NeuroQuantology | March 2023 | Volume21 | Issue 5 | Page 1728-1733| doi: 10.48047/nq.2023.21.05.

NQ222165
Bhakti Kishor Nirmal et al/LONG WAVE DIATHERMY COMBINED WITH PHYSIOTHERAPY MANAGEMENT FOR POST OPERATIVE ELBOW
STIFFNESS: A CASE STUDY

LONG WAVE DIATHERMY COMBINED WITH

PHYSIOTHERAPY MANAGEMENT FOR POST
OPERATIVE ELBOW STIFFNESS: A CASE STUDY
AUTHORS AFFLIATIONS:
1.Bhakti Kishor Nirmal
Affiliations: Intern, MGM Institute of Physiotherapy,Aurangabad.Maharashtra University of Health
Sciences, Nashik (MUHS).EmailID:bhaktinirmal22@gmail.com
2.Shaikh Amreen Afsarpatel
Affiliations: Clinical Physiotherapist, Musculoskeletal department, MGM School of Physiotherapy,
Aurangabad, a constituent unit of MGMIHS, Navi Mumbai. Maharashtra, IndiaEmail ID:
amreenshaikh96pt@gmail.com
3.Shruti Dnyaneshwar Ramekar(Corresponding Author)
Affiliations: -Intern, MGM School of Physiotherapy, Aurangabad, a constitute unit of MGMIHS,
Navi Mumbai, Maharashtra, India.Email ID: shrutiramekar111@gmail.com
4.Shelke Amruta Mahadev
Affiliations: Intern,Musculoskeletal department,School of Physiotherapy, Aurangabad,
aconstituent unit of MGMIHS, Navi Mumbai. Maharashtra,IndiaEmail ID:
amrutashelke908@gmail.com
5.Jadhav Pooja Keshav
Affiliations: Intern,Musculoskeletal department,School of Physiotherapy, Aurangabad,
aconstituent unit of MGMIHS, Navi Mumbai. Maharashtra,IndiaEmail ID:pj970629@gmail.com
6.Laxmi Raghu Pillai
Affiliations: Intern,Musculoskeletal department,School of Physiotherapy, Aurangabad,
aconstituent unit of MGMIHS, Navi Mumbai. Maharashtra,IndiaEmail ID:laxmipillai55@gmail.com 1728

ABSTRACT
Background: Elbow stiffness is a common complication after elbow surgeries. Physiotherapy
rehabilitation plays a crucial role in restoring elbow function after surgery. Long-wave diathermy
(LWD) is a widely used modality in postoperative management of elbow stiffness.
Case Description: A 51-year-old female homemaker was sent toPhysiotherapy department She
experienced discomfort and stiffness around the elbow joint.the patient was involved in an RTA. It
was revealed a fracture of the right olecranon compound III B fracture with a right head fracture.
She underwent ORIF surgery with olecranon plating. On the Numerical Pain Rating Scale (NPRS), the
pain was 7/10 while activity (movement)PT intervention was more conservative with LWD to
manage her pain.
Conclusion: Postoperative long-wave diathermy for elbow stiffness can be a helpful therapy option
for improving joint mobility and reducing discomfort. Long-wave diathermy combined with joint
mobilisation exercises may produce greater results than either method alone.
DOINumber:10.48047/nq.2023.21.5.NQ222165 NeuroQuantology2023;21(5):1728-1733

eISSN1303-5150 www.neuroquantology.com
NeuroQuantology | March 2023 | Volume21 | Issue 5 | Page 1728-1733| doi: 10.48047/nq.2023.21.05.NQ222165
Bhakti Kishor Nirmal et al/LONG WAVE DIATHERMY COMBINED WITH PHYSIOTHERAPY MANAGEMENT FOR POST OPERATIVE ELBOW
STIFFNESS: A CASE STUDY
INTRODUCTION:
Elbow stiffness refers to limited
movement of the elbow joint, with a loss of
greater than 30 degrees in extension but less
than 120 degrees in flexion. Causes of elbow
stiffness can be classified as traumatic, such
as a result of injury, or atraumatic, such as
arthritis or nerve damage. It can also be
congenital, present from birth, or acquired,
developed later in life. The stability
components of the elbow, such as ligaments,
bones, and muscles, play a role in determining
the range of motion, and any disruption to
these components can lead to decreased
mobility. Patients with elbow stiffness after
fracture reduction and stabilization are
evaluated, and the findings suggest that
thickening of the soft tissues, particularly the
capsule, is linked to decreased range of
motion (ROM)[1].
Painless mobility at the elbow joint is vital for
appropriate function because it allows
humans to arrange their hands in space.
Following a traumatic injury, a series of
circumstances may occur, resulting in a
reduction in passive range of motion from the
usual anatomic arc. Post-traumatic stiffness,
or arthrofibrosis, in the elbow joint is
functionally restrictive and has a negative
impact on quality of life [2]. It is characterised
as intrinsic (intra-articular) or extrinsic
(extraarticular). Patients who have
established risk factors for the development
of heterotopic ossification (HO) and suffer
severe elbow injuries. Indomethacin or
radiation therapy for prophylaxis. Preliminary
HO excision found to be reliable and effective.
It is critical to properly analyse the range of
motion (ROM) of the elbow. It is critical to
identify whether the patient has a physically
compromised elbow ROM that has been
proved to be stable and successful based on
experience and physical examination. It is
critical to determine if thehas functional
elbow ROM by history and physical
examination [3].
Long Wave Diathermy is commonly used to
reduce pain, improve metabolic activities,
raise deep tissue temperature, and improve
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range of motion. Although the depth of tissue
heating varies depending on the
thermotherapy modality, the basic
physiological responses and advantage of
using heat remain relatively constant and
include: increased circulation and blood flow,
increased metabolism, increased muscle
temperature, increased tissue temperature,
decreased pain, decreased tissue stiffness,
and muscle spasm relaxation. Long Wave
Diathermy employs an electric current to
generate heat deep into a specific tissue. It
can penetrate as far as two inches beneath
the skin's surface[4].
CASE DESCRIPTION:
A 51-year-old female homemaker was
sent to MGM Physiotherapy in Aurangabad's
Musculoskeletal Department. She
experienced discomfort and stiffness around
the elbow joint. Her history revealed that
about 1.5 months ago, the patient was
involved in an RTA. She was brought to a local
hospital where tests revealed a fracture of the
right olecranon compound III B fracture with a
right head fracture. She underwent ORIF 1729
surgery with olecranon plating.
PATIENT INFORMATION:
SUBJECTIVE FINDINGS:
Patient has a dull aching quality type
of pain at elbow joint.On the Numerical Pain
Rating Scale (NPRS), the pain was 7/10 while
activity (movement) and 2/10 during rest. Her
activities of daily living were substantially
hampered. She also mentions the pain
aggravates while movement. Because of pain
patient is having difficulty in performing
household chores. Patients appears to have
history of Hypertension since,12 years for
which she takes daily dose of medications.
CLINICAL FINDINGS:
In the evaluation procedure, in
postural assessment we found out that her
rightside scapula is protracted. Tenderness is
present over the right olecranon process.
Grade 3 swelling is positive over the wrist and
elbow joint. Superficial, deep, combined
sensations are normal and intact.
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NeuroQuantology | March 2023 | Volume21 | Issue 5 | Page 1728-1733| doi: 10.48047/nq.2023.21.05.NQ222165
Bhakti Kishor Nirmal et al/LONG WAVE DIATHERMY COMBINED WITH PHYSIOTHERAPY MANAGEMENT FOR POST OPERATIVE ELBOW
STIFFNESS: A CASE STUDY

JOINT EXAMINATION

JOINT PRE TREATEMENT POST END FEEL

AROM/ PROM TREATEMENT
AROM/ PROM
WRIST FLEXION Incomplete and Complete and Empty
painful painfree
WRIST EXTENSION Incomplete and Complete and Empty
painful painfree
RADIAL DEVIATION Incomplete and Incomplete and Empty
painful painfree
ULNAR DEVIATION Incomplete and Incomplete and Empty
painful painfree
ELBOW FLEXION Incomplete and Incomplete and Empty
painful painful
ELBOW EXTENSION Incomplete and Incomplete and Empty
painful painful 1730
Table 1.1: Joint Range of motion Pre and Post treatment and its end feel.
MANUAL MUSCLE TESTING
MUSCLE RT. PRE LT. PRE RT.POST LT POST
STRENGTH TREATEMENT TREATEMENT TREATEMENT TREATEMENT
SHOULDER 3+ 5 4 5
FLEXORS
EXTENSORS 4 5 5 5
ABDUCTORS 4 5 5 5
ADDUCTORS 4 5 5 5
MEDIAL 3+ 5 4 5
ROTATORS
LATRAL 3+ 5 4 5
ROTATORS
ELBOW 3 4+ 3+ 4+
FLEXORS
EXTENSORS 3 4+ 3+ 4+
WRIST 3 4+ 4 4+
FLEXORS
EXTENSORS 3 4+ 4 4+
RADIAL 3+ 4+ 4 4+
DEVIATORS
ULNAR 3+ 4+ 4 4+
DAVIATORS
Table 1.2: Baseline MRC muscle power grading [pre -treatment and post-treatment]

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NeuroQuantology | March 2023 | Volume21 | Issue 5 | Page 1728-1733| doi: 10.48047/nq.2023.21.05.NQ222165
Bhakti Kishor Nirmal et al/LONG WAVE DIATHERMY COMBINED WITH PHYSIOTHERAPY MANAGEMENT FOR POST OPERATIVE ELBOW
STIFFNESS: A CASE STUDY
Fig.1 Preoperative Xray
DIAGNOSTIC EVALUATION: Some radiological
investigation, like X-ray, were assessed on the
basis on subjective and objective evaluation.
Finally ,findings are positive for Postoperative
Elbow stiffness.
THERAPEUTIC INTERVENTION:
Initially in this case, a combination of
physical therapy interventions were used to
address pain, stiffness, and muscle integrity of
the elbow joint, shoulder, and
wrist.Cryotherapy was used to reduce pain in
the affected area. This involves the
application of cold therapy for a duration of 5
to 10 minutes, twice a day. This can help to
reduce inflammation and swelling in the area,
which can contribute to pain. Long wave
diathermy was also used to reduce pain,
decrease stiffness, and improve muscle
integrity in the elbow joint. This involves the
use of a high-frequency electrical current to
generate heat in the affected area, which can
help to increase blood flow, reduce stiffness,
and promote healing.the intensity of LWD for
post-operative elbow stiffness will typically
range from 100 to 150 watts was used for 10
to 15minutes.Wand exercises, strengthening
with theraband and dumbbell exercises, finger
ladder exercises, and pulley exercises were
also introduced to address the shoulder.
These exercises can help to improve range of
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Fig.2 Postoperative Xray
motion, strengthen muscles, and improve 1731
muscle integrity in the affected area.For the
elbow joint, Kalternborn mobilization and
mainland mobilization techniques (scooping)
were used. These techniques involve the use
of gentle, controlled movements to mobilize
the joint, reduce stiffness, and improve range
of motion.A Paraffin wax bath was used for
the wrist to reduce pain and stiffness. This
involves immersing the affected area in warm
paraffin wax, which can help to increase blood
flow, reduce stiffness, and promote
healing.Finally, ergonomic advice was given to
address any factors that may be contributing
to the patient's symptoms. This may involve
adjustments to work or daily activities to
reduce strain on the affected area.Frequent
breaks can help you avoid overuse injuries
that can lead to elbow stiffness. Try taking a
10-15 minute break every hour or so to
stretch your arms and move around.Consider
investing in ergonomic tools that are designed
to reduce strain on your arms and elbows. For
example, using a kitchen tool with an
ergonomic handle can help reduce stress on
your elbow joints.Make sure you're sitting or
standing with good posture to help reduce the
strain on your elbows. Avoid hunching over or
slouching, and make sure your shoulders are
relaxed.Overall, this combination of
interventions aims to reduce pain, improve
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NeuroQuantology | March 2023 | Volume21 | Issue 5 | Page 1728-1733| doi: 10.48047/nq.2023.21.05.NQ222165
Bhakti Kishor Nirmal et al/LONG WAVE DIATHERMY COMBINED WITH PHYSIOTHERAPY MANAGEMENT FOR POST OPERATIVE ELBOW
STIFFNESS: A CASE STUDY

the range of motion, and promote healing in the affected areas.

1732

Fig.3 Application of LWD on elbow joint Fig.4 Strengthening Exercise of elbow

joint
FOLLOW-UP AND OUTCOMES
Outcomes used was Visual analogue scale [VAS] and Numerical Pain rating Scale[NPRS].
Outcome Pre-treatment 1st Post -treatment
measures Day of 1st week last Day of 2nd
week
VAS scale 7 3
NPRS scale 7/10 3/10

INTERVENTION ADHERENCE AND patients with postoperative elbow stiffness.

TOLERABILITY-
The patient played an active role by looking at
specific rehabilitation and exercises.
ADVERSE AND UNANTICIPATED EVENTS-
Neither unpleasant or unexpected incidents
happened.
DISCUSSION:
Long-wave diathermy is a therapeutic
modality that uses high-frequency
electromagnetic waves to generate heat in
deep tissues, leading to increased blood flow,
reduced pain, and improved joint mobility. It
can be an effective treatment option for
postoperative elbow stiffness, as it helps to
reduce pain, inflammation, and muscle spasm,
thus facilitating joint movement.
In a study by Choudhary et al. (2017)[5], long-
wave diathermy was found to significantly
improve elbow ROM and reduce pain in
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The authors concluded that long-wave
diathermy can be an effective and safe
treatment modality for elbow stiffness
following surgical procedures.
In another study by Jia et al. (2021)[6], the
authors investigated the effects of long-wave
diathermy combined with joint mobilization
exercises in patients with postoperative elbow
stiffness. The results showed that the
combination of long-wave diathermy and joint
mobilization exercises significantly improved
elbow ROM and reduced pain compared to
joint mobilization exercises alone.
Studies of Chapman-Jones et al., 2017[7]; Ersoy
et al., 2020; Habib et al., 2018have shown
that long-wave diathermy is effective in
reducing pain, increasing range of motion
(ROM), and improving elbow function in
patients with elbow stiffness post-surgery.
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NeuroQuantology | March 2023 | Volume21 | Issue 5 | Page 1728-1733| doi: 10.48047/nq.2023.21.05.NQ222165
Bhakti Kishor Nirmal et al/LONG WAVE DIATHERMY COMBINED WITH PHYSIOTHERAPY MANAGEMENT FOR POST OPERATIVE ELBOW
STIFFNESS: A CASE STUDY

CONCLUSION: 3. Keschner MT, Paksima N. The stiff

Postoperative management of elbow elbow. Bull NYU Hosp Jt Dis.
stiffness with long-wave diathermy can be an 2007;65(1):24-28.
effective treatment option to improve joint 4. Aishwarya B, Noble Nelson Long Wave
mobility and reduce pain. The combination of Diathermy Therapy for Pain Relief.
long-wave diathermy and joint mobilization ISSN 2394 – 3386
exercises may provide better outcomes than 5. Choudhary, A., Soni, R., & Singh, S.
either modality alone. However, further (2017). Role of long wave diathermy
research is needed to determine the optimal in post-operative elbow stiffness.
treatment regimen for postoperative elbow Journal of Clinical Orthopaedics and
stiffness. Trauma, 8(Suppl 2), S58-S62.
PATIENT PERSPECTIVE https://doi.org/10.1016/j.jcot.2016.1
The patient's perspective was that she 0.014
was so stressed out by pain that she 6. Jia, Y., Feng, Y., Zhang, Z., & Sun, J.
complained with an VAS score of 7/10 on day (2021). Long-wave diathermy
one, but that her pain had dropped to 3/10 on combined with joint mobilization
the VAS scale at the end of the fourth week. exercises for postoperative elbow
INFORMED CONSENT stiffness: A randomized controlled
Yes, patient’s informed consent was trial. Journal of Hand Therapy, 34(3),
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https://doi.org/10.1016/j.jht.2020.03.
HUMANETHICS: 002
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