<![CDATA[Journal of Orthopaedic & Sports Physical Therapy - Laura C. Schmitt, PT, MSPT, ATC, MPT]]> http://www.jospt.org/lauracschmitt Wed, 30 Apr 2008 09:05:25 EST 0 Management of a Patient With a Forearm Fracture and Median Nerve Injury http://www.jospt.org/issues/articleID.256/article_detail.asp Laura C. Schmitt, Laura A. Schmitt, Katherine S. Rudolph

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

]]> http://www.jospt.org/issues/articleID.256/article_detail.asp Role of Scapular Stabilizers in Etiology and Treatment of Impingement Syndrome http://www.jospt.org/issues/articleID.592/article_detail.asp Laura C. Schmitt, Lynn Snyder-Mackler
Shoulder pain and dysfunction with overhead activities resulting from subacromial impingement syndrome is common. Subacromial impingement syndrome has generally been classified as primary or secondary. A thorough history and physical examination are essential to identifying the etiology of the subacromial impingement syndrome and to direct treatment. Primary subacromial impingement syndrome, resulting from mechanical encroachment into the subacromial space usually by an acromial hook or spurs, occurs in middle age. Individuals with primary subacromial impingement syndrome have symptoms of shoulder pain and weakness with overhead activities. Impingement tests (eg, Neer, Hawkins) are positive. Typically, external rotation, flexion, and abduction of the shoulder are weak and painful. Night pain, usually an inability to sleep on the painful shoulder, is a common symptom of the full-thickness rotator cuff tears that can also occur in this age group. Trauma is usually the mechanism of injury. Persons with secondary subacromial impingement syndrome also have symptoms of pain and weakness with overhead activities. These individuals are usually young and often participate in sports that require repetitive overhead motion (eg, baseball, swimming, volleyball). Symptoms with secondary impingement are attributed to rotator cuff tendinitis. These symptoms are thought to result from overuse of the rotator cuff tendons to compensate for subtle anterior or multidirectional glenohumeral instability. More recently, scapulothoracic muscle weakness has been identified as a cause of secondary subacromial impingement syndrome. Here, the lack of scapular stability is thought to contribute to secondary subacromial impingement syndrome. J Orthop Sports Phys Ther. 1999;29(1):31-38. Key Words: shoulder pain, subacromial, tendinitis]]> http://www.jospt.org/issues/articleID.592/article_detail.asp