Frequency Specific Microcurrent Resolves Chronic Pain and Adhesions After Ulnar Transposition Surgery
Jodie Adams1* and Carolyn McMakin2
1 New Heights Physical Therapy, 5736 NE Glisan St, Portland Oregon, 97213, Portland
2 Fibromyalgia and myofascial pain clinic of Portland, Portland
Summary
Frequency specifi c microcurrent (FSM) has been used to treat myofascial pain syndrome [1,2] fi bromyalgia
associated with spine trauma [3], delayed onset muscle soreness [4], acute and chronic neuropathic pain [5]
and chronic scarring in burn patients [6]. In this case, its use was modifi ed to include not only the treatment of
neuropathic pain but the treatment of neural adhesions in a patient with a ten year history of pain at rest and painful
restricted range of motion following an ulnar nerve anterior transposition surgery in 2001. Eleven standard physical
therapy sessions including augmented soft tissue mobilization using plastic tools, and muscle strengthening
exercises and stretching failed to resolve symptoms. Three sessions of frequency specifi c microcurrent produced
complete resolution of pain and symptoms. Patient remained symptoms free at one-year follow up.
Introduction
Postoperative perineural scarring is a signiϐicant problem following ulnar nerve
transposition surgery and the prognosis following surgery is worse when signiϐicant
scarring occurs [7]. Dense scarring has been associated with poor outcomes when
ulnar nerve transposition fails to alleviate symptoms. Re-operating on patients with
a poor outcome from an initial transposition surgery produced fair to poor results
in 55% of patients. Only 4 of 9 patients experienced symptom resolution following
neurolysis surgery [8].
Physical therapy has been discussed as an option in avoiding surgery in mild cases
of ulnar compression neuropathy [9]. But there is no literature that discusses physical
therapy options for treating an unsuccessful postsurgical outcome following ulnar
nerve decompression surgery.
Neuropathic pain and adhesions following ulnar nerve transposition surgery are
therefore typically difϐicult to treat within a medical and physical therapy treatment
model. Manual physical therapists can perform neural mobilization techniques alone
or in combination with joint mobilization to reduce pain and improve range of motion
but the process can be slow, painful and difϐicult [10].
The purpose of treatment in this case was to discover if frequency speciϐic
microcurrent showed promise in the treatment of chronic neuropathic pain and
adhesions following unsuccessful ulnar nerve anterior transposition surgery.
The patient was a 28-year-old male who presented on 8/22/2011 for treatment
of hypersensitivity and severe left cubital and forearm pain. His pain had varied and
persisted since an ulnar nerve transposition surgery in 2001. His ϐirst child was due to
be born within two weeks of his initial treatment and he sought care so that he would
be able to lift and carry his infant daughter.
In recounting his history he stated that his left elbow pain began to gradually
increase at age 13 following multiple falls and accidents that produced trauma to the
left elbow such as skateboarding and bicycle accidents, an all-terrain-vehicle (ATV)
accident and a fall from a one-story roof. By age 15, when he began driving, elbow
ϐlexion produced signiϐicant pain. Nerve conduction performed at age 19 demonstrated
a reduction in conduction velocity across the ulnar nerve at the elbow and normal
conduction across the wrist. The preoperative clinical assessment showed weakness
in abductor digiti minimi, diminished sensation of the left fourth and ϐifth ϐingers and
a very positive Tinnel’s sign at the ulnar groove. The preoperative diagnosis was ulnar
entrapment neuropathy.
No conservative therapy was attempted and ulnar nerve anterior transposition
surgery was performed at age 19 in September 2001.
The operative report stated that the “ulnar nerve lay within the ulnar groove and
appeared to be entrapped by ϐibrous bands adjacent to the ϐlexor carpi ulnaris. There
was no evidence of neuroma”. “With operative magniϐication and microdissection, the
nerve was mobilized and branches to the ϐlexor carpi ulnaris spared. The mobilization
allowed anterior transposition of the nerve. A notch was cut in the fascia above and
below the transposition to avoid kinking of the nerve at the point of transposition. The
ulnar grove was closed with non-absorbable #3-0 silk suture. A subcutaneous pocket
was fashioned for the nerve with #3-0 Vicryl suture, with a ϐinal skin closure of #3-0
Vicryl suture, #5-0 Monocryl and Steri-Strips.”
Surgery produced no signiϐicant change in pain and the patient had no follow up
therapy. He experienced increased cutaneous sensitivity and pain in the area over the
following 10 years.
In 2010 at age 28, he initiated physical therapy for “left elbow, forearm
Frequency specifi c microcurrent resolves chronic pain and adhesions after ulnar transposition surgery
Published: September 19, 2017 101
Materials and Methods
The ϐirst treatment in August 2011 included Frequency Speciϐic Microcurrent
(FSM) to reduce nerve pain so the patient would tolerate manual therapy and gentle
soft tissue mobilization. The patient tolerated treatment well and had some temporary
pain reduction. He returned one month later for a second treatment in September
2011. At this treatment the frequencies described as “reducing scar tissue in the
nerve” [11] were applied with the limb at rest and while performing passive nerve
glide techniques within a pain free range.
Photograph 1: Contact placement for elbow treatment
Caption: Treatment contacts are set up with the positive leads in a warm wet
towel wrapped around the neck where the nerve exits the spine and the negative leads
wrapped in a warm wet towel at the end of the nerve to be treated, near the elbow. The
therapist uses the hands under the contacts to mobilize the forearm nerve and fascia.
Frequency Speciϐic Microcurrent uses a frequency thought to address a certain
pathology, such as inϐlammation or scarring on one channel and a frequency describing
a certain tissue on the second channel. The frequency combination observed to reduce
nerve pain is 40 hertz on channel A and 396 Hz on channel B [11]. The frequency
observed to increase range of motion and reduce scar tissue density in the nerve
was 13 hertz on channel A and 396 hertz on channel B. 396 hertz is thought to be the
frequency that affects the nerve as a tissue. 40 hertz is the frequency that has been
observed to reduce inϐlammation and pain [3]. 13 hertz is thought to be the frequency
that softens or dissolves scar tissue [6].
Frequency Speciϐic Microcurrent was developed in 1996 when frequencies from
a list created with a device manufactured in 1922 were applied with a two-channel
microcurrent device instead of the original electrical equipment. Microcurrent devices,
while approved in the category of TENS (transcutaneous electrical nerve stimulation)
do not function as TENS devices since the subsensory current is 1000 times less than
TENS. The original equipment has never been available for examination and the list
was used as if the verbal descriptions of the frequencies were correct [12].
At the second treatment performed in September 2011, a two-channel Precision
Micro (Precision Microcurrent, Newberg Oregon) was used to apply 40 hertz on
channel A and 396 hertz on channel B for 30 minutes. Two leads from each channel
were inserted into two graphite gloves that were wrapped in warm wet hand towels
to provide broader current distribution and good conductivity. The polarized pulsed
positive direct (DC) current was applied with the positive leads at the neck and the
negative leads at the left hand. The current levels were set at 200 microamps and a
medium wave slope was used. This application has been observed to reduce nerve
pain and hyperesthesia [5].
The patient’s pain and palpatory sensitivity were eliminated after 30 minutes
treatment using 40 hertz and 396 hertz. Range of motion was still restricted due to
pain. The device settings were then changed to deliver 13 hertz on channel A and 396
hertz on channel B [11]. Gentle passive range of motion within the pain free range
at the elbow and wrist was performed for 30 minutes. During this movement phase
of treatment, 40 hertz on channel A and 396 hertz on channel B were used several
times for 5 minutes to eliminate increases in pain caused by movement. Once pain
was reduced the frequencies were returned to 13 hertz and 396 hertz and passive
movement was resumed. It was observed that 13 hertz had no effect on pain and 40
hertz had no effect to increase range. In the last 15 minutes of treatment the patient
performed active range of motion in the elbow, wrist and shoulder with no increase
in pain. At the end of treatment, range of motion was full and pain free and cutaneous
hyperesthesia had been eliminated (Table 1).
Frequency specifi c microcurrent resolves chronic pain and adhesions after ulnar transposition surgery
Published: September 19, 2017 102
Results and Discussion
At follow-up one week later the patient was pain free with full range of motion
but complained of hyperesthesia at the surgical scar site. The device was applied as
previously described; 40 hertz was used on one channel and 396 hertz was used on
the second channel until the hyperesthesia resolved. The patient self-discharged after
this treatment.
At follow-up one year later, in 2012, the patient rated his pain as 0/10 on a VAS
scale. TAOS functional index was 100% improved from 80%. He rated himself as 7/7
perceived improvement on Global Rating of Change scale. Physical examination showed
full pain free range of motion at the shoulder, elbow and wrist. Manual muscle testing
of the wrist and elbow was 5/5. He had no pain on palpation in the arm or forearm.
Sensation was diminished in the medial arm and forearm but not hypersensitive as it
was prior to treatment. He still reported pain when resting his elbow on a hard surface
but stated that it did not impair any activities. He reported being able to hold his infant
daughter comfortably with his left arm from the time of her birth through the one-year
follow up. The patient reports that he remains pain free with full range of motion in
2017.
Conclusion
Frequency Speciϐic Microcurrent shows promise in the treatment of neuropathic
pain and neural adhesions in failed ulnar nerve transposition surgery and provided
complete relief of symptoms after three treatment sessions when eleven sessions of
standard physical therapy had failed. It is possible that this treatment may also be
useful as conservative treatment to be used instead of or prior to surgery. Further
research should be conducted.
References
1. McMakin C. Microcurrent Treatment of Myofascial Pain in the Head, Neck and Face. Top Clin Chiro.
1998; 5: 29-35. Ref.: https://goo.gl/pBnPm5
2. McMakin C. Microcurrent therapy: a novel treatment method for chronic low back myofascial pain.
J Bodyw Mov Ther. 2004; 8: 143-153. Ref.: https://goo.gl/yxbgvM
3. McMakin C, Gregory W, Phillips T. Cytokine changes with microcurrent therapy of fi bromyalgia
associated with cervical trauma. J Bodyw Mov Ther. 2005; 9: 169-176. Ref.: https://goo.gl/jNLRPc
4. Curtis D, Fallows S, Morris M, McMakin C. The effi cacy of frequency specifi c microcurrent therapy on
delayed onset muscle soreness. J Bodyw Mov Ther. 2010; 14: 272-279. Ref.: https://goo.gl/Dt6o2q
5. McMakin C. Non-pharmacologic treatment of neuropathic pain using Frequency Specifi c
Microcurrent. The Pain Practitioner. 2010; 68-73.
6. Huckfeldt R, Mikkelson K, Larson L. The Use of Microcurrent and Autocatalytic Silver Plated Nylon
Dressings in Human Burn Patients: A Feasibility study. Maui, Hawaii: Proceedings of John Boswick
Burn and Wound Symposium. 2003.
7. Leffert, RD. Anterior submuscular transposition of the ulnar nerves by the Learmonth technique. J
Hand Surg Am. 1982; 7: 147-155. Ref.: https://goo.gl/8YW4MM
Table 1: Pre and Post- Treatment Outcomes.
2010 Pre Treatment 2010 Post treatment-Standard PT-11 Sessions
TAOS* 86% TAOS* 92%
VAS* 5/10 VAS 4/10
2011 Pre FSM Treatment 2011 Post FSM Treatment -3 Sessions
TAOS* 80% Full function self report, patient self discharge
VAS 7/10 VAS 0/10
2012 Post FSM treatment-Follow-up
TAOS 100%
VAS 0 /10
*TAOS functional index score.
**VAS-Visual analogue scale 0-10/10.
Frequency specifi c microcurrent resolves chronic pain and adhesions after ulnar transposition surgery
Published: September 19, 2017 103
8. Dagregorio G, Saint-Cast Y. Simple neurolysis for failed anterior submuscular transposition of the
ulnar nerve at the elbow. Int Orthop. 2004; 28: 342-346. Ref.: https://goo.gl/rZkqCi
9. Robertson C, Saratsiotis J. A review of compressive ulnar neuropathy at the elbow. J Manipulative
Physio Ther. 2005; 28: 345. Ref.: https://goo.gl/U9ae9z
10. Butler DS. Mobilization of the nervous system. Churchill Livingston. 1991.
11. McMakin C. Treating neuropathic pain, Elsevier Science Press, Edinburgh, Frequency Specifi c
Microcurrent in Pain Management. Textbook for practitioners. 2010; 41-72.
12. McMakin C. Resurrecting Resonance, North Atlantic Books, Berkeley, CA. The Resonance Effect.
2017; 10-14.