Reversal of a Sudeck's Atrophy by the Adjunctive Use of Transcutaneous Electrical Nerve Stimulation : A Case Report Regina Bodenheim and

J Harold Bennett PHYS THER. 1983; 63:1287-1288.

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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.

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-

Volume 63 / Number 8, August

1983

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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 sec. 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

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

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

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