PHONOPHORESIS

BY:
KARISHMA.GAVLI
 INTRODUCTION
 PHONOPHORESIS:Is defined as the
movement of drugs through skin into the
subcutaneous tissues under the influence of
ultrasound .
 Also called as Sonophoresis or
ultrasonophoresis.

 PRINCIPLE:
Phonophoresis relies on perturbation of
the tissue causing more rapid particle
movement and thus encouraging
absorption of the drug.
 Ultra sound facilitates the passage of some drugs
into and through the skin

 The effects are due to both absorption of the

drug and to the ultrasound

 Lower ultrasonic frequencies appear to lead to

deeper drug penetration

 Pulsing the ultrasound may lead to better drug

penetration

 The quantity of drug entering the skin is

proportional , in general ,to the time and
intensity of ultrasound application
 PHYSICS
 Molecules into the target must be broken into
component elements and radicals by natural
chemical process and recombined with
existing blood stream radicals
 Soundwaves may easily penetrate to depths
of 4 to 6cm,but no clinical evidence of
molecular transfer to depths greater than 1 to
2 mm
 However it is highly unlikely that substances
of molecular sizes can be forced into the
tissues to those depths.
 EFFECTS OF
PHONOPHORESIS
 The thermal effects of ultrasonic increase
tissue permeability.
 The medication follows the path of beam.
 Continuous ultrasonic at an intensity great
enough to produce thermal effects may
induce a pro-inflammatory response.
 If the goal is to decrease inflammation ,
pulsed ultrasonic with low spatial-averaged
temporal peak intensity may be the best
choice.
 PENETRATION OF
DRUGS
 Once the drug has passed through the
epidermis ,it is likely to be dispersed in the
circulation to an extent which depends on the
vascularity of the tissues concerned and the
ease with which molecules of the drugs can
enter blood vessels.

 Low frequency leads to greater penetration.

 Deeper penetration does not necessarily infer

greater effectiveness.
 Therapeutic effects occur in the dermis and
epidermis ,such as cutaneous anaesthetic
effect of lignocaine

 This has been shown to occur in that 1.5 and

3 MHz ultrasonic appeared to be more
effective in achieving absorption of local
anaesthetic than 0.75 MHz

 Pulsed is more effective than continuous in

transfer of analgesic
 DRUGS USED IN
PHONOPHORESIS
 Anti-inflammatory drug hydrocortisone has been widely
used.

 Other steroid-type drugs and non-steroidal anti-

inflammatory drugs mainly salicylates.

 Anti-inflammatory analgesic cream trolamine salicyclate

,the effectiveness of this agent on DOMS (delayed onset
muscle soreness)

 A lotion containing zinc oxide, tannic acid, urea and

menthol has been applied by phonophoresis to treat
herpes simplex virus type II in both oral and genital
infections with good results.

 Antibiotics such as penicillin have been given by

phonophoresis for the treatment of skin infection.
Hydrocortisone gel or ointment (1-
10%)
 It may be used for strong anti-
inflammatory action in acute
inflammation of soft tissues.
 In rare cases skin rashes may be
seen which is best treated by
antihistaminic drugs.
 It helps in treating many skin
reactions such as psoriasis,
scleroderma and bursitis.
Lidocaine(4-5%) gel (xylocaine)-
 It is very effective for analgesic and
relief of acute pain with no adverse
reaction.
Zinc oxide cream(20%)-
 Zinc is a healing agent and can be
useful in treating open wounds.
Methyl salicylate(4.8%) ointment or
salicylate (10%) ointment (myoflex)-
 As a basic anti-inflammatory agent
salicyclate may be considered for
chronic painful disorders of the
musculoskeletal system.
 Patient sensitive to aspirin should not
be treated with salicylates.
Iodine(4.7%) ointment (iodex)-
 It is used in softening of scar tissues ,
soft tissue adhesion , calcification of
ligaments and tendons and also for
adhesive capsulitis of joints.
 Patients allergic to sea food should
not be treated with iodine.
PRODUCT ACTIVE TRANSMISSION
INGREDIENTS RELATED TO WATER(%)
0.75M 1.5MHz 3MHz
Hz
STEROIDS: HYDROCORTISONE,DI
COBADEX METHICONE 55 67 75
CREAM,
HYDROCORTISONE
61 71
LOCOID
LIPOCREAM
BUTYRATE 38
ANTI- BENZOCAINE
INFLAMMATORY SALICYLAMIDE, 87 11 120
DRUGS:
CORTICOSTEROIDS
INTRALGIN GEL,
MOVALET
,HEPARINOID, 33 48 69
SALICYCLIC ACID
CREAM
LOCAL LIGNOCAINE,
ANAESTHETICS: PRILOCAINE, 83 90 95
EMLA CREAM,
LIGNOCAINE
XYLOCAINE
OINTMENT
HYDROCHLORIDE 2 2 0
 APPLICATION
 The drug to be driven is combined in a
suitable gel or cream which forms the
couplant.
 It is smeared onto the part using spatula so
that it is not applied by patient fingers.
 Treatment head is used in a usual manner.
 Relatively high intensities of 1 and 1.5 W/cm2
have been used.
 The depth of the target tissue determines the
frequency used.
 The time of the treatment depends on the
area over which phonophoresis is to be
applied.
 1 minute treatment for every 10cm2 area is
reasonable (although some suggest 5 minute
for each 25cm2, i.e. about 1 minute for 30cm2.
 After the completion of treatment , the drug
should be removed from both the patient’s
skin and transducer head.
 Since the cream or gel containing the drug is
being used as the coolant, it is important that
it transmits ultrasonic adequately.
 (gels are more efficient coupling agents than
creams particularly for high frequency
ultrasonic-1.5 & 3MHz)
 CONDITIONS TREATED WITH
PHONOPHORESIS
 Post – injury
conditions(dislocation,
distortion of joints,
inflammation of muscle ,
tendons etc.)
 Pain in rheumatic diseases.
 Low back pain of
neurological origin( i.e. root
pain discopathies, sciatica)
 Bursitis and similar
inflammatory ailments.
 Carpal tunnel syndrome.
 Foot /toe pain/ Achilles
sprains and strains.
 Ankle/knee/calf/neck sprains
and strains
 Wrist /hand /elbow /shoulder
sprains and strains
 Hip/thigh sprains and strains.
 Ligament strains
 Osteoarthritis
 Post –exercise recovery(when
the workout goes a bit too far)
 Plantar fascitis(heel spurs)
 Rheumatoid arthritis
 Shoulder capsulitis
 Supraspinatus /infraspinatus
 Tarsal tunnel syndrome
 Tendonitis (acute or chronic)
 Tennis elbow or golfers elbow
 Tension headaches
 Upper and low back strains
 CONTRAINDICATION
 Rapidly dividing tissue

 Spread of infection

 Vascular problems

 Radiotherapy

 Implants

 Anaesthetic area.
 REFERENCES
 Low and reed
 Khatri
 Joseph khan
 www. Google .com
 Wikipedia
 electrotherapy.org
Thank you