Intramuscular Electrical Stimulation for Muscle Activation of Tibialis Anterior After Surgical Repair: A Case Report.

J Orthop Sports Phys Ther. 2017 Oct 15;:1-19

Authors: Hollis S, McClure P

Abstract
Study Design Case report. Background Loss of voluntary activation of musculature can result in muscle weakness. External neuromuscular stimulation can be utilized to improve voluntary activation but is often poorly tolerated because of pain associated with required stimulus level. Intramuscular electrical stimulation requires much lower voltage and may be better tolerated and therefore more effective at restoring voluntary muscle activation. Case Description A 71-year-old male sustained a rupture of the distal attachment of the tibialis anterior tendon. Thirty-two weeks after surgical repair, there was no palpable or visible tension development in the muscle belly or tendon. Dorsiflexion was dependent on toe extensors. Electrical stimulation applied via a dry needling placement in the muscle belly was utilized to induce an isometric contraction. Outcomes Four sessions of intramuscular electrical stimulation were delivered. By day four (2nd visit), the patient was able to dorsiflex without prominent use of extensor hallucis longus. By day six (3rd visit), active range of motion dorsiflexion with toes flexed increased 20° (-10° to 10°). Eighteen days after the initial treatment, the patient walked without his previous high-steppage gait pattern and the tibialis anterior muscle test improved to withstanding moderate resistance (manual muscle test score 4/5). Discussion The rapid change in muscle function observed suggests intramuscular electrical stimulation may facilitate voluntary muscle activation. Level of Evidence Therapy, level 5. J Orthop Sports Phys Ther, Epub 15 Oct 2017. doi:10.2519/jospt.2017.7368.

PMID: 29034798 [PubMed – as supplied by publisher]