Info for medical professionals 2018

Tissue Damage - Tissue Diagnostics - Tissue Regeneration - Tissue Remodeling

With neck injuries there can arise damage to joint ligaments, joint capsules and meniscus in the neck. The common denominator for these injuries are that the damaged tissue mainly is composed of collagen tissue. Accurate diagnostics of damaged tissue is crucial for a good starting point for precise rehabilitation. At Firda Physical Medicine Centre high-end ultrasound is a very important aid in thorough tissue diagnostics.

Collagen tissue is white in ultrasound images. Contiguous white fields with dense structure and good form is a sign of suitable collagen quality and function. Non-contiguous white fields, and white spots, can indicate fragmentation of tissue/damaged tissue, which weakens stability and function.

EXAMPLE:The image below is an example from the atlantoaxial joints on the right and left side. The patient is a female under 30 years. She presents with a neck injury in the transition between the neck and head with clinically tested tissue damage findings to joint capsules and ligaments between atlas / axis (C1,2).

Area - C1-2 facet joint - ligaments/capsules - lateral part / outer part

Image 1: June 2017. Right side C1 - 2 joint/soft tissue

Ultrasound (GE Logiq E9, 2017 model) lateral of C1-2 joint - ventrally towards nose (L), towards back of the head (R). Longitudinal section on joint surface C1-2, joint capsule and capsular ligaments this level. Distance L-R - ca 4 centimeters.

Joint gap in the central part of the joint.
Ventral part of the joint capsule which is significantly damaged.
Damaged/fragmented ligament - ventral/dorsal part of capsular ligament.
Segmented musculature - M. Obliquus Capitis Inf. Weakened muscle status with infiltration.

Image 2: November 2017. Right side C1 - 2 joints/soft tissue. Same section as image 1.

This is what the section looks like after ultrasound guided focused acoustic compression therapy ( Piezo Wave 2 ) autumn 2017.

We see a more contiguous ventral part of the joint capsule where we have managed to stimulate tissue regeneration and tissue remodeling with the use of Multi Cervical Unit for tissue remodeling, shaping, and repair.

Our goal for autumn 2018 is to start using a neck testing/training machine based on a robot with artificial intelligence developed in Norway.

Ventral and dorsal capsular ligaments are significantly denser and of better quality.

Image 3: June 2017. Left side C1-2 joint/soft tissue

More extensive damages to the front joint capsule. Loose capsule flaps.
Condensed tissue/scar tissue forming central parts of capsule. Thickened capsule tissue.
Fragmented rear part capsule/capsular ligament. Some intact ligament structures.

Image 4: November 2017. Left side C1-2 joint/soft tissue. Same section as image 3.

After tissue stimulation using ultrasound guided focused acoustic compression therapy (Piezo Wave 2) and remodeling (using MCU) during autumn 2017, observable changes are apparent in November 2017.

Clearly improved structure of ligaments and capsular structures.
There is improvement of the ventral and dorsal part of joint capsule - but the result here is unsatisfactory.

After having used different ultrasound devices, we find that the high-end products from GE gives us the best results - Logic E9. This device has been very important to us in our work!

Ultrasound - MRI

Our experience with MRI 3.0T, lying down starting position - cervical column with positions - with T2 and STIR sequences performed in London - gives a clearly better "map" for further ultrasound and regenerative (tissue stimulation for repairing collagen tissue) treatment, for those who have had this examination. We see that with our clinical examination prior to the use of customized MRI procedures/execution - where we collaborate and ensure that the MRI method is adapted for the individual patient, this provides a better foundation for a more targeted rehabilitation than for those who do not have this MRI examination ahead of time. One must NOT confuse high-end MRI neck 3,0T with upright MRI 0,5T. Upright MRI has in our view no place in current diagnostics of neck injuries. Upright MRI has is too low in image resolution, specificity, and sensitivity for tissue damage. The risk of misdiagnosing is exorbitant.

When combining positional MRI (3T) with positional CT (Aquillion ONE 640 slice CT scanner) this is a very good diagnostic combination. We here visualize joints and joint positions with the surrounding tissue with good quality assessment. (Radiation dose per CT examination 1,5 - 2,8 mS per total CT examination).

When it comes to acoustic compression therapy, one device stands out in our opinion- Piezo Wave 2. This device performs well with regards to tissue depth stimulation along with the possibility of good signal control. One must make a distinction between this kind of acoustic compression and the older radial pressure wave. In our view, radial pressure wave is a 2nd generation old method that cannot be used for back and neck treatment.

The Firda Method - Executed in this fashion we have the best foundation for performing targeted and effective rehabilitation with the knowledge and equipment available in 2018.

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