Study Design: Case report. Objectives: Patients with peripheral nerve injury may demonstrate long-lasting impairments and functional limitations. In this case report, we describe the assessment of a patient with a peripheral nerve injury and a conventional plan of care, along with the novel intervention of neuromuscular electrical stimulation (NMES). We feel that the additional NMES intervention was instrumental in achieving more rapid functional improvements than the more traditional interventions that are reported in the literature. Background: The patient was a 21-year-old male who sustained a forearm fracture that was complicated by injury to the anterior interosseous branch of the median nerve. He was unable to flex the interphalangeal (IP) joint of his thumb, had decreased strength of thenar eminence musculature, and was unable to perform fine motor activities with his hand. Methods and Measures: Electrophysiological tests revealed partial denervation of the flexor pollicis longus and pronator quadratus muscles. In the fifth physical therapy session, NMES to the flexor pollicis longus and thenar muscles was added to the patient’s conventional plan of care. Results: With a conventional ROM and strengthening plan of care, no improvement was seen in thumb IP joint flexion over a period of 2 weeks. After 3 sessions of NMES and conventional interventions, gains in active ROM were made in thumb IP joint flexion. After 9 sessions of NMES and conventional interventions, force of thumb IP flexion was registered on a pinch dynamometer. Twenty weeks after initial examination, strength and ROM measures had improved and the patient reported no functional deficits. Conclusions: The patient showed gains in strength of the thumb IP joint after a few NMES sessions, which suggests that NMES was a helpful adjunct to the plan of care, even though the precise mechanism underlying the functional gains are not known.

J Orthop Sport Phys Ther. 2004;34(2):47-56. doi:10.2519/jospt.2004.0885

Key Words: anterior interosseus nerve, neuromuscular electrical stimulation, thumb, upper extremity

We will discuss the mechanisms by which dynamic knee stability may be achieved and relate this to issues that interest clinicians and scientists concerned with dynamic knee stability. Emphasis is placed on the neurophysiologic evidence and theory related to neuromuscular control. Specific topics discussed include the ensemble firing of peripheral mechanoreceptors, the potential for muscle stiffness modulation via force and length feedback, postural control synergies, motor programs, and the neural control of gait. Factors related to answering the difficult question of whether or not knee ligament injuries can be prevented during athletic activities are discussed. Prevention programs that train athletes to perform their sport skills in a safe fashion are put forth as the most promising prospect for injury prevention. Methods of assessing neuromuscular function are reviewed critically and the need for future research in this area is emphasized. We conclude with a brief review of the literature regarding neuromuscular training programs.

J Orthop Sports Phys Ther. 2001;31(10):546-566.

Key Words: knee, stability