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Frequency Specific Microcurrent Resolves Chronic Pain and Adhesions After Ulnar Transposition Surgery

Case Report

Authors

Jodie Adams¹* and Carolyn McMakin²

¹New Heights Physical Therapy, 5736 NE Glisan St, Portland Oregon, 97213, Portland
²Fibromyalgia and myofascial pain clinic of Portland, Portland

*Address for Correspondence: Jodie Adams, New Heights Physical Therapy, 5736 NE Glisan St, Portland Oregon, 97213, Portland, Email: Jodie@newheightstherapy.com

Publication Details

Submitted: 29 August 2017
Approved: 18 September 2017
Published: 19 September 2017
Journal: Journal of Novel Physiotherapy and Rehabilitation
ISSN: 2573-6264

Summary

Frequency specific microcurrent (FSM) has been used to treat myofascial pain syndrome, fibromyalgia associated with spine trauma, delayed onset muscle soreness, acute and chronic neuropathic pain, and chronic scarring in burn patients. In this case, its use was modified 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 specific microcurrent produced complete resolution of pain and symptoms. Patient remained symptoms free at one-year follow up.

Introduction

Postoperative perineural scarring is a significant problem following ulnar nerve transposition surgery and the prognosis following surgery is worse when significant scarring occurs. 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.

Physical therapy has been discussed as an option in avoiding surgery in mild cases of ulnar compression neuropathy. 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 difficult 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 difficult.

The purpose of treatment in this case was to discover if frequency specific microcurrent showed promise in the treatment of chronic neuropathic pain and adhesions following unsuccessful ulnar nerve anterior transposition surgery.

Case Presentation

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 first 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.

Medical History

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 accidents
Bicycle accidents
All-terrain-vehicle (ATV) accident
Fall from a one-story roof

By age 15, when he began driving, elbow flexion produced significant 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.

Preoperative Assessment

Weakness in abductor digiti minimi
Diminished sensation of the left fourth and fifth fingers
Very positive Tinnel’s sign at the ulnar groove
Preoperative diagnosis: Ulnar entrapment neuropathy

Surgical Procedure (September 2001)

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 fibrous bands adjacent to the flexor carpi ulnaris. There was no evidence of neuroma.” “With operative magnification and microdissection, the nerve was mobilized and branches to the flexor 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 final skin closure of #3-0 Vicryl suture, #5-0 Monocryl and Steri-Strips.”

Surgery produced no significant 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.

Previous Physical Therapy (2010)

In 2010 at age 28, he initiated physical therapy for “left elbow, forearm and hand pain that had worsened over time” since the surgery. His VAS pain score was 5/10.

Treatment Protocol (February 2 – April 12, 2010):

11 physical therapy treatments total
9 sessions with assisted soft tissue therapy using acrylic tools (ASTYM)
4 sessions included e-stim and ice
Every visit included exercise therapy:
- Mobilization of median and ulnar nerves
- Foam roller thoracic mobilization
- Prone-ball scapular strengthening
- Biceps, triceps and latissimus dorsi strengthening with hand weights

Results:

Pre-treatment TAOS: 86%
Post-treatment TAOS: 92%
VAS pain score at discharge: 4/10

Current Presentation (August 2011)

He sought additional physical therapy at our facility in August 2011 due to increased pain and concern that he would not be able to hold his infant daughter. He stated that prior physical therapy had produced temporary reduction in pain but did not change the hyperesthesia or tingling.

Current Assessment:

VAS Pain Score: 7/10
TAOS Functional Index: 80%
Most Restricted Activities: Sleeping, recreation, carrying, and driving (3/5)
Moderately Restricted: Personal care and lifting (4/5)

Physical Examination Findings

Range of Motion:

Elbow range of motion full but painful past 95 degrees of flexion
Elbow extension was position of comfort
Shoulder abduction and flexion caused pain in left forearm and elbow
Shoulder flexion: 127 degrees with scapular elevation
Shoulder abduction: 132 degrees
Wrist range of motion normal but painful with repetition

Strength Testing:

Elbow flexion/extension: 4/5 with pain
Wrist supination/pronation: 4/5 with pain
Upper limb tension testing: Positive with pain in median and ulnar nerve distributions

Sensory Testing:

Hyperesthesia and pain in ulnar nerve cutaneous distributions in medial arm and forearm
Could not tolerate any touch or pressure in these areas
Couldn’t rest his arm on any surface

Materials and Methods

Treatment Protocol

The first treatment in August 2011 included Frequency Specific 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” were applied with the limb at rest and while performing passive nerve glide techniques within a pain free range.

FSM Theory and Application

Frequency Specific Microcurrent uses a frequency thought to address a certain pathology, such as inflammation or scarring on one channel and a frequency describing a certain tissue on the second channel.

Key Frequencies Used:

40 hertz on channel A + 396 Hz on channel B: Observed to reduce nerve pain
13 hertz on channel A + 396 hertz on channel B: Observed to increase range of motion and reduce scar tissue density in the nerve
396 hertz: Thought to be the frequency that affects the nerve as a tissue
40 hertz: The frequency that has been observed to reduce inflammation and pain
13 hertz: Thought to be the frequency that softens or dissolves scar tissue

Treatment Equipment and Setup

Equipment: Two-channel Precision Micro (Precision Microcurrent, Newberg Oregon)

Contact Placement:

Two leads from each channel inserted into two graphite gloves
Gloves wrapped in warm wet hand towels for broader current distribution and good conductivity
Positive leads: Placed at the neck where nerve exits the spine
Negative leads: Placed at the left hand (end of nerve to be treated)
Current levels: Set at 200 microamps
Wave type: Medium wave slope, polarized pulsed positive direct (DC) current

Second Treatment Protocol (September 2011)

Phase 1 – Pain Reduction (30 minutes):

40 hertz on channel A and 396 hertz on channel B
Applied for 30 minutes
Result: Patient’s pain and palpatory sensitivity were eliminated

Phase 2 – Scar Tissue Treatment (30 minutes):

13 hertz on channel A and 396 hertz on channel B
Gentle passive range of motion within pain-free range at elbow and wrist
Intermittent pain management: When movement caused pain increase, returned to 40 hertz/396 hertz for 5 minutes, then back to 13 hertz/396 hertz

Key Observation: 13 hertz had no effect on pain and 40 hertz had no effect to increase range.

Phase 3 – Active Movement (15 minutes):

Patient performed active range of motion in elbow, wrist and shoulder with no increase in pain
End result: Range of motion was full and pain free, cutaneous hyperesthesia had been eliminated

Results and Discussion

Immediate Results (Post-Treatment)

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.

One-Year Follow-Up Results (2012)

Outcome Measures:

VAS Pain Score: 0/10 (improved from 7/10)
TAOS Functional Index: 100% (improved from 80%)
Global Rating of Change: 7/7 perceived improvement
Range of Motion: Full pain-free range of motion at shoulder, elbow, and wrist
Strength: Manual muscle testing of wrist and elbow was 5/5
Palpation: No pain on palpation in arm or forearm
Sensation: Diminished in medial arm and forearm but not hypersensitive
Functional Activities: Able to hold infant daughter comfortably with left arm from birth through one-year follow up

Residual Symptoms:

Still reported pain when resting elbow on hard surface but stated it did not impair any activities

Long-term Follow-up: The patient reports that he remains pain free with full range of motion in 2017.

Treatment Outcomes Summary

Timeframe	Treatment	TAOS Score	VAS Pain Score	Functional Status
2010 Pre-Treatment	Standard PT	86%	5/10	Limited function
2010 Post-Treatment	11 Standard PT Sessions	92%	4/10	Minimal improvement
2011 Pre-FSM	–	80%	7/10	Worsened symptoms
2011 Post-FSM	3 FSM Sessions	Self-discharge	0/10	Full function
2012 Follow-up	–	100%	0/10	Complete resolution

Conclusion

Frequency Specific 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.

Key Clinical Findings

FSM was effective where traditional physical therapy failed
Rapid resolution – 3 sessions vs. 11 unsuccessful sessions
Sustained results – patient remained symptom-free at 1-year and 6-year follow-up
Functional improvement – able to care for infant daughter as desired
Non-invasive alternative to repeat surgery with poor prognosis

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Copyright: This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite this article: Adams J, McMakin C. Frequency specific microcurrent resolves chronic pain and adhesions after ulnar transposition surgery. J Nov Physiother Rehabil. 2017; 1: 099-103.