冲击波疼痛治疗汇总课件.ppt

1、China_2010-08-29RSWT WORKSHOP体外冲击波疗法体外冲击波疗法China_2010-08-29有效治疗范围有效治疗范围Radial ExtensionHandpiece 手柄表面，高能流密度surface,high ED0,35 mJ/mm2深度，低能流密度depth,low ED 探头Transmitter在组织中传播spreads in the tissueED:能流密度ED:energy flux densityChina_2010-06-23生物效应生物效应Biological effects声学边界的能量释放Energy release at acoustic

2、 boundaries空化作用Cavitation 增加细胞壁的通透性Increase of cell wall permeability刺激微循环（血液、淋巴）Stimulation of Microcirculation(Blood,Lymph)释放P物质Release of Substance P 减少非髓鞘神经Reduction of unmyelinated nerves释放一氧化氮（血管舒张，细胞新陈代谢增加，血管新生，抗炎作用）Release of Nitric oxide(vasodilation,increased cell metabolism,neoangogenesis

3、,anti-inflammatory effect)抗菌作用Antibacterial effect 刺激生长因子（血管、骨骼、胶原蛋白新生）Stimulation of Growth factors(neogenesis of vessels,bone,collagen)刺激干细胞Stimulation of Stem cells China_2010-08-29绝对禁忌症绝对禁忌症ABSOLUTE CONTRAINDICATIONS 妊娠妊娠Pregnancy 血栓症血栓症thrombosis 血凝固紊乱（血友病）血凝固紊乱（血友病）coagulation disorders(haemop

4、hilia)肿瘤疾病肿瘤疾病tumour diseases 急性炎症急性炎症acute inflammation 目标治疗区脓肿目标治疗区脓肿pus focus in the target areaChina_2010-08-29相对禁忌症相对禁忌症RELATIVE CONTRAINDICATIONS 抗凝血剂使用者，特别是苯丙香豆素（维生素抗凝血剂使用者，特别是苯丙香豆素（维生素K拮抗剂）拮抗剂）use of anticoagulants,especially marcumar(vitamin k antagonist)有多发性神经病的糖尿病有多发性神经病的糖尿病 polyneuropath

5、y in case of diabetes mellitus 可的松治疗结束六周后才能使用体外冲击波治疗可的松治疗结束六周后才能使用体外冲击波治疗 cortisone therapy up to 6 weeks before first ESWT treatment 风湿性疾病风湿性疾病 rheumatic diseaseChina_2010-08-29 肿胀肿胀swelling 变红变红reddening 血肿血肿haematomas 瘀点瘀点petechiae 灼伤般疼痛感灼伤般疼痛感pain like sunburn 治疗初期病情恶化治疗初期病情恶化first worsening副作用副

6、作用SIDE EFFECTSChina_2010-08-29冲击波治疗的益处冲击波治疗的益处Benefits of Shock Wave Treatment 几次治疗后，疼痛即得到缓解几次治疗后，疼痛即得到缓解/减轻减轻 pain relief/reduction after a few treating sessions 治疗依从性好治疗依从性好 the compliance is very good 治疗后病人能直接感受到第一疗效治疗后病人能直接感受到第一疗效 the patients can feel first effects directly after the treatment

7、能治疗复杂症状及相关适应症能治疗复杂症状及相关适应症 treatment of complex symptoms/indications possibleChina_2010-08-29冲击波治疗的益冲击波治疗的益处处Benefits of Shock Wave Treatment 治疗结缔组织治疗结缔组织 treatment of connective tissue 活化淋巴系统活化淋巴系统 activation of lymphatic system 大面积治疗大面积治疗 treatment of large areas possible 作用于神经系统（门控制、疼痛记忆）作用于神经系统（

8、门控制、疼痛记忆）effects on the nervous system(gate control,pain memory?)China_2010-08-29经典适应症经典适应症CLASSIC INDICATIONSChina_2010-08-29经典适应症经典适应症Classic Indications Calcific tendonitis/shoulder pain钙化性肌腱炎/肩痛Achillodynia 跟腱痛Plantar fasciitis 足底筋膜炎Ulnar humeral epicondylitis肱骨内上踝炎Tibial stress syndrome胫骨压力症候群R

9、adial humeral epicondylitis肱骨外上髁炎Trochanteric tendonitis转子肌腱炎Patellar tendonitis髌腱炎China_2010-08-29治疗方法治疗方法 PROTOCOL 查找主要痛点和其他痛点查找主要痛点和其他痛点look for the main and other pain points 与病人密切交谈与病人密切交谈close dialogue with the patient 生物反馈生物反馈biofeedback 2000次发散式冲击波次发散式冲击波 radial shocks 2000 多数学派的治疗方法多数学派的治疗方

10、法protocol of the most studies 传统派传统派old school新派：联合疗法，治疗扳机点新派：联合疗法，治疗扳机点 new:combined therapy,trigger pointsChina_2010-08-29治疗方法治疗方法PROTOCOL 治疗间隔：治疗间隔：5-7天天 interval5 7days 治疗次数：治疗次数：3-5次次 sessions3 5 最晚在第最晚在第5次治疗后进入休息期次治疗后进入休息期 break latest after 5th sessionChina_2010-08-29钙化肌腱炎钙化肌腱炎/肩痛肩痛Calcific t

11、endonitis/Shoulder pain前期超声或前期超声或X线定位线定位/决定治疗决定治疗区域与深度区域与深度Preliminary ultrasound orx-ray localization/determination of penetration depth and treatment area在皮肤上标记出治疗区域在皮肤上标记出治疗区域Marking of therapeutic window on the skin在在90%的例子中，旋转套的冈的例子中，旋转套的冈上肌腱感染，需要治疗上肌腱感染，需要治疗。In approx.90%of the casesthe supras

12、pinatus tendon of the rotator cuff is affected and has to be treated China_2010-08-29钙化肌腱炎钙化肌腱炎/肩痛肩痛Calcific tendonitis/Shoulder painChina_2010-08-29钙化肌腱炎钙化肌腱炎/肩痛肩痛Calcific tendonitis/Shoulder painChina_2010-08-29钙化肌腱炎钙化肌腱炎/肩痛肩痛Calcific tendonitis/Shoulder painChina_2010-08-29钙化肌腱炎钙化肌腱炎/肩痛肩痛Calcific

13、 tendonitis/Shoulder painChina_2010-08-29Calcific tendonitis/Shoulder pain 钙化性肌腱炎钙化性肌腱炎/肩痛肩痛Sessions 治疗治疗次数次数Energy 能级能级(bar)Pulses/session 每每次治疗使用脉冲数次治疗使用脉冲数Freq 频率频率(Hz)Trans-mitter 探头探头Supraspinatus tendon 冈上肌腱1.Pain points 痛点3 51.8 4.01500 300012 15R15,DI152.Muscles 肌肉1.8 3.02000 300015 21D20-ST

14、reatment interval:5-7day 治疗间隔：治疗间隔：5-7天天病人仰卧位病人仰卧位 R-SW应用应用 于腹外侧位于腹外侧位Supine patient positioning R-SW application in ventrolateral position 钙化性肌腱炎钙化性肌腱炎/肩痛肩痛Calcific tendonitis/Shoulder pain 仅使用发散性冲击波疗法Only with radial shock wave therapyChina_2010-08-29Tenderness in the region of thelateral epicondy

15、le确定上踝侧 位区柔软度Greatest tension is elicited withthe elbow in extension,forearmin pronation,and wrist in flexion肘部外展、前臂转至手掌向下、腕关节弯曲，造成最大张力状态Preliminary ultrasound/x-ray for localization ofepicondyle 前期上踝超声或x线定位Marking of therapy region 标记治疗区域 肱骨外上踝炎肱骨外上踝炎Radial humeral epicondylitisChina_2010-08-29肱骨内上

16、髁炎肱骨内上髁炎Radial humeral epicondylitis DDChina_2010-08-29Radial humeral epicondylitis 肱骨外上髁炎肱骨外上髁炎Sessions 治疗治疗次数次数Energy 能级能级(bar)Pulses/session 每次治疗使用每次治疗使用脉冲数脉冲数Freq 频率频率(Hz)Transmitter 探头探头Tendon insertion(painful spot)腱附着端（痛点）1.Pain points 痛点5 81.8 4.01500 300012 15R151.8 3.02000 300015 21D20-SAd

17、jacent upper arm and forearm muscles邻近的上臂与前臂的肌肉邻近的上臂与前臂的肌肉2.Muscles 肌肉Treatment interval:5-7 days 治疗间隔：治疗间隔：5-7天天病人仰卧位病人仰卧位 肘部弯曲大约肘部弯曲大约130度，手掌向下。度，手掌向下。R-SW（R15）应用于腱附着端。接着使用）应用于腱附着端。接着使用D20-S治疗邻近的上臂与前臂的肌肉。治疗邻近的上臂与前臂的肌肉。肱骨外上髁炎肱骨外上髁炎Radial humeral epicondylitis 仅使用发散性冲击波疗法Only with radial shock wave

18、therapy China_2010-08-29病人仰卧位病人仰卧位-肘关节外展。肘关节外展。用用V-ACTOR按摩邻近肌肉。按摩邻近肌肉。Supine patient positioning Extension of elbow joint.Smoothing of surrounding muscles with the V-ACTOR.肱骨外上髁炎Radial humeral epicondylitisESWT New Treatment GuideChina_2010-08-29Preliminary ultrasound/x-ray for localization of epico

19、ndyle 前期上髁超声或x线定位Marking of therapy region 标记治疗区域肱骨内上髁炎肱骨内上髁炎Ulnar humeral epicondylitis ESWT New Treatment GuideChina_2010-08-29Ulnar humeral epicondylitis 肱骨内上髁炎肱骨内上髁炎Sessions 治疗治疗次数次数Energy 能级能级(bar)Pulses/session 每次治疗使用每次治疗使用脉冲数脉冲数Freq 频率频率(Hz)Transmitter 探头探头Tendon insertion(painful spot)腱附着端1.

20、Pain points 痛点5 81.8 4.01500 300012 15R15Adjacent upper arm and forearm muscles邻近的上臂与前臂的肌肉2.Muscles 肌肉1.8 3.02000 300015 21D20-STreatment interval:5-7 days 治疗间隔：治疗间隔：5-7 天天Supine patient positioning Flexion of elbow joint approx.30 to 40 degree,supination position.R-SW(R15)application at the tendon

21、insertion.病人仰卧位病人仰卧位 肘关节弯曲大约肘关节弯曲大约30-40度，手心向上。度，手心向上。R-SW(R15)应用于腱附着端。应用于腱附着端。Supine patient positioning Extension of elbow joint,supination position.Smoothing of forearm muscles with D20-S.病人仰卧位病人仰卧位 肘关节外展，手心向上。用肘关节外展，手心向上。用D20-S按摩前臂肌肉。按摩前臂肌肉。肱骨内上髁炎肱骨内上髁炎Ulnar humeral epicondylitis仅使用发散性冲击波疗法Only

22、radial shock wave therapy China_2010-08-29肱骨内上髁炎肱骨内上髁炎Ulnar humeral epicondylitis病人仰卧位病人仰卧位-肘关节外展。肘关节外展。用用V-ACTOR按摩邻近肌肉。按摩邻近肌肉。Supine patient positioning Extension of elbow joint.Smoothing of surrounding muscles with the V-ACTOR。China_2010-08-29Preliminary ultrasound/x-ray for localization,determina

23、tion of penetrationdepth 前期超声或X线定位，确定治疗深度Marking of therapy region 标记治疗区域转子肌腱炎转子肌腱炎Trochanteric Tendonitis ESWT New Treatment GuideChina_2010-08-29转子肌腱炎转子肌腱炎Trochanteric Tendonitis DDChina_2010-08-29Trochanteric tendonitis 转子肌腱炎转子肌腱炎Sessions 治疗治疗次数次数Energy 能级能级(bar)Pulses/session 每次治疗使用每次治疗使用脉冲数脉冲数F

24、req 频率频率(Hz)Transmitter 探头探头Tendon insertion 腱附着端1.Pain points 痛点6 82.8 3.52000 300015 21R15,DI15Adjacent muscles 相关肌肉2.Muscles 肌肉2.0 3.52000 400021D20-S,D35-STreatment interval:5-7 days 治疗间隔：治疗间隔：5-7天天Lateral patient positioning Smoothing of associated muscles with D35.病人侧卧位病人侧卧位 用用D35按摩相关肌肉。按摩相关肌肉

25、。Lateral patient positioning R-SW application(DI15)on the tip of the trochanter,M.piriformis and associated muscles.病人侧卧位病人侧卧位 R-SW（DI15）应用于转子尖、）应用于转子尖、梨状肌及相关肌肉。梨状肌及相关肌肉。转子肌腱炎转子肌腱炎 Trochanteric Tendonitis 仅使用发散式冲击波疗法Only radial shock wave therapy China_2010-08-29Patellar tendonitis(Jumpers Knee)髌骨肌腱

26、炎（跳跃膝）髌骨肌腱炎（跳跃膝）Preliminary ultrasound/x-ray for localization,determination of penetrationdepth 前期超声或x线定位，确定治疗深度Marking of therapy region 标记治疗区域China_2010-08-29髌骨肌腱炎（跳跃膝）髌骨肌腱炎（跳跃膝）Patellar tendonitis(Jumpers Knee)China_2010-08-29Patellar tendonitis 髌骨肌腱炎髌骨肌腱炎Sessions 治治疗次数疗次数Energy 能级能级(bar)Pulses/s

27、ession 每次治疗使每次治疗使用脉冲数用脉冲数Freq 频率频率(Hz)Transmitter 探头探头Patella,tibial tendon insertion 髌骨、胫骨腱附着端1.Pain points 痛点6 82.8 3.52000 300015 21R15,DI15Adjacent muscles 相邻肌肉2.Muscles 肌肉2.0 3.52000 400021D20-S,D35-STreatment interval:5-7 days 治疗间隔：治疗间隔：5-7 天天Supine patient positioning with the knee on a half

28、roll.Fixation of patellar zone with a cuff.R-SW(R15)application at the patella(tip,basis)and tibial tendon insertion.病人仰卧位，膝盖置于半圆柱形物上。用一条绷带固定髌骨区。病人仰卧位，膝盖置于半圆柱形物上。用一条绷带固定髌骨区。R-SW(R15)应用于髌骨（尖部、底部）及胫骨腱附着端。应用于髌骨（尖部、底部）及胫骨腱附着端。Supine patient positioning with the knee on a half roll.Fixation of paellar zo

29、ne with a cuff.Smoothing of adjacent muscles with D20.病人仰卧位，膝盖置于半圆柱形物上。用一条绷病人仰卧位，膝盖置于半圆柱形物上。用一条绷带固定髌骨区。用带固定髌骨区。用D20按摩相邻肌肉。按摩相邻肌肉。髌骨肌腱炎髌骨肌腱炎Patellar tendonitis(Jumpers Knee)仅使用发散式冲击波疗法Only radial shock wave therapy China_2010-08-29 Preliminary ultrasound/x-ray 前期超声/X线定位 Marking of therapy region 标记治疗

30、区域胫骨压力综合征（胫骨疲劳性骨膜炎）胫骨压力综合征（胫骨疲劳性骨膜炎）Tibial stress syndrome(Shin splint)ESWT New Treatment GuideChina_2010-08-29Tibial stress syndrome 胫骨压力综合征胫骨压力综合征Sessions 治疗治疗次数次数Energy 能级能级(bar)Pulses/session 每次治疗使用每次治疗使用脉冲数脉冲数Freq 频率频率(Hz)Transmitter 探头探头Medial,inner edge of shin bone 胫骨内缘1.Pain points 痛点6 82.8

31、 3.52000 300015 21R15,DI15Adjacent muscles 相邻肌肉2.Muscles 肌肉2.0 3.52000 400021D20-S,D35-STreatment interval:5-7 days 治疗间隔：治疗间隔：5-7 天天Supine patient positioning with knee on a half roll.R-SW application.病人仰卧位，膝盖置于半圆柱形物上。使用病人仰卧位，膝盖置于半圆柱形物上。使用R-SW。胫骨压力综合征（胫骨疲劳性骨膜炎）胫骨压力综合征（胫骨疲劳性骨膜炎）Tibial stress syndrome

32、(Shin splint)仅使用发散式冲击波疗法Only radial shock wave therapy China_2010-08-29跟腱痛跟腱痛AchillodyniaPreliminary ultrasound/x-ray 前期超声/x线定位Marking of therapy region 标记治疗区域China_2010-08-29跟腱痛跟腱痛AchillodyniaChina_2010-08-29跟腱痛跟腱痛AchillodyniaChina_2010-08-29足底筋膜炎足底筋膜炎Plantar fasciitisPreliminary ultrasound/x-ray 前

33、期超声/x线定位Localization of pain points withbio-feedback 根据人体生物反馈定位痛点Marking of therapy region 标记治疗区域China_2010-08-29足底筋膜炎，跟骨骨刺足底筋膜炎，跟骨骨刺Plantar fasciitis,Heel SpurChina_2010-08-29足底筋膜炎，跟骨骨刺足底筋膜炎，跟骨骨刺Plantar fasciitis,Heel SpurChina_2010-08-29足底筋膜炎，跟骨骨刺足底筋膜炎，跟骨骨刺Plantar fasciitis,Heel SpurChina_2010-08-

34、29Plantar fasciitis 足底筋膜炎足底筋膜炎Sessions 治治疗次数疗次数Energy 能级能级(bar)Pulses/session 每次治疗使用脉每次治疗使用脉冲数冲数Freq 频率频率(Hz)Transmitter 探头探头Acute and chronic pain 急性与慢性疼痛1.Pain points 痛点3-52.0 3.03000 350012 15R15,DI152.Muscles 肌肉1.8 3.02000 300015 21D20-SAbdominal patient position with foot on a half roll.R-SW(DI

35、15)application.Localization of patients with bio-feedback.病人腹卧们，脚置于半圆柱形物上。使用病人腹卧们，脚置于半圆柱形物上。使用R-SW(DI15)。利用生物反馈进行痛点定位。利用生物反馈进行痛点定位。Treatment interval:5-7 days 治疗间隔：治疗间隔：5-7天天足底筋膜炎足底筋膜炎Plantar fasciitis 仅使用发散式冲击波疗法Only radial shock wave therapy China_2010-08-29研究研究StudiesChina_2010-08-29Improvement%改

36、善度改善度RSW发散式冲击波发散式冲击波2 month2个月55.26 month6个月72.912 month12个月84.02000次冲击波，治疗3次，一周一次2000,3 sessions,1/week跟骨骨刺跟骨骨刺Heel SpurChina_2010-08-29肱骨外上髁炎肱骨外上髁炎HERImprovement%改善度改善度Verum冲击波治疗组冲击波治疗组Control对照组对照组1 week1周73284 weeks4周634852 weeks52周81发散式冲击波，2000次，治疗3次，1周1次RSW,2000,3 sessions,1/weekChina_2010-08-

37、29肩袖钙化性肌腱炎肩袖钙化性肌腱炎Calcific Tendinitis of Rotator Cuff%Pain free 无无疼痛感疼痛感Improvement有明显改善有明显改善Unchanged无变化无变化Worse恶化恶化4 weeks 4周25.7 54.314.25.73 month 3个月5014.330.710.76 month 6个月59.325.914.8012 month 12个月80.319.2RSW,5 sessions,1/weekCalcium deposit%钙沉积钙沉积Gone钙化消失钙化消失Disintegration分解分解No Change无变化无变

38、化4 weeks 4周17.620.961.53 month 3个月44.86.948.36 month 6个月65.34.430.412 month 12个月7525RSW,2000,3 sessions,1/week 发散式冲击波，2000次，治疗3次，1周1次China_2010-08-29钙化性肌腱炎，聚焦式冲击波钙化性肌腱炎，聚焦式冲击波Tendinosis Calcarea,FSWAfter 1 year1年之后反馈年之后反馈Recalcification再钙化再钙化5%OP骨质疏松5%Resorption骨吸收90%China_2010-08-29夹挤综合症，聚焦式冲击波夹挤综合

39、症，聚焦式冲击波Impingement Syndrome,FSWFollow up追踪观察追踪观察Verum 冲击波治疗组冲击波治疗组Placebo安慰剂组安慰剂组Mid中期75.4%good 良好52.3%Long term长期80.7%40.9%China_2010-08-29Sports-Induced Diseases1 yearfollow up1年后反馈年后反馈Achillodynia跟腱痛跟腱痛Patella tip syndrome髌骨尖综合征髌骨尖综合征Tibialis anterior syndrome胫前综合征胫前综合征Pain free 疼痛消失60%40%58.8%I

40、mprovement 有改善12.5%24.4%17.7%No change 无明显变化27.5%35.6%23.5%发散式冲击波，治疗5次，1周1次RSW,5 sessions,1/weekChina_2010-08-29肌筋膜疼痛综合症Myofascial pain syndrome扳机点治疗Trigger point treatmentChina_2010-08-29肌筋膜疼痛综合征肌筋膜疼痛综合征Myofascial pain syndrome可用可用RSWT成功治愈的骨科适应症成功治愈的骨科适应症 Orthopaedic indications which can be treate

41、d successfully with RSWT 上位及低位颈部综合征上位及低位颈部综合征Upper and lower Cervical-Syndrome肩周痛肩周痛Periarticular shoulder pain前臂屈伸肌腱炎前臂屈伸肌腱炎Tendomyosis in the extensor and flexor region of the forearm 上踝病变上踝病变Epicondylopathy背痛背痛Dorsalgia(Back pain)臀肌痛臀肌痛GlutealgiaChina_2010-08-29肌筋膜疼痛综合征肌筋膜疼痛综合征Myofascial pain syn

42、drome可用可用RSWT成功治愈的骨科适应症成功治愈的骨科适应症 Orthopaedic indications which can be treated successfully with RSWT 内收肌疼痛内收肌疼痛Pain in the adductor muscles 股屈伸肌痉挛股屈伸肌痉挛Shortenings in the femoral flexor and extensor muscles 小腿筋膜间室综合征小腿筋膜间室综合征Peroneal compartment syndrome胫前综合征胫前综合征Tibial anterior syndrome 胫骨压力综合征（胫骨

43、疲劳性骨膜综合征）胫骨压力综合征（胫骨疲劳性骨膜综合征）Tibial stress syndrome(Shin splint)伴有伴有/不伴有跟腱痛的小腿肌肉萎缩不伴有跟腱痛的小腿肌肉萎缩Shortening of the calf muscle with and without Achillodynia 跖骨痛跖骨痛MetatarsalgiaChina_2010-08-29肌筋膜疼痛综合征肌筋膜疼痛综合征Myofascial pain syndrome治疗长度Length of treatment取决于肌肉刺激的持续范围和时间Depending on the extent and durat

44、ion of the muscle irritation早期疼痛可经过1-2次治疗成功治愈。Early stage complaints can be treated successfully with 1-2 treatments sessions 多数案例中，痛点的缓解/解除需要4-8次治疗（一周12次治疗）In most cases several treatment sessions(4-8)are required to release/eliminate the pain points(1-2 treatments/week).建议尽早采用扳机点治疗It is recommende

45、d to start trigger point treatment at the most possible early stageChina_2010-08-29肌筋膜疼痛综合征肌筋膜疼痛综合征Myofascial pain syndrome 冲击波治疗的优点Benefits of shock wave therapy 促进组织再生Strong regenerative effect on the tissue可深入组织治疗，而不伤皮肤Penetrate deep inside the tissue without harming the skin 因此冲击波操作方便，易于重复治疗。可被大

46、多数患者接受。Therefore shock wave therapy can be easily repeated and is well tolerated by most patients.China_2010-08-29 超声波扫描术超声波扫描术Sonography 给病人提供最安全的治疗方案 Gives the patients the most possible treatment safety 可识别不可采用ESWT治疗的结构改变（例如肿瘤）Structural modifications which must not be treated with RSWT(e.g.tumor

47、s)will be recognized肌筋膜疼痛综合征肌筋膜疼痛综合征Myofascial pain syndrome 冲击波治疗前的诊断Diagnostics before shock wave therapy China_2010-08-29上位及低位颈部综合征上位及低位颈部综合征Upper and lower Cervical-Syndrome 臂痛、背痛、头痛with brachialgia,dorsalgia and cephalgia China_2010-08-29Trapezius muscle 斜方肌斜方肌 Trapezius muscle 斜方肌斜方肌Sessions治疗

48、次数治疗次数Energy 能级能级(bar)Pulses/session 每次治疗使用脉冲每次治疗使用脉冲数数Freq 频率频率(Hz)Trans-mitter 探头探头Total pulses/treatment 每疗程总脉冲数1.Pain points 痛点4 81.2 3.04000-6000 10 15R15,D20-SPulses/trigger point 每扳机点脉冲数2.Pain points 痛点1.2 3.0300-100010 15R15,D20-SSmoothing muscles over large area 大面积肌肉按摩3.Muscles 肌肉1.2 2.820

49、0010 21 R15,D20-SRecommended treatment:radial.使用发散式治疗使用发散式治疗上位及低位颈部综合征上位及低位颈部综合征Upper and lower Cervical-Syndrome臂痛、背痛、头痛with brachialgia,dorsalgia and cephalgiaChina_2010-08-29半棘肌半棘肌/夹肌，夹肌，C3以下以下Semispinalis/Splenius muscle,caudal C3 上位及低位颈部综合征上位及低位颈部综合征Upper and lower Cervical-Syndrome 臂痛、背痛、头痛wit

50、h brachialgia,dorsalgia and cephalgia China_2010-08-29半棘肌半棘肌/夹肌，夹肌，C3以下以下Semispinalis/Splenius muscle caudal C3 Semispinalis muscle 半棘肌半棘肌Sessions治疗次数治疗次数Energy 能级能级(bar)Pulses/session 每次治疗使用脉每次治疗使用脉冲数冲数Freq 频率频率(Hz)Trans-mitter 探头探头Total pulses/treatment 每疗程总脉冲数1.Pain points 痛点4 81.2 2.44000 6000 1