ASSIGNMENT

PHYSIOTHERAPY IN
ORTHOPEDIC TRAUMA

Submitted to Submitted by
Dr. Zainy Khan Rashmi Jain
MPT (2nd SEM)
 A Case report on the impact of physiotherapy
rehabilitation on partial claw hand secondary to
borderline tuberculoid Hansen disease. (Swapna
Jawade et.al, 2020)
Hansen’s disease known as leprosy originated from Mycobacterium leprae a chronic
infectious disease. It hampers mostly skin and peripheral nerves. Claw hand is a secondary
impairment following Hansen’s disease, especially for those not gone under physiotherapy
treatment.
This study presents the case report of a person affected with leprosy and partial claw hand
deformity and had undergone physiotherapy management.

Case report
A 30-year-old female noticed a light-colored lesion over her right arm for 7 months. She had
visited the dermatology department of AVBRH with complaints of loss of sensation of the
lesion and tingling numbness over her right hand after a few days of the appearance of the
lesion. She had also complained of difficulty in holding objects and doing fine movements.
The dermatologist referred the patient for NCV studies and diagnosed them with borderline
tuberculoid Hansen disease with partial Ulnar clawing of the right hand.

She had a partial clawing of the little and ring finger of the right hand with hyperextension at
the MCP joint and flexion at PIP and DIP joint of the little and ring finger. Muscle wasting of
thenar and hypothenar was seen over the right hand. On palpation, there was thickening of
the ulnar nerve. On sensory examination, there was a loss of pain and touch sensation over
the hypopigmented patch. There was a loss of perception of touch and temperature on the
medial two fingers (little and ring finger) of the right hand. Frommet's test (book test) and
card test were positive in the right hand. The functional outcome was 2/10 taken on the
patient-specific functional scale.

Intervention
In the first 2 weeks, Electrical muscle stimulation was applied to stimulate an individual
motor point of Abductor digiti minimi, Interrossoi, lumbricals, and flexor digitorium
profundus by using pen electrodes, the electrical pulse at a frequency less than 1/s (0.05-0.1
ms). Low-frequencies (2Hz) transcutaneous electrical nerve stimulation (TENS) was applied
for 10 minutes. Maitland’s mobilization was given for 1-2 oscillation/sec for 1 minute to
improve ROM. Myofascial release technique was applied with a foam roller lasting for 30
seconds (5×3 sets) and 1-minute rest and massage were given on shortened muscles to reduce
tightness.
In this case used modified physiotherapy rehabilitation for partial Ulnar clawing following
borderline tuberculoid Hansen’s disease aid in early regain of sensation, ROM, and hand
muscle strength and restores functional grasp.

Postpartum Femoral Nerve Palsy: A Case Study

and the Role of Electrophysiologic Testing and
Neuromuscular Electrical Stimulation (W. Bellew
et.al, 2020)
Peripheral neuropathies during pregnancy and the postpartum period are common. The vast
majority of nerve injuries associated with childbirth can be attributed to the labor and
delivery process itself. The most commonly injured nerve is the lateral femoral cutaneous
nerve. When damage to the lateral femoral cutaneous nerve occurs, paresthesias of the lateral
thigh are common and are commonly known as meralgia paresthetica.

Case study
A 26-year-old woman (gravida 1, term delivery 1, premature delivery 0, abortion 0, and
living child 1) with acute onset of isolated right quadriceps weakness following parturition.
The total labor duration, in this case, was 18 hours, 30 minutes of which were in the second
stage. Following epidural anesthesia administration, she was restricted to the dorsal lithotomy
position for a total of 45 minutes. A prolonged or extended period in the lithotomy position
has been identified as the causative factor in reports of femoral nerve palsy after
uncomplicated deliveries.
The self-administered intervention of NMES was given twice daily. The asymmetrical
biphasic pulsed waveform was used with the following parameters: 400- μsec pulse duration,
35-pps frequency, 2-sec ramp up, 0-sec ramp down, and 15-sec contraction time, and 45-sec
rest between repetitions.
After 2 weeks of NMES, her volitional quadriceps force exceeded her elicited force.
Use of Neuromuscular Electrical Stimulation in the Treatment of Use
of Neuromuscular Electrical Stimulation in the treatment of Neonatal
Brachial Plexus Palsy: A Literature Review (Denise Justice et.al,
2018)

The review included 4 major studies, 2 studies were performed in Nigeria and others in India
and US. There were no significant changes in muscle power but there was an improvement in
Range of motion and morphometric parameters such as arm circumference. Therefore, mixed
evidence was obtained regarding its effectiveness.
Russian Stimulation/Functional Electrical Stimulation in the
Treatment of Foot Drop Resulting from Lumbar Radiculopathy: A
Case Series (Tina J. Wang et.al, 2019)
Russian stimulation” or “Russian currents” functional electric stimulation (FES) has been
beneficial for improving muscle force-generating ability as part of a physical therapy
regimen. It is a medium frequency generator that uses frequencies in the range of 2400 to
2500 Hz and is often used conjunctively in the management of athletic injuries, such as
anterior cruciate ligament (ACL) tears, with physical therapy programs to improve strength.
All patients were diagnosed with lumbar radiculopathy from physical examination and
imaging by physical medicine and rehabilitation. The study included the patients who
developed foot drop secondary to lumbar radiculopathy. The patients underwent Russian
stimulation with a single physical therapist. Manual muscle testing was conducted in
accordance with the Medical Research Council classification.
Russian stimulation was applied to the tibialis anterior muscle belly. A burst frequency of
50bps with 70mACC with 10/50 seconds on/off over 12 minutes and a 50-percent duty
cycle 50 percent was applied to the muscle to achieve tetany with volitional dorsiflexion to
the best of the patient’s abilities. The physical therapist-assisted foot dorsiflexion during the
“on” cycle to ease the pain. All patients were able to tolerate stimulation with a minimal
amount of discomfort and no adverse effects.
The results showed that Russian stimulation might serve as an effective nonsurgical option
for patients with lumbar radiculopathy resulting in foot drop.