Reversal of a Sudeck`s Atrophy by the Adjunctive Use of

Reversal of a Sudeck's Atrophy by the Adjunctive Use of
Transcutaneous Electrical Nerve Stimulation
A Case Report
REGINA BODENHEIM
and J. HAROLD BENNETT
Key Words: Electrotherapy, Pain, Sudeck's atrophy.
The patient, a 43-year-old man, fell from a ladder
on January 19, 1981, sustaining fractures of the right
distal tibia and fibula plus contusion and strain of the
low back. He was treated with closed reduction of the
fractures, and the leg was cast-braced. After the cast
was removed, the patient was unable to bear weight
on the right lower extremity because of pain and
required fairly constant medication for analgesic,
anti-inflammatory, and sedative effects. A secondary
diagnosis 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 (TENS) treatment as a pain control measure.
The treatment goal was to improve weight acceptance
of the right leg, thereby leading to an increase in bone
stock for the correction of the Sudeck's atrophy.
At this time, the patient was attempting to walk
with a standard cane in one hand. Floor contact on
the right foot was very brief and was accomplished
with the lateral toes only. Range of motion of the
right ankle could not be determined because the
patient was unwilling to move it. He complained of
severe pain in the lower third anteromedial portion
of the right leg and in the ankle between the medial
malleolus and the Achilles tendon. To a lesser degree,
he complained of low back pain.
The patient was treated with TENS* for one hour
three times a week from February 28 through April
Ms. Bodenheim was Assistant Director, Department of Physical
Therapy, St. James Hospital, Newark, NJ, at the time of the described
treatment and is now Chief Physical Therapist, Orthopedic and
Rehabilitation Institute, 175-62 Hillside Ave, Jamaica, NY 11432
(USA).
Dr. Bennett is Attending Orthopedic Surgeon, Crippled Children's
Hospital and St. James Hospital, Newark, NJ.
This article was submitted September 20, 1982; was with the authors
for revision 7 weeks; and was acceptedfor publication April 12, 1983.
Volume 63 / Number 8, August
1983
Fig. 1. November 30, 1981. Osteoporosis seen particularly 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 medial
malleolus and bladder 57, which lies at the apex of
the division of the two heads of the gastrocnemius
muscle of the right lower leg. The low back was
treated with electrode placement to bladder 26 bilat-
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Fig. 3. July 20, 1982. Reversal of atrophic bone process
demonstrated.
Fig. 2. May 3, 1982. Increased bone density is apparent
two months after start of treatment.
erally. These points are between L5 and S1 and close
to the vertebral column.2, 3
Width, rate, and intensity of current settings were
adjusted to patient tolerance. For impulse rate and
width control, a setting of 2 proved consistently comfortable for the patient. These settings on the Mentor
100 model TENS unit correspond to a pulse rate of
20 pulses per second and a width of 100 µsec.
The patient progressed to full weight bearing without need for the cane by the last week in March. By
the end of April, the right ankle had full range of
motion in dorsiflexion and plantar flexion. The use
of pain and anti-inflammatory medications was gradually tapered off. The patient was judged able to
return to work by the physician in May 1982.
The use of TENS as described in this case was
successful in achieving pain control and so promoted
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weight acceptance on the involved extremity. (Roentgenograms of the extremity before, during, and after
treatment are shown in Figures 1 through 3.) There
was an increase in bone stock and reversal of an
atrophic process in a significantly short time. Without
further research, it is not possible to evaluate the
effects of the specific acupuncture points stimulated
on either the reversal of the atrophic process or on
the time factor.
* Mentor Model 100, Mentor Corp, 1499 W River Rd N, Minneapolis, MN 55411.
REFERENCES
1. Shands AR, Raney RB, Brashear WR: Handbook of Orthopedic Surgery, ed. 6. St. Louis, MO, The CV Mosby Co,
1963, p 132
2. Mann F: Acupuncture. New York, NY, Random House Vintage Books, 1972, pp 14, 20, 29, 125, 158
3. Matsumoto T: Acupuncture for Physicians. Charles C
Thomas, Publisher. Springfield, IL, 1974, pp 69-70, 73, 77,
121, 138-139
PHYSICAL THERAPY