Chattanooga recommends the use of an appropriate gel or lotion specifically designated for use as a coupling medium with therapeutic ultrasound.²

Patient Susceptibility

Some patients are more sensitive to ultrasound output and may experience a reaction similar to a heat rash. The clinician is urged to inspect the treatment area during and following treatment, and discontinue treatment if an adverse reaction occurs.²

Regarding service, Chattanooga recommends that all ultrasound units be returned annually for recalibration.

Overall Design

For more ultrasound products, go to the Therapy/Electrotherapy section of our Buyers Guide.

The only design flaw that I have encountered with the Intelect is that the applicator head attaches to the main unit by way of an eight-pin male connector, or DIN plug. Transportation of the unit causes the electrical cord to twist, stressing the wires at the DIN plug connection. The cord also tends to twist during patient treatment.

Other than that, the Intelect TranSport is affordable, efficient, and functional; provides an effective adjunctive treatment modality for various musculoskeletal problems; and is helpful in preheating soft tissues prior to performing manual techniques. In general, my patients find their ultrasound treatments for specific musculoskeletal problems such as shoulder tendinopathies, plantar foot pain, carpal tunnel syndrome, neck and back pain of a muscular or facet nature, and knee osteoarthritis comfortable; and the clinical results are generally favorable.

Gerald A. Anzalone, DC, of Hudson Valley Neck and Back Care, Peekskill, NY, has been in practice for 9 years. He is a writer and lecturer about health care issues. Contact him at .

References

1. Klein MJ. Deep heat. eMedicine from WebMD. Available at: www.emedicine.com/pmr/topic203.htm. Accessed November 27, 2006.

2. Chattanooga Group, Intelect TransSport Ultrasound User Manual. Available at: www.chattgroup.com/downloads/User%20Manual/Intelect%20Transport.pdf. Accessed November 27, 2006.