ZMPCZM016000.11.09 Electrotherpay study summaries for surgeons provided by medstar NW
Electrotherapy Study Summaries for Surgeons
Provided by MedStar NW
Representing Zynex Medical
Schmerz. 2005 Jun;15(3):158‐63.
Postoperative transcutaneous electrical nerve stimulation (TENS) in shoulder
surgery (randomized, double blind, placebo controlled pilot trial.
Likar R, Molnar M, Pipam W, Koppert W, Quantschnigg B, Disselhoff B, Sittl R.
BACKGROUND: The aim of this study was to determine whether 3 days of TENS therapy postoperatively
after shoulder operations would result in better pain relief and/or reduced analgesic intake when
compared to placebo. METHOD: The study was carried out randomized, double‐blind and placebo
controlled. Thirty patients were randomized to two groups. The verum group received TENS SM1AKS 80
Hz 6 mA and the placebo group received TENS SM1AKS 80 Hz 0 mA. The pain was assessed pre‐
operatively using the Hamburg Pain Adjective List. Premedication and Anaesthesia were standardized.
TENS was applied to the patients immediately postoperatively for 8 hours and then on the following
days 5 times daily for 45 minutes. The effectiveness was evaluated postoperatively using a visual
analogue scale (rest, activity), the Hamburg Pain Adjective List and postoperative analgesic
consumption. RESULTS: The visual analogue scale at rest and on activity showed no significant difference
between the groups. Postoperative analgesic consumption of morphine hydrochloride in the first 24
hours was at time 8 hours postoperative significantly and at all other time points markedly less in the
verum group compared to the placebo group. The sensory secondary scale score of the "Hamburg Pain
Adjective List" was significantly lower postoperatively compared to preoperatively in the verum group.
CONCLUSION: We were able to show in this study that TENS applied postoperatively after shoulder
surgery clearly reduced analgesic consumption in the first 72 hours. Furthermore there was a significant
difference in the pain scores using the "Hamburg Pain Adjective List" in favour of the verum group. TENS
applied postoperatively is a effective, simple modality with few side‐effects.
J Bone Joint Surg Am. 1995 Aug;77(8):1166‐73.
Strength of the quadriceps femoris muscle and functional recovery after
reconstruction of the anterior cruciate ligament. A prospective, randomized
clinical trial of electrical stimulation.
Snyder‐Mackler L, Delitto A, Bailey SL, Stralka SW.
Department of Physical Therapy, University of Delaware, Newark 19716, USA.
Immediately after reconstruction of the anterior cruciate ligament, 110 patients were randomly
assigned to treatment with high‐intensity neuromuscular electrical stimulation (thirty‐one patients),
high‐level volitional exercise (thirty‐four patients), low‐intensity neuromuscular electrical stimulation
(twenty‐five patients), or combined high and low‐intensity neuromuscular electrical stimulation (twenty
patients). All treatment was performed isometrically with the knee in 65 degrees of flexion. All of the
patients participated in an intensive program of closed‐kinetic‐chain exercise. After four weeks of
treatment, the strength of the quadriceps femoris muscle and the kinematics of the knee during stance
phase were measured. Quadriceps strength averaged 70 per cent or more of the strength on the
uninvolved side in the two groups that were treated with high‐intensity electrical stimulation (either
alone or combined with low‐intensity electrical stimulation), 57 per cent in the group that was treated
with high‐level volitional exercise, and 51 per cent in the group that was treated with low‐intensity
electrical stimulation. The kinematics of the knee joint were directly and significantly (p < 0.05)
correlated with the strength of the quadriceps. There was a clinically and statistically significant (p <
0.05) difference in the recovery of the quadriceps and the gait parameters according to the type of
operation that had been performed: the patients who had had reconstruction of the anterior cruciate
ligament with use of an autologous patellar‐ligament graft did poorly compared with the other patients.
J Bone Joint Surg Am. 1999 Aug;73(7):1025‐36.
Electrical stimulation of the thigh muscles after reconstruction of the anterior
cruciate ligament. Effects of electrically elicited contraction of the quadriceps
femoris and hamstring muscles on gait and on strength of the thigh muscles.
Snyder‐Mackler L, Ladin Z, Schepsis AA, Young JC.
Department of Physical Therapy, Sargent College of Allied Health Professions, Boston, Massachusetts
The effects of neuromuscular electrical stimulation on the strength of the thigh muscles and on gait
were examined in ten patients after reconstruction of the anterior cruciate ligament. The patients were
randomly assigned to one of two treatment groups: neuromuscular electrical stimulation and volitional
exercise, or volitional exercise alone. A four‐week course of electrically elicited co‐contraction of the
thigh muscles resulted in significant attenuation of the characteristic loss of strength of the quadriceps
as compared with volitional exercise. There was no significant difference between groups in any
measure of performance of the hamstring muscles. In the group that received neuromuscular electrical
stimulation, the values for cadence, walking velocity, stance time of the involved limb, and flexion‐
excursion of the knee during stance were significantly different from those of the volitional exercise
group. Flexion‐excursion of the knee during stance was directly and significantly correlated with
strength of the quadriceps femoris muscle. Flexion of the knee during stance was qualitatively different
in the involved extremity as compared with the uninvolved extremity in all patients. There is a rapid
flexion of the knee at weight acceptance that is maintained throughout stance and probably reflects
stabilization of the joint by muscular coactivation to compensate for weakness of the quadriceps. The
patients who received neuromuscular electrical stimulation had stronger quadriceps muscles and more
normal gait patterns than those in the volitional exercise group.
Clin J Sport Med. 2003 Jan;13(1):16‐20.
The effects of home interferential therapy on post‐operative pain, edema, and
range of motion of the knee.
Jarit GJ, Mohr KJ, Waller R, Glousman RE.
Kerlan‐Jobe Orthopaedic Clinic, Los Angeles, California 90045, USA.
OBJECTIVE: We studied the effects of home interferential current therapy (IFC) on postoperative pain,
range of motion, and edema in subjects undergoing anterior cruciate ligament (ACL) reconstruction,
menisectomy, or knee chondroplasty. DESIGN: Randomized, double‐blind, placebo‐controlled
prospective study. SETTING: A tertiary care outpatient orthopaedic clinic/ambulatory surgery center.
SUBJECTS OR PARTICIPANTS: Eighty‐seven subjects were separated into three groups based on their
type of knee surgery and within each group randomized into a treatment or placebo group.
INTERVENTIONS: All subjects received home IFC units. Subjects randomized to treatment group received
a working IFC unit. Placebo subjects received units that were previously set to deliver no current. MAIN
OUTCOME MEASUREMENTS: Post‐operative edema at 24, 48, and 72 hours, and weeks 1‐8; range of
motion at 1, 3, 6, and 9 weeks; pain immediately after surgery, at 24, 48, and 72 hours, and weeks 1‐7;
and amount of pain medication taken at days 1‐10 were compared between treatment and placebo
groups. RESULTS: All IFC subjects reported significantly less pain and had significantly greater range of
motion at all post‐operative time points. ACL and menisectomy IFC subjects experienced significantly
less edema at all time points, while chondroplasty subjects experienced significantly less edema until 4
weeks postoperatively. CONCLUSIONS: These findings indicate that home IFC may help reduce pain, pain
medication taken, and swelling while increasing range of motion in patients undergoing knee surgery.
This could result in quicker return to activities of daily living and athletic activities.
Electrical stimulation versus voluntary exercise in strengthening thigh
musculature after anterior cruciate ligament surgery.
Delitto A, Rose SJ, McKowen JM, Lehman RC, Thomas JA, Shively RA.
Program in Physical Therapy, Washington University Medical School, St. Louis, MO.
Phys Ther 1998 Jul;68(7):1145.
Twenty patients who had undergone anterior cruciate ligament reconstructive surgery were placed
randomly and independently in an Electrical Stimulation Group (n = 10) or Voluntary Exercise Group (n =
10) to compare the effectiveness of these two muscle‐strengthening protocols. Patients in both groups
used simultaneous contraction of quadriceps femoris and hamstring muscles during a training regimen
that consisted of either voluntary exercise or electrical stimulation trials five days a week for a three‐
week period within the first six postoperative weeks. After patients completed the training regimen,
bilateral maximal isometric measurements of gravity‐corrected knee extension and flexion torque were
obtained for both groups and percentages were calculated. Results showed that patients in the
Electrical Stimulation Group finished the three‐week training regimen with higher percentages of both
extension and flexion torque when compared with patients in the Voluntary Exercise Group (extension: t
= 4.35, p less than .05; flexion; t = 6.64, p less than .05). These results indicate that patients in an
electrical stimulation regimen can achieve higher individual thigh musculature strength gains than
patients in a voluntary exercise regimen when simultaneous contraction of thigh muscles is prescribed
during an early phase of postoperative rehabilitation.
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