7/28/2019 Phys Ther 1983 Bodenheim 1287 8

1/4

1983; 63:1287-1288.PHYS THER.Regina Bodenheim and J Harold BennettA Case ReportUse of Transcutaneous Electrical Nerve Stimulation :Reversal of a Sudeck's Atrophy by the Adjunctive

http://ptjournal.apta.org/content/63/8/1287services, can be found online at:The online version of this article, along with updated information and

Collections

OsteoporosisInjuries and Conditions: Lower ExtremityElectrotherapyCase Reports

in the following collection(s):This article, along with others on similar topics, appears

e-Letters

"Responses" in the online version of this article."Submit a response" in the right-hand menu under

or click ohereTo submit an e-Letter on this article, click

E-mail alerts to receive free e-mail alertshereSign up

by guest on April 2, 2013http://ptjournal.apta.org/Downloaded from

http://ptjournal.apta.org/cgi/collection/osteoporosishttp://ptjournal.apta.org/cgi/collection/osteoporosishttp://ptjournal.apta.org/cgi/collection/injuries_and_conditions_lower_extremityhttp://ptjournal.apta.org/cgi/collection/injuries_and_conditions_lower_extremityhttp://ptjournal.apta.org/cgi/collection/electrotherapyhttp://ptjournal.apta.org/cgi/collection/case_reportshttp://ptjournal.apta.org/letters/submit/ptjournal;63/8/1287http://ptjournal.apta.org/letters/submit/ptjournal;63/8/1287http://ptjournal.apta.org/subscriptions/etoc.xhtmlhttp://ptjournal.apta.org/http://ptjournal.apta.org/http://ptjournal.apta.org/http://ptjournal.apta.org/subscriptions/etoc.xhtmlhttp://ptjournal.apta.org/letters/submit/ptjournal;63/8/1287http://ptjournal.apta.org/cgi/collection/osteoporosishttp://ptjournal.apta.org/cgi/collection/injuries_and_conditions_lower_extremityhttp://ptjournal.apta.org/cgi/collection/electrotherapyhttp://ptjournal.apta.org/cgi/collection/case_reports

7/28/2019 Phys Ther 1983 Bodenheim 1287 8

2/4

Reversa l of a Sud eck ' s A t rophy b y t h e Ad j u n c t iv e Use ofTranscu taneous E lec t r i ca l Ne rve S t imu la t ionA Case ReportR E G I N A B O D E N H E I Ma n d J . H A R O L D B E N N E T T

K ey W o r d s : Electrotherapy, Pain, Sudeck's atrophy.

The patient, a 43-year-old man, fell from a ladderon J anuary 19, 1981, sustaining fractures of the rightdistal tibia and fibula plus contusion and strain of thelow back. He was treated with closed r eduction of thefractures, and the leg was cast-braced. A fter the castwas removed, the patient was unable to bear weighton the right lower extremity because of pain andrequired fairly constant medication for analgesic,anti-inflammatory, and sedative effects. A secondarydiagnosis of Sudeck's atrophy was made.1 This condition proved very resistant to treatment.On February 28, 1982, 13 months after the injury,the patient was referred to our physical therapy department for transcutaneous electrical nerve stimulation (T ENS) treatment as a pain control measure.The treatment goal was to improve weight acceptanceof the right leg, thereby leading to an increase in bonestock for the correction of the Sudeck's atrophy.

A t this time, the patient was attempting to walkwith a standard cane in one hand. F loor contact onthe right foot was very brief and was accomplishedwith the lateral toes only. R ange of motion of theright ankle could not be determined because thepatient was unwilling to move it. H e complained ofsevere pain in the lower third anteromedial portionof the right leg and in the ankle between the medialmalleolus and the Achilles tendon. T o a lesser degree,he complained of low back pain.T he patient was treated with T ENS* for one hourthree times a week from February 28 through A pril

Fig. 1. November 30, 1981. Osteoporosis seen particu-larly in distal fibula 10 months after injury.30, 1982. The electrodes were placed in areas designated as acupuncture points: kidney 3, which is located medially to the inner border of the medialmalleolus and bladder 57, which lies at the apex ofthe division of the two heads of the gastrocnemiusmuscle of the r ight lower leg. T he low back wastreated with electrode placement to bladder 26 bilat-

M s. Bodenheim was Assistant Director, Department of PhysicalTherapy, St. J ames Hospital, N ewark, NJ , at the time of the describedtreatment and is now Chief Physical Therapist, Orthopedic andRehabil itation Insti tute, 175-62 Hi ll side Ave, J amaica, NY 11432(USA).Dr. Bennett is A ttending Orthopedic Surgeon, Crippled Chi ldren'sHospital and St. James Hospital, Newark, N J .This article was submitted September 20, 1982; was with the authorsfor revision 7 weeks; and was accepted or publication April 12, 1983.

Volume 63 / Number 8, August 1983 1287

by guest on April 2, 2013http://ptjournal.apta.org/Downloaded from

http://ptjournal.apta.org/http://ptjournal.apta.org/http://ptjournal.apta.org/

7/28/2019 Phys Ther 1983 Bodenheim 1287 8

3/4

Fig. 2. May 3, 1982. Increased bon e densi ty is ap parenttwo mo nths af ter s tar t of t reatment .

erally. T hese points are between L 5 and S1 and closeto the vertebral column.2, 3Width, rate, and intensity of current settings wereadjusted to patient tolerance. F or impulse rate andwidth control, a setting of 2 proved consistently comfortable for the patient. T hese settings on the M entor100 model T E NS unit correspond to a pulse rate of20 pulses per second and a width of 100 sec.T he patient progressed to full weight bearing without need for the cane by the last week in M arch. Bythe end of April, the right ankle had full range ofmotion in dorsiflexion and plantar flexion. T he useof pain and anti-inflammatory medications was gradually tapered off. The patient was judged able toreturn to work by the physician in M ay 1982.

T he use of T ENS as described in this case wassuccessful in achieving pain control and so promoted

Fig. 3. Ju ly 20, 1982. Reversal of at rophic bon e processdemons t ra ted .

weight acceptance on the involved extremity. (R oentgenograms of the extremity before, during, and aftertreatment are shown in F igures 1 through 3.) Therewas an increase in bone stock and reversal of anatrophic process in a significantly short time. Withoutfurther research, it is not possible to evaluate theeffects of the specific acupuncture points stimulatedon either the reversal of the atrophic process or onthe time factor.* Mentor M odel 100, M entor C orp, 1499 W River R d N, M inneapolis, M N 55411.

REFERENCES1 . Shands AR, Raney RB, Brashear WR: Handbook of Orthopedic Surgery, ed. 6. St. Louis, MO, The CV Mosby Co,1963 , p 1322. Mann F: Acupuncture. New York, NY, Random House Vintage Books, 1972, pp 14, 20, 29, 125, 1583. Matsumoto T: A cupuncture for Physicians. Charles CThomas, Publ isher. Springfield, IL, 19 74, pp 69 -7 0, 7 3, 77,1 2 1 , 1 3 8 - 1 3 9

1 2 8 8 PHYSICAL THERAPYby guest on April 2, 2013http://ptjournal.apta.org/Downloaded from

http://ptjournal.apta.org/http://ptjournal.apta.org/http://ptjournal.apta.org/

7/28/2019 Phys Ther 1983 Bodenheim 1287 8

4/4

1983; 63:1287-1288.PHYS THER.Regina Bodenheim and J Harold BennettA Case ReportUse of Transcutaneous Electrical Nerve Stimulation :Reversal of a Sudeck's Atrophy by the Adjunctive

Cited by

http://ptjournal.apta.org/content/63/8/1287#otherarticles

This article has been cited by 1 HighWire-hosted articles

Information

Subscription http://ptjournal.apta.org/subscriptions/

Permissions and Reprints http://ptjournal.apta.org/site/misc/terms.xhtml

Information for Authors http://ptjournal.apta.org/site/misc/ifora.xhtml

by guest on April 2, 2013http://ptjournal.apta.org/Downloaded from

http://ptjournal.apta.org/content/63/8/1287#otherarticleshttp://ptjournal.apta.org/http://ptjournal.apta.org/http://ptjournal.apta.org/http://ptjournal.apta.org/http://ptjournal.apta.org/content/63/8/1287#otherarticles