Diatermia

(Tecarterapie)

Coordonator: Conf. Univ. Dr. IANC Dorina

Student: RUSCETTA Simone

Ce este diatermia?
Diatermia (din limba greaca dia=profund)
este o forma de termoterapie care se
foloseste de hipertermia profunda asupra
tesuturilor moi si structurile osteoarticulare.
Este cunoscuta si sub denumire de T.e.ca.r.
(dunumirea comerciala de la Unibell);
Tecarterapia (T.e.ca.r.= Transfer energetic
capacitiv rezistiv) este o forma de
termoterapie endogena.

Cand a aparut Tecarterapia?

Conceptul de diatermie are sute de ani
vechime, fiind cunoscut deja la sfarsitul
secolului XIX in nordul Europei sub
denumirea de terapia a 100.000 de volts.
Primul aparat de diatermie este datat din
1902 datorita lui Nagelschimdt, care folosise
primul sistem de diatermie cu placi, bazat pe
un sistem de condensator-rezistor.

Figura 1 Aparat de diatermie din 1902 (http://www.tecarroma.it/wpcontent/uploads/2014/05/76c4e49149ae8a3ec24fc2e80b175bc2b2ef6218.jpg)

Tecarterapia azi
Unibell International la sfarsitul anilor 90 a
reluat acest concept, imbunatatindu-l datorita
progreselor tehnologiei. Astfel, s-a creat un
aparat electromedical de diatermie modulabil,
avand doua tipuri de circuit (capacitiv, pentru
tesuturi moi si rezistiv pentru structurile
osteoarticulare).
Denumirea corecta ar fi diatermie endogena, dar
se foloseste denumirea comerciala Tecar
(marca inregistrata Unibell).

Cum functioneaza Tecar-ul?

Figura 2 Aparat de diatermie (Tecar)

http://www.centrofisioterapicoarcorese.it/images/p035_1_00.png

 Tecarterapia este o forma de

diatermie/hipertermie profunda ENDOGENA
(laser, ultrasunet etc. sunt EXOGENE).
Prin trecerea si alternarea rapida a sarcinilor
electrice prin tesuturi se creeaza, datorita
efectului Joule, o crestere a temperaturii
tesuturilor, avand un efect vasodilatator care
aduce un flux major de sange in zona tratata
(vasodilatatie districtuala), avand un efect
Antinflamator, antalgic si de regenerare.

Diatermia are ca efect:

Vasodilatarea tuturor structruilor capilare si
microcapilare
Aflux sporit de oxigen si nutriente la nivelul
tesuturilor afectate
Stimularea sistemului linfatic
Modificarea permeabilitatii peretilor celulari
reechilibrand fluidurile dintre celula si spatiul
interstitial

Tecar capacitiv
Modalitatea capacitiva se foloseste atunci
cand tratam tesuturi cu o rezistenta
scazuta, precum tesutul cutanat,
conjunctiv, sistemul circulator si linfatic.
Pentru a obtine efectul capacitiv curentul
este aplicat prin folosirea a doi electrozi: un
electrod izolat (activ) si un contra-electrod
non-izolat pe latura opusa zonei tratate
(principiul condensatorului).

Modalitatea capacitiva

Modalitatea rezistiva
Indicata in tratarea tesuturilor cu un
procentaj de apa mai scazut (deci cu o
rezistenta mai mare).
Se folosesc doi electrozi non-izolati.
Foarte importanta este geometria
electrozilor, deoarece curentul trece printrun con de curent imaginar care porneste de
la baza elctrodului mic pana la baza
electrodului mare.

Modalitatea rezistiva

Tecar si Sportul
Tecarterapia la inceputul ei a fost folosita
in sportul de performanta deoarece
efectele ei permitau o reducere
semnificativa a timpilor de recuperare.

Indicatii si generalitati
Se obtine un efect antalgic de la prima
sedinta
Se obtin rezultate cu un ciclu mai scurt de
tratament fata de cealalte tehnici de
recuperare
Are o eficacitate deosebita in afectiunile
muscolo-scheletale
Nu este dureroasa

Tratament pentru tendinopatia la

insertia tendonului Ahilian : studiu
clinic

Treatment for insertional Achilles

tendinopathy: a systematic review
Autori Wiegerinck JI, Kerkhoffs GM, van Sterkenburg MN, Sierevelt IN,
van Dijk CN.
http://www.ncbi.nlm.nih.gov/pubmed/?term=tecar+tendinopathy

Abstract
PURPOSE:
Systematically search and analyse the results of surgical and non-surgical treatments for insertional Achilles tendinopathy.
METHODS:
A structured systematic review of the literature was performed to identify surgical and non-surgical therapeutic studies
reporting on ten or more adults with insertional Achilles tendinopathy. MEDLINE, CINAHL, EMBASE (Classic) and the
Cochrane database of controlled trials (1945-March 2011) were searched. The Coleman methodology score was used to
assess the quality of included articles, and these were analysed with an emphasis on change in pain score, patient
satisfaction and complication rate.
RESULTS:
Of 451 reviewed abstracts, 14 trials met our inclusion criteria evaluating 452 procedures in 433 patients. Five surgical
techniques were evaluated; all had a good patient satisfaction (avg. 89 %). The complication ratio differed substantially
between techniques. Two studies analysed injections showing significant decrease in visual analogue scale (VAS).
Eccentric exercises showed a significant decrease in VAS, but a large group of patients was unsatisfied. Extracorporeal
shockwave therapy (ESWT) was superior to both wait-and-see and an eccentric training regime. One study evaluated laser
CO(2), TECAR and cryoultrasound, all with significant decrease in VAS.
CONCLUSIONS:
Despite differences in outcome and complication ratio, the patient satisfaction is high in all surgical studies. It is not
possible to draw conclusions regarding the best surgical treatment for insertional Achilles tendinopathy. ESWT seems
effective in patients with non-calcified insertional Achilles tendinopathy. Although both eccentric exercises resulted in a
decrease in VAS score, full range of motion eccentric exercises shows a low patient satisfaction compared to floor level
exercises and other conservative treatment modalities.
PMID: 23052113 [PubMed - indexed for MEDLINE]

Obiectiv
Cercetare sistematica si analiza a
rezultatelor tratamentelor chirurgicale si
non-chirurgicale pentru tendinopatia
tendonului Ahilian la nivelul insertiei lui.

Metode si subiecti
O cercetare in bazele de date MEDLINE, CINAHL,
EMBASE (Classic) si Cochrane Database of controlled
trials (1945-Martie 2011) a fost efectuata pentru a
identifica cazurile chirurgicale si non chirurgicale gasind
peste zece cazuri de tendinopatie a tendonului ahilian la
adulti.
S-a folosit metoda Coleman pentru a nota calitatea
cazurilor gasite dupa care a urmat o analiza punand
accent pe durerea inregistrata la pacienti, satisfactia si
rata de complicatie a traumatismului.

Rezultatele obtinute
Din 451 articole (abstracts) revazuite, 14 cazuri au indeplinit
criteriile de cercetare ale studiului evaluand 452 de procedure
la 433 de pacienti. Cinci tehnici chirurgicali au fost evaluate,
toate avand un raspuns pozitiv din partea pacientilor (medie
89%).
Rata de complicare este diferita in functie de tehnica folosita.
Doua studii au aratat ca injectiile scad inflamatia in mod
semnificativ in scara vizuala analogica. Exercitii excentrice au
aratat si ele o scadere in VAS, dar o mare parte dintre pacienti
nu au agreat tratamentul. Terapia Shockwave extracorporala
(ESWT) celor doua tratamente .
Un alt studiu a evaluat laser CO2, TECAR si Cryoultrasound,
toate avand un raspuns pozitiv in VAS.

Concluzii
In ciuda diferentelor intre rezultate si rata de
complicatii, reiese ca toti pacienti care au beneficiat
de tratament chirurgical au fost multumiti dar nu se
poate stabili care dintre tehnicile chirurgicale este
mai eficienta. ESWT pare sa fie eficienta la pacientii
unde nu apare calcifiere la nivelul insertiei
tendonului. Chiar daca ambele grupe de exercitii
excentrice dau rezultate descrescatoare pe scala
vizuala analogica, exercitiile pe toata amplitudine de
miscare nu sunt agreate de pacienti ca si exercitiile
la sol sau alte modalitati de tratament conservative.

Unde scurte diatermice pulsate si mobilizari

articulare pentru recastigarea ROM-ului
normal al articulatiei cotului dupa
traumatism sau interventie chirurgicala cu
implant metalic
Pulsed Shortwave Diathermy and Joint Mobilizations for
Achieving Normal Elbow Range of Motion After Injury or Surgery
With Implanted Metal
Autor Draper DO.
http://www.ncbi.nlm.nih.gov/pubmed/25299443?
report=abstract

Abstract
Context : Regaining full, active range of motion (ROM) after trauma to the elbow is difficult.
Objective : To report the cases of 6 patients who lacked full ROM in the elbow because of
trauma. The treatment regimen was thermal pulsed shortwave diathermy and joint mobilizations.
Design : Case series. Setting : University therapeutic modalities laboratory. Patients of
Other Participants : Six patients (5 women [83%], 1 man [17%]) lacked a mean active ROM of
24.5 of extension approximately 4.8 years after trauma or surgery. Intervention(s) : Treatment
consisted of 20 minutes of pulsed shortwave diathermy at 800 pulses per second for 400
microseconds (40-48 W average power, 150 W peak power) applied to the cubital fossa,
immediately followed by 7 to 8 minutes of joint mobilizations. After posttreatment ROM was
recorded, ice was applied to the area for about 30 minutes. Main Outcomes Measure(s) :
Changes in extension AROM were assessed before and after each treatment. Once the patient
achieved full, active ROM or failed to improve on 2 consecutive visits, he or she was discharged
from the study. Results : By the fifth treatment, 4 participants (67%) achieved normal
extension active ROM, and 2 of the 4 (50%) exceeded the norm. Five participants (83%)
returned to normal activities and full use of their elbows. One month later, the 5 participants had
maintained, on average, (mean SD) 92% 6% of their final measurements. Conclusions : A
combination of thermal pulsed shortwave diathermy and joint mobilizations was effective in
restoring AROM of the elbow extension in 5 of the 6 patients (83%) who lacked full ROM after
injury or surgery.

Obiectiv
Raport asupra 6 cazuri de pacienti cu fulllacked ROM la cot datorita unui traumatism.

Participanti/Subiecti
Sase pacienti ( 5 fete [83%], 1 baiat
[17%]) cu lipsa de 24.5 grade de extensie
de ROM activ dupa aproximativ 4.8 ani de
la traumatism/interventie

Metode/Interventie
Tratamentul a constat in 20 de minute de
aplicare de unde scurte diatermice (800
de pulsatii pe secunda pentru 400 ms ,4048 W putere medie, 150 W putere de varf)
pe fosa cubitala urmand imediat dupa
tratament 7/8 minute de mobilizari
articulare. Dupa fiecare tratament s-a
inregistrat ROM-ul, s-a aplicat gheata pe
aria interesata timp de 30 de minute.

Evaluare
Schimbarile in extensie AROM au fost
evaluate inainte si dupa tratament. Daca
un pacient a recastigat ROM-ul total sau
nu a obtinut o ameliorare dupa doua
sedinte la rand, acesta a fost eliminat din
cercetare.

Rezultatele obtinute
De la al cincelea tratament, 4 participanti
(67%) au recastigat extensia normala
activa a cotului dintre care 2 din 4 (50%)
au mers peste limita. 5 participanti (83%)
s-au intors la activitati zilnice obisnuite
folosind complet articulatia cotului. Dupa o
luna, cei 5 participanti au mentinut, in
medie ( SD) 92% 6% din rezultatele
obtinute.

Concluzii
O combinatie intre undele scurte pulsate
diatermice si mobilizari articulare au efect
asupra recuperarii AROM-ului extensiei
cotului la 5 din 6 pacienti (83%) care
aveau articulatia complet blocata dupa un
traumatism sau o interventie chirurgicala.