Ultrasound guided dry needling of chronic tendinopathy
A number of different methods of treating chronic tendinopathy has recently been presented. One of the methods that are increasingly experiencing greater interest is the "dry needling" of the chronic problems. (In some literature called Ultrasound Guided Percutaneous pines Tenotomi)
In working manual therapist and acupuncture. For many years used dry needling as a method to treat chronic tendon pathology, and has followed closely the research that has been presented on the site in recent years.Muscle & Skeleton that examined the use of ultrasound diagnosis in a manual therapist practice. In this article, commented the need for ultrasound as a guide to perform a dry needling accurately and efficiently. Some researchers also call this method for a percutaneous needle Tenotomi.
Recently used ultrasound (U.S.) to guide the needle into the actual tendon injury. The use of ultrasound has several obvious advantages. The clinical diagnosis can be ensured by UL. This avoids incorrect processing structure. At the same time ensures that the needles hit the U.S. jurisdiction in the tendon. Clinical trials are not good for determining where in the tendon injury is. Palpation is not a safe diagnostic tool in this respect. Using UL is the investigator exactly the scene.
Chinese medicine and acupuncture, and western education in physical therapy, orthopedic medicine (OMI) and manual therapy. In Chinese medicine have been published many articles in which "pepring" of the scene is used as acupuncture. It is not known in most communities, when people first and foremost envisions acupuncture as a method in which one uses a more global approach with pins.
By combining this method with the U.S. so we can go in and find where the tendon injury is and treat accurately. By uses both classical acupuncture needles and thin injection needles in this treatment. The advantage of using an injection needle is that it is stiffer and can easily be inserted via eg the thick layer of skin over the plantar fascia. An acupuncture needle tends to bend. In addition, an injection needle a more potent "cutting effect" that creates a somewhat larger "trauma" and thus a larger internal bleeding in the tendon. The advantage of an acupuncture needle is that the treatment is less painful. However, as mentioned earlier in this section as acupuncture needle creates a minor injury and one must often deal with more frequently to achieve the desired effect.
It perform 2-6 treatments with 1-2 week intervals in the treatment of chronic tendinopathy. During treatment with injection needle he often waits two weeks between treatments, whereas with acupuncture needles then you can / should deal with weekly. Often, only a few treatments may be enough to achieve the desired stimulation of the body to begin regeneration of tendon injury.
As a manual therapist had to treat patients without local anesthetic. The local anesthetic gives the therapist the ability to process longer so that you get stimulated whole tendon injury on a treatment. Without anesthesia, the patient will often not hold the entire treatment, so this must be carried out in several stages. One way which aids this problem if you do not have access to physician collaboration that local anesthetic is to ask the patient to take oral analgesics before treatment. This will possibly make the patient more susceptible to treatment. But he adds that all in all patients tolerated the treatment well without oral or local analgesia.
Having used tenotomi / dry needling as a method for many years before he began using U.S. guidance, able to compare the effects before and after UL - guidance. UL gives me the opportunity to make precise the treatment, he said. It is not just "touch and feel" as it is able to before. Used the U.S. as a diagnostic and counseling tool in the clinic for over 3 years.
Ultrasound diagnostics in combination with acupuncture is an effective treatment for tendon pathology and bursitis. Typical treatment areas is lateral epicondylitis, supraspinatus tendinopathy and plantar fasciitis. But the method can be used on all tendinopathy and bursitis where the medical history, clinical tests and the U.S. together give you an answer about the structure that should be addressed. It emphasize that the U.S. alone is not an adequate tool to perform diagnostics. But with physiotherapy knowledge of testing, the group has everything it takes to be good at this method. Internationally, it was the often radiology, pediatric, radiographers and sonographer who used ultrasound abdomen and barren, but now holds it to be more focus on skeletal muscle. Especially rheumatology use ultrasound frequently to assess the extent and localization of inflammation. There is now an increasing number of physiotherapists, manual therapists, clinical orthopedic physical therapists and chiropractors who use ultrasound practice. And the group is growing. Encourage everyone with an interest in skeletal muscle injuries to use ultrasound guided Percutaneous pines Tenotomi / dry needling as a treatment option for bursitis and tendinopathy.
Association for Clinical Orthopedic Medicine organizes an annual anatomy, dissection and injection rate for physical therapists and doctors at the preparations. This is an excellent way to familiarize themselves with the technique and anatomy is required to use tenotomi as an effective management tool.
Ultrasound with how had tested the treatment of 14 different tendon pathology with ultrasound guided percutaneous needle tenotomi. Their hypothesis was that treatment was equally effective even if you do not inject cortisone for tenotomien. They got good results in his study, but since the study lacked blinding, large enough numbers and a control group, so the results should be tested in a larger study. The method was used to treat lateral epicondylitis. This study was of higher quality, but the method they used was tenotomi followed by injection of cortisone to control inflammation in the aftermath. The authors in this study even discussed the possibility of carrying out treatment without cortisone, and presented a hypothesis that it was mainly the needle damaging effect that initiated regeneration, and that cortisone had no active role. But you used when cortisone to control inflammation after treatment.
In light of recent studies on the effect of Association for Clinical Orthopedic Medicine and cortisone their possible negative effects on healing after injury, is unsure of the need for cortisone. If the method of tenotomi is designed to create a new acute inflammation so that repair processes locally in the tissue is at it again, why would you then to inhibit this effect by injecting cortisone? Some have argued that cortisone softens scar tissue, but remains more research.