Last updated: September 17, 2024 at 3:41 PM

During a recent popcorn trip, I fell on the street in Susukino, Sapporo, and suffered an avulsion and fracture of the middle finger of my right hand. At the same time, ligament damage was observed in my ring finger, resulting in a serious injury that took two months to fully recover.
As for the progress of subsequent treatment, after 4 weeks of immobilization using a built-in finger supporter, the fractured bone in the second joint of the middle finger was able to connect normally, and the patient is now on the road to recovery.

However, if rehabilitation treatment after a fracture is neglected, the soft tissue of the ligament becomes stiff, the joint remains deformed, the range of motion is narrowed, and the finger becomes unable to bend. In fact, at the orthopedic hospital I currently attend, I heard from someone who had experienced this, and I realized the need to provide proper care.

Currently, at the orthopedic clinic where I am visiting, I am continuing rehabilitation treatment with a bubble jet bath with water temperature of 40° and therapy by a masseuse in parallel with treatment using low-power pulsed ultrasound (LIPUS) using the ultrasonic fracture treatment device Accellus2. I am.
Intuitively, a bubble jet bath and massage treatment seems to have the most immediate effect, as warming and massaging the joints softens the ligaments, expanding the range of motion and improving blood circulation. Massaging with a shower head while taking a bath also seems to be effective.

Please note that outpatient LIPUS treatment is currently only available twice a week due to the reservation situation.
Therefore, in order to supplement my time on other days, I decided to purchase a 1MHz ultrasound treatment device ``YUNCHI Ultrasonic Physical Therapy Device'' online and perform ultrasound treatment myself.
However, the treatment device you purchased this time is not a medical device approved by the Ministry of Health, Labor and Welfare, so you are solely responsible for the consequences of its use.
Although the safety of this device has been confirmed based on its specifications, if it worsens inflammation, we will immediately stop using it.

History of treatment

The history of treatment to date is summarized below.

An avulsion fracture of the middle finger of the right hand was discovered.

After returning from a trip to Sapporo, an X-ray examination revealed an avulsion fracture of the second joint of the middle finger of the right hand, as well as damage to collateral ligaments in the middle and ring fingers due to symptoms of abnormal swelling in the joint. This was the weekly diagnosis result.
The extent of ligament damage can only be confirmed by MRI (our hospital does not have one).

As an emergency treatment for an avulsion fracture, the second joint of the middle finger of the right hand is strongly pulled, the joint is returned to its correct position, and the condition of the bone is checked again using an X-ray.
If there is no problem with the condition, apply a compress around the affected area, secure it with a sheen, and wrap a bandage as shown in the video below. From now on, progress will be observed.

Using supports and waterproof covers

I bought a finger support from Rakuten because it was quite a pain to re-wrap the bandage every time I changed the compress.
The supporter has a built-in sheene (metal fixing device), but in the case of a fracture, the sheene needs to be bent at the correct angle, so please have your doctor adjust the angle at a later date. I did.

In addition, I purchased a waterproof cover from Amazon to prevent the supporter from getting wet during the shower. For your reference, we have uploaded each medical product in the gallery below.

Ultrasonic fracture treatment with Accellus2

At the orthopedic clinic I visit, I use an ultrasonic fracture treatment device. Accellus2 We are continuing treatment with low-power pulsed ultrasound (LIPUS).
LIPUS treatment is performed by applying ultrasound to the fracture site for about 20 minutes once a day, and is a treatment method that promotes healing of the fracture. By irradiating the fracture site with intermittent ultrasound sound pressure, bone formation can be promoted and the healing time can be shortened by approximately 40%.
It can also be used for injuries to soft tissues (muscles, ligaments, tendons, etc.), and can be used from the acute stage without worsening inflammation. It has been certified as advanced medical care by the Ministry of Health, Labor and Welfare, and has been implemented in Japan since 1998.

The eye-catching X-rays are the results 4 weeks after starting LIPUS treatment. From this photo, you can see that the avulsion fracture in his right middle finger (red circle) has completely healed. Although my right ring finger (green circle) escaped fracture, the finger was bent outward at the second joint due to ligament damage.

As shown in the gallery below, LIPUS treatment involves applying a special gel to the affected area, fixing the probe, and applying low-power pulsed ultrasound for 20 minutes.

About ultrasound therapy

Ultrasound therapy is a treatment method that uses mechanical ultrasound vibrations. Ultrasonic vibrations can be expected to improve and increase blood flow, alleviate pain, and improve tissue extensibility.

Ultrasound is defined as a sound wave that vibrates at a frequency that is too high to be heard by the human ear (20kHz or higher). Ultrasound therapy increases the therapeutic effect by irradiating the mechanical vibrations of ultrasound waves onto the living body.
When ultrasonic waves are irradiated, biological tissue is heated by the mechanical vibrations, and tiny air bubbles of several micrometers within the body repeatedly compress and expand, stimulating cell membranes appropriately and activating cells.
When ultrasound waves travel through tissue, the ultrasound energy is rapidly absorbed and attenuated by deep tissues such as ligaments, tendons, and other connective tissues, where it is converted into thermal energy (thermal effect).

Ultrasound therapy generally uses two types of frequencies: 1MHz and 3MHz, but 1MHz reaches deeper, making it suitable for treating large muscle injuries. On the other hand, 3MHz acts on areas up to 2cm from the body surface, so it is suitable for treating superficial areas.
In addition, it is possible to heat tissue at a depth of 3-5 cm at 1MHz and at a depth of 1-2 cm at 3MHz.
The heating effect is more than three times higher at 3MHz, so it is used at less than 1/3 the intensity when applied at 1MHz.

Ultrasound treatment generally has no side effects, but there are some cases in which it should be avoided for safety reasons.
Cases in which ultrasound treatment should be avoided are as follows:

-If you are wearing a pacemaker, treatment is difficult because there is concern that heat may cause problems.
- Avoid using ultrasound therapy if you have a malignant tumor or a serious disease in your blood vessels or spinal cord.
・The eyes, brain, and reproductive organs are not subject to ultrasound treatment.
・It is also included in the contraindications during pregnancy, as the effect on the fetus is unknown.
・Do not irradiate the eyes as this will cause the tissue to become hollow.
・Do not use on affected areas with malignant tumors as the tumor will grow.
・Ultrasonic therapy devices cannot be used for fractures or bone cracks in people of the generation with growing cartilage (0 to around high school age). This is because it can cause growth problems in the bones.
・The risk associated with the ultrasound path is that tissue along the path to the target may be heated, causing tissue damage that can lead to significant brain cell damage and even death. This heating can be caused by inappropriate treatment targeting, scarring, treatment tissue being too close to skin or bone, energy absorption by bone, or burns from high heat.

[How to use ultrasound]

The ultrasound emitted from an ultrasound therapy device does not propagate through the air, so a mediating substance such as a gel is required between the conductor and the skin in order to take the ultrasound into the body.

[How to set thermal effect and non-thermal effect]

The purposes of ultrasound therapy can be broadly divided into two: (1) those that utilize thermal effects, and (2) those that utilize vibration effects (non-thermal effects).

Setting conditions to distinguish between the two are determined by 1) frequency, 2) intensity, 3) irradiation rate, 4) moving speed of the conductor, 5) irradiation area, and 6) implementation time. (See table below)

	thermal effect	Non-thermal effect
Frequency	1-3MHｚ	Mainly 1MHz
strength	0.5-1.5W/㎠	0.1-0.3W/㎠
Exposure rate	50% or more	20% or less
Movement speed	2-4㎝/second	fixed
Irradiation area	1.5-2x	fixed
treatment time	3-10 points	3-20 minutes

If the purpose is to achieve a thermal effect, a hot spot will be generated due to the beam non-uniformity ratio, and there is a risk that only one part will be overheated and cause burns.
Therefore,The moving range should be 1.5-2 times the effective irradiation area, and the conductor should be moved at a speed of 2-4 cm/sec.

If a non-thermal effect is desired, the intensity and irradiation rate should be lowered to suppress heating effects as much as possible. Due to the low intensity and low irradiation rate, no hot spots are generated even when the conductor is fixed, so there is almost no risk of burns.
Treatment time varies depending on the area, and 3-5 minutes for normal soft tissues, 15 minutes for tendon injuries, and 20 minutes for fractures are considered necessary to promote healing.

[Treatment method using thermal effect]

Tissues with high ultrasound absorption coefficients are generally those with high collagen content, whereas tissues with low absorption coefficients are those with high water content.
Therefore, the heating effect on tissues such as blood, fat, and muscle is small, and the heating effect on tissues such as tendons, ligaments, joint capsules, fascia, and bones is high.
It has been reported that when irradiating 1MHz ultrasound with an intensity of 1W/cm2, the temperature of soft tissue increases by 0.2℃ per minute on average.
The absorption of ultrasound is proportional to the protein content of the tissue through which it is propagated, so it is well absorbed by bones and joint capsules that contain a lot of collagen tissue, which tends to cause a rise in temperature. In particular, the joint capsule is the main cause of joint contracture, so it is effective to irradiate the restricted area and then stretch it.
Ultrasound is applicable to localized deep tissues, and is highly effective for treating contractures after cast immobilization, burns, and postoperative adhesions and scars.

[Treatment method using non-thermal effect]

The following biological reactions have been reported to occur with low-intensity ultrasound therapy.

1. Increased intracellular calcium
2. Increased cell membrane permeability
3. Increased mast cell degranulation
4. Increased chemoattractant and histamine release
5. Enhanced macrophage reactivity
6. Protein synthesis rate by fibroblasts

These reactions are expected to have the effect of accelerating tissue healing and hastening recovery from injury.
Studies have shown that applying ultrasound to the fracture site can shorten bone union time by nearly 40%. It is particularly effective for intractable fractures and is said to significantly improve the success rate of bone union.
The recommended frequency is once a day for about 20 minutes.

* References
　About the therapeutic effects and methods of ultrasound therapy – rehatora.net
　Effects of different ultrasound output intensities on the infraspinatus muscle

Massage using ejector bath HK-151

After a 10-minute bubble jet bath treatment using the Ejector Bath HK-151, a hot bath therapy device for upper extremities, which is an eye-catching medical device, the massage therapist will begin the treatment.
In the bubble jet bath, the soft tissues of the joints are warmed and softened, so during this time you can repeat the goo bar on your palms to increase the range of motion of your finger joints.

Ultrasonic therapy device purchased on AliExpress

To complement my LIPUS treatment, I purchased an ultrasound therapy device from AliExpress for home treatment.
Accellus2, which has been introduced in orthopedic surgery, is sold for 300,000 to 400,000 yen, which is expensive, so it is difficult to buy it. In addition, managed medical device sales companies are selling ultrasonic therapy devices from American manufacturers on Rakuten. US PRO 2000 2nd edition can be purchased for around 30,000 yen. Even though it's an American manufacturer, it's actually an OEM (made in China) from a Chinese company.

This model does not have the same specs as the IPUS-specific ultrasound treatment device (Accellus2 has 30mW/cm2), but when the duty cycle is set to "Low", the low-power ultrasound is 0.32W (effective ultrasound intensity: 0.08W/cm2). ㎠ = 80mW/㎠ ±20%), so it can be used to some extent for the treatment of bone fractures.

However, it would be a pain to spend 30,000 yen for one-time use, so this time I will buy a model with the same specifications as the US PRO 2000 (older model), which is the only Chinese model on AliExpress that is sold in the 10,000 yen range. I purchased the YUNCHI Ultrasonic Physiotherapy Device, an ultrasonic therapy device manufactured by YUNCHI.

In addition, on AliExpress, the same model is listed by multiple sellers under appropriate brand names, but most of the models sold for less than 10,000 yen do not come with a gel, so there is a possibility that they are second-hand products. Please be careful as there are some. I am purchasing a genuine product with a selling price of 12,813 yen.

The specifications of the YUNCHI ultrasonic physical therapy device are as follows.The frequency is 1MHz, so it is safer than a 3MHz treatment device, and the risk of burns is relatively low. Please note that if you select the "US" type when ordering, the AC adapter will be compatible with Japanese specification plugs.

<Features>
1. 3 gear strength: 0.72/0.96/1.20W/cm²±20%
2. Pulse duration: 3/4/5ms, pulse repetition period: 10ms
3. Beam maximum power: 9.6W
4. Duty cycle: (low: 30% medium: 40% high gear: 50%)
5. Effective sound intensity: (low: 2.88 medium: 3.84 high gear: 4.80W ±20%)
6. 3 timing gears: 5/10/15 minutes
7. Effective irradiation area: 4.0cm²±20%
8. タッチコントロール & LEDディスプレイ
9. Built-in heater function in probe
10. Treatment scope: arthritis, rheumatism, neck and shoulder pain
11. Gel included

<Specifications>
Frequency: up to 1MHz
Maximum output: 9.6W
Rated voltage: 100-240V, 50/60Hz, 600mA
Adapter output: DC15V/3A
Brand Name: Yunchi
Waterproof grade: IPX7 (ultrasonic probe only)
Size: 202x49x70mm
Weight: 336g (including adapter)

<Function>
1. Analgesic effect: This muscle therapy machine destroys the membrane of nasal receptors, suppresses the generation and transmission of pain signals, and has analgesic effect. Suitable for people who often work for long periods of time or whose body muscles are in a stiff state, relaxing the body and mind and relieving fatigue.

2. Promote decomposition: This analgesic device can improve intercellular permeability, blood circulation and decomposition, help eliminate waste from the body, effectively improve health, and improve acupuncture treatment. Stimulates points and improves microcirculation. Improves blood circulation and promotes cell renewal.

3. Promote bone healing: The pain relief massager can promote bone remodeling and healing, promote the dissolution of hardened fibroblasts, promote regeneration, and effectively treat bone tissue diseases. Target. Delayed healing and non-union of fractures, early adult femoral head enamel helps restore health.

4. High performance: Shockwave therapy machine can also improve the appearance of the treated area and reduce inflammation in the affected area. Shockwave therapy can help promote tissue recovery and improve health. It does not damage normal tissue cells and avoids the possibility of surgery and associated risks.

5. Easy to use: The pain therapy machine adopts ergonomic design, provides settings, is easy to operate, and is fully functional. The analgesic effect of shock wave therapy device is more obvious than other physical therapy devices. It especially helps relieve shoulder pain and is good for osteoarthritis.

Operation confirmation of YUNCHI ultrasonic physical therapy equipment

The following video is a confirmation of the operation of YUNCHI ultrasound physical therapy equipment. Turn on the power and set the gear strength to "L", then put a drop of water on the probe and it is OK if blisters appear.

Usage examples of YUNCHI ultrasound physical therapy equipment

YUNCHI ultrasonic physical therapy equipment applies a generous amount of special gel to the probe and the affected area, then applies the probe to the affected area for treatment. Even if the gear strength is "low", this treatment device has a high output of 0.72W/cm² compared to LIPUS (0.03W/cm²), so fixing the probe to the affected area is dangerous and is prohibited. Masu.
The effective irradiation area of ​​this device is 4.0 cm2, so in order to reduce the risk of burns, the probe must be moved at a speed of 2-4 cm/sec to areas outside the 4 cm radius. If moving is not possible, shorten the time the probe is in contact with the affected area by moving the probe on and off the affected area.
The probe is used in a reciprocating or circular motion around the treatment area. If you feel pain, immediately remove the probe from the affected area and apply additional gel liberally to the affected area as needed.
Furthermore, since the probe of this device has a built-in heater function, it is also expected to provide thermal treatment effects to the affected area.

The current state of treatment is that after the fracture has completely healed, we move on to the rehabilitation treatment phase, which alleviates the pain caused by the ligament damage and expands the range of motion of the joints that are no longer able to bend.
Based on research reports that 3 to 5 minutes is usually appropriate for treating the soft tissue around the avulsion fracture (second joint of the middle finger) and the collateral ligament of the second joint of the ring finger. This time, to be safe, I decided to set the gear strength to "low" and use the treatment for less than 5 minutes each day after taking a bath.
For the time being, the treatment period with this machine is expected to be a maximum of 3 weeks.

According to a medical professional who happened to be at a popcorn shop the other day, the muscles connected to the fingers are not only collateral ligaments, but also the muscles that connect to the palm of the hand to move the fingers. Applying the probe not only to the backs and sides of the fingers but also to the palm of the hand will further enhance the massage effect. However, the probe should not be applied to areas that are swollen or inflamed.

YUNCHI Ultrasonic Physical Therapy Equipment Instruction Manual

We will upload reminders and instruction manuals (English/Japanese) for this product to the gallery. The translation into Japanese is by his Galaxy AI on the Galaxy S24 smartphone.

[Reminder]

【operating instructions】

Purchase ultrasound treatment gel

The gel (50g) that comes with the YUNCHI ultrasonic physical therapy device has a small content, so as an alternative, from Yahoo! Shopping, Ito Ultrashort Wave Co., Ltd. Osteotron V (Selling price 400,000 yen) I purchased the ultrasonic coupler gel (260g) that comes with it.