Ultrasound as a stimulus for musculoskeletal disorders
Ultrasound is an inaudible form of acoustic sound wave at 20 kHz or above that is widely used in the medical field with applications including medical imaging and therapeutic stimulation. In therapeutic ultrasound, low-intensity pulsed ultrasound (LIPUS) is the most widely used and studied form that...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2017-04-01
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| Series: | Journal of Orthopaedic Translation |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214031X16302704 |
| _version_ | 1818534621808164864 |
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| author | Ning Zhang Simon Kwoon-Ho Chow Kwok-Sui Leung Wing-Hoi Cheung |
| author_facet | Ning Zhang Simon Kwoon-Ho Chow Kwok-Sui Leung Wing-Hoi Cheung |
| author_sort | Ning Zhang |
| collection | DOAJ |
| description | Ultrasound is an inaudible form of acoustic sound wave at 20 kHz or above that is widely used in the medical field with applications including medical imaging and therapeutic stimulation. In therapeutic ultrasound, low-intensity pulsed ultrasound (LIPUS) is the most widely used and studied form that generally uses acoustic waves at an intensity of 30 mW/cm2, with 200 ms pulses and 1.5 MHz. In orthopaedic applications, it is used as a biophysical stimulus for musculoskeletal tissue repair to enhance tissue regeneration. LIPUS has been shown to enhance fracture healing by shortening the time to heal and reestablishment of mechanical properties through enhancing different phases of the healing process, including the inflammatory phase, callus formation, and callus remodelling phase. Reports from in vitro studies reveal insights in the mechanism through which acoustic stimulations activate cell surface integrins that, in turn, activate various mechanical transduction pathways including FAK (focal adhesion kinase), ERK (extracellular signal-regulated kinase), PI3K, and Akt. It is then followed by the production of cyclooxygenase 2 and prostaglandin E2 to stimulate further downstream angiogenic, osteogenic, and chondrogenic cytokines, explaining the different enhancements observed in animal and clinical studies. Furthermore, LIPUS has also been shown to have remarkable effects on mesenchymal stem cells (MSCs) in musculoskeletal injuries and tissue regeneration. The recruitment of MSCs to injury sites by LIPUS requires the SDF-1 (stromal cell derived factor-1)/CXCR-4 signalling axis. MSCs would then differentiate differently, and this is regulated by the presence of different cytokines, which determines their fates. Other musculoskeletal applications including bone–tendon junction healing, and distraction osteogenesis are also explored, and the results are promising. However, the use of LIPUS is controversial in treating osteoporosis, with negative findings in clinical settings, which may be attributable to the absence of an injury entry point for the acoustic signal to propagate, strong attenuation effect of cortical bone and the insufficient intensity for penetration, whereas in some animal studies it has proven effective. |
| first_indexed | 2024-12-11T18:13:57Z |
| format | Article |
| id | doaj.art-e3f5a632b95a4aa39cd7b4994530d5cb |
| institution | Directory Open Access Journal |
| issn | 2214-031X |
| language | English |
| last_indexed | 2024-12-11T18:13:57Z |
| publishDate | 2017-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Orthopaedic Translation |
| spelling | doaj.art-e3f5a632b95a4aa39cd7b4994530d5cb2022-12-22T00:55:30ZengElsevierJournal of Orthopaedic Translation2214-031X2017-04-019C525910.1016/j.jot.2017.03.004Ultrasound as a stimulus for musculoskeletal disordersNing Zhang0Simon Kwoon-Ho Chow1Kwok-Sui Leung2Wing-Hoi Cheung3Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, ChinaMusculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, ChinaMusculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, ChinaMusculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, ChinaUltrasound is an inaudible form of acoustic sound wave at 20 kHz or above that is widely used in the medical field with applications including medical imaging and therapeutic stimulation. In therapeutic ultrasound, low-intensity pulsed ultrasound (LIPUS) is the most widely used and studied form that generally uses acoustic waves at an intensity of 30 mW/cm2, with 200 ms pulses and 1.5 MHz. In orthopaedic applications, it is used as a biophysical stimulus for musculoskeletal tissue repair to enhance tissue regeneration. LIPUS has been shown to enhance fracture healing by shortening the time to heal and reestablishment of mechanical properties through enhancing different phases of the healing process, including the inflammatory phase, callus formation, and callus remodelling phase. Reports from in vitro studies reveal insights in the mechanism through which acoustic stimulations activate cell surface integrins that, in turn, activate various mechanical transduction pathways including FAK (focal adhesion kinase), ERK (extracellular signal-regulated kinase), PI3K, and Akt. It is then followed by the production of cyclooxygenase 2 and prostaglandin E2 to stimulate further downstream angiogenic, osteogenic, and chondrogenic cytokines, explaining the different enhancements observed in animal and clinical studies. Furthermore, LIPUS has also been shown to have remarkable effects on mesenchymal stem cells (MSCs) in musculoskeletal injuries and tissue regeneration. The recruitment of MSCs to injury sites by LIPUS requires the SDF-1 (stromal cell derived factor-1)/CXCR-4 signalling axis. MSCs would then differentiate differently, and this is regulated by the presence of different cytokines, which determines their fates. Other musculoskeletal applications including bone–tendon junction healing, and distraction osteogenesis are also explored, and the results are promising. However, the use of LIPUS is controversial in treating osteoporosis, with negative findings in clinical settings, which may be attributable to the absence of an injury entry point for the acoustic signal to propagate, strong attenuation effect of cortical bone and the insufficient intensity for penetration, whereas in some animal studies it has proven effective.http://www.sciencedirect.com/science/article/pii/S2214031X16302704fracture healingLIPUSmusculoskeletal repairstem cell differentiationstem cell recruitment |
| spellingShingle | Ning Zhang Simon Kwoon-Ho Chow Kwok-Sui Leung Wing-Hoi Cheung Ultrasound as a stimulus for musculoskeletal disorders Journal of Orthopaedic Translation fracture healing LIPUS musculoskeletal repair stem cell differentiation stem cell recruitment |
| title | Ultrasound as a stimulus for musculoskeletal disorders |
| title_full | Ultrasound as a stimulus for musculoskeletal disorders |
| title_fullStr | Ultrasound as a stimulus for musculoskeletal disorders |
| title_full_unstemmed | Ultrasound as a stimulus for musculoskeletal disorders |
| title_short | Ultrasound as a stimulus for musculoskeletal disorders |
| title_sort | ultrasound as a stimulus for musculoskeletal disorders |
| topic | fracture healing LIPUS musculoskeletal repair stem cell differentiation stem cell recruitment |
| url | http://www.sciencedirect.com/science/article/pii/S2214031X16302704 |
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