316916351752-Basics-of-Laser-Orthopedic-view-.ppt

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Inflammation,

pain andtissue healing:



LASER

L. light

A. amplification via

S. Stimulated

E. Emission of

R Radiation

Laser (L.A.S.E.R) is an acronym for light

amplification

via Stimulated Emission of Radiation. This

means that

the photons are amplified by the physical

processes of

the laser design



LASER

• LLLT is a complementary form

of treatment and, therefore, is not

intended to replace other

electrotherapeutic modalities, such

as medication, Physiotherapy,

ultrasound, interferential therapy,

and magnetic therapy.

• In a number of therapeutic

applications, however, LLLT hasbeen rated more highly in its

effectiveness than these other

modalities (Baxter et al, 1991).



Where it acts ?



Where it acts ? (Continues



Where it acts ? (Continues:)





Laser Construction

• A laser is constructed from three

principal parts:

• An energy source (usually referred

to as the pump or pump source),

• A gain medium or laser medium,

and

• Two or more mirrors that form an

optical resonator

http://en.wikipedia.org/wiki/Laser_pumping

http://en.wikipedia.org/wiki/Active_laser_medium

http://en.wikipedia.org/wiki/Optical_resonator

http://en.wikipedia.org/wiki/Optical_resonator

http://en.wikipedia.org/wiki/Active_laser_medium

http://en.wikipedia.org/wiki/Laser_pumping



A laser is constructed from three principal parts:

An energy source (usually referred to as the pump or pump source),

A gain medium or laser medium, and

Two or more mirrors that form an optical resonator



1. Soft tissue surgery: CO2, Er:YAG laser2. Hard tissue application: Inflammation, pain

and tissue healing( including bone pain and

bone regeneration)

3. Cosmetic surgery (removing tattoos, scars,stretch marks, sunspots, wrinkles,

birthmarks, and hairs): see laser hair

removal. Laser types used in dermatology

include ruby (694 nm), alexandrite (755 nm),

pulsed diode array (810 nm), Nd:YAG (1064

nm), Ho:YAG (2090 nm), and Er:YAG (2940

nm).

Medical Application of Lasers



•Eye surgery:

LASIK (laser vision correction)

LASEK (laser-assisted sub-epithelial

keratectomy)

PRK (photorefractive keratectomy)•Laser scalpel (General surgery,

gynecological, urology, laparoscopic)

•Dental procedures

•Photobiomodulation (i.e. laser therapy)

"No-Touch" removal of tumors, especially of the brain and spinal cord.

• Acupuncture.

•In dentistry for caries removal,

endodontic/periodontic procedures, tooth

whitening, and oral surgery.



Laser Tissue Interactions:

• Thermal

• Caused by elevated temperature after absorption of laser energy

• Nearly all wavelengths and exposure durations

• Photochemical

• Caused by chemical reactions within body tissueafter absorption

• of laser energy

• Only with wavelength less than 0.550 mm

• Dominant effect for exposure durations greater than 10 sec

• Laser Bioeffects And Concepts of NHZ, MPE,

etc.• Shockwave (Acoust ic )

• An explosive effect when short pulses areabsorbed on the retina

• Pulse duration less than 10 msec

•



Laser Tissue Interactions:

• Photo chem ical Interact ion

• The laser energy is absorbed by metabolically

active pigments of the mitochondria in various

cutaneous and subcutaneous layers: here

involved are the two enzymes of the oxidation

chain, Cytochrome a/a3 and Flavoprotein withabsorption maxims of wavelengths applied.

• It is supposed that the changes in the

stereochemical conformation induced by an

electro magnetic field leads to an increase in

activity and improves the concentration of ATP

by up to 200%. In addition, an increase inoxygen and glucose metabolism is observed.

The main effect is an optimized function of the

Na-K pump at the cell membrane, an increased

protein synthesis (prostaglandin, enzyme) and a

significantly higher rate of mitosis.



Cellular Activities

• Increased cell metabolism (Increased cellfunction)

• Increased collagen synthesis (Increasedhealing of soft tissues)

• Increased osteoblast production (Increased

healing of bone)• Increased circulation

• Increased formation of new capillaries (tinyblood vessels) by release of growth factors

• Increased T-cell production (Increasedimmune function)

• Increased production of neurotransmitters suchas endorphins, serotonin, ACTH etc.(Increased nerve function)

• Increased chronic pain threshold throughdecreased C-fiber activity (Decreased pain)



Physiological Effects of Laser

• Accelerated tissue healing and repair by

40%

• Increased tensile strength in tissue repair

• Increase callous and bone formation

• Reduced or eliminated pain

• Decreased edema and inflammation

• Improved immune response

• Stimulates nerve function

• Promotes Cellular

Oxygenation/Detoxification



Diagrammatic events

Diagrammatic events how

laser reduces inflammation &

pain, and affects tissue

healing:

–a. Inflammation

– b. pain

– c. Tissue healing



Stages of reduction of

inflammation by Laser:



Subsides inflammation by:

• 1. Stabilization of cellular membrane

• 2. ATP production and synthesis

• 3. Vasodilatation is stimulated viaHistamine,

• Nitric Oxide (NO) and Serotonin.

• Acceleration of leukocytic activity.

• 5. Increased Prostaglandin synthesis,

• 6. Reduction in Interleukin 1(IL-1).

• 7. Enhanced lymphocyte response.

• 8. Increased angiogenesis.

•9. Temperature modulation.• 10. Enhanced superoxide dismutase(SOD) levels.

• 11. Decreased C-reactive protein andneopterin levels.



Stages of pain management by

Laser



Reduces pain by:

• 1. Increase in b-Endorphins.

• 2. Blocked depolarization of C-fiber

afferent nerves.

• 3. Increased nitric oxide production.

• 4. Increased nerve cell action potential.

• 5. Axonal sprouting and nerve cell

regeneration.

• 6. Decreased Bradykinin levels.

• 7. Increased release of acetylcholine.

• 8. Ion channel normalization.



Stages of Tissue healing by Laser



Reduces healing time by:

• 1. Enhanced leukocyte infiltration.

• 2. Increased macrophage activity.

• 3. Increased neovascularization.

• 4. Increased fibroblast proliferation.• 5. Keratinocyte proliferation.

• 6. Early epithelialization.

• 7. Growth factor increases.

• 8. Enhanced cell proliferation and

differentiation.• 9. Greater healed wound tensile

strength.



Conclusion

• Over the past 20 years, laser and LED deviceshas been widely being used in medical science with

proved & promising success for treatment of avariety of medical conditions including carpal tunnelsyndrome, cervical neck pain, low back pain, jointpain, frozen shoulder, generalized muscle pain. andacceleration of wound healing.

• Besides orthopedic application, Laser is beingsuccessfully used in other medical branches (Surgery, Eye, ENT, Gastroenterology, Neurosurgeryetc.).

•



Conclusion

\ There are thousands of research, study and medicalapplications, that LASER is a very effective modality

of treatment . It is being widely used all over theworld with promising and successful also inOrthopedic surgery which is very target oriented,convenient and cost effective.

• NASA are currently using technical light therapy(Laser) for medical conditions in space applications.

•All of these events validate the growing

acceptance in mainstream medicine for the medicalefficacy of laser therapy as a viable, often superior therapeutic treatment modality.

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316916351752-Basics-of-Laser-Orthopedic-view-.ppt