ULTRASOUND Background A 12-year-old junior high school student sustained a deep bruise of the left quadriceps muscle in a fall from his skateboard. The parents were advised by their pediatrician to...

ULTRASOUND

Background A 12-year-old junior high school student sustained a deep bruise of the left quadriceps muscle in a fall from his skateboard. The parents were advised by their pediatrician to apply cold initially and then moist heat until the problem resolved. At this time, 1 month postinjury, significant restriction of left knee motion remains. A referral was initiated to physical therapy at the parents’ request. Physical examination revealed active knee motion of only 10–65 degrees. There was point tenderness and a well-demarcated hematoma palpable in the middle third of the vastus lateralis.

Impression Knee motion restriction secondary to soft-tissue contusion and hematoma formation.

Treatment Plan A course of pulsed therapeutic ultrasound was initiated to decrease the hematoma formation through increased collagen-connective tissue extensibility and reabsorption of the extracellular debris from the original contusion. The patient reported a mild sensation of warmth. At the conclusion of the treatment, the patient was instructed in active and active-assistive knee range-of-motion exercises.

Response Following initial ultrasound treatment and exercise, patient experienced a 10-degree improvement in knee flexion and extension range of motion. At the completion of the tenth treatment session, knee range of motion was within normal limits, and the patient was aggressively pursuing a quadricepsstrengthening regimen. Ultrasound treatments were discontinued at that time with efforts focused on strengthening and functional use of the left lower extremity. The rehabilitation professional employs physical agent modalities to create an optimum environment for tissue healing while minimizing the symptoms associated with the trauma or condition.