“EFFICACY OF FARADIC ELECTRICAL

STIMULTION IN REDUCING PAIN AND

RANGE OF MOTION IN PATIENTS WITH
CHRONIC LATERAL EPICONDYLITIS’’
 INTRODUCTION

Lateral epicondilitis is most common over use syndrome which is a

classic repetitive strain injury seen all over the world. Though it is not a
complicated problem it had exposed to light due to problems associated
with it. It got importance because of its frequent incidence in all age
groups précising people in manual works

 LATERAL EPICONDILITIS:

 It is a pathological condition of common extensor muscles

at its origin on lateral humeral condyle.

 Lateral epicondilitis is a painful condition affecting the

tendinous origin of common wrist extensor from lateral
epicondyle.

It is also called as LATERAL EPICONDYLAGIA, (OR) LATERAL

EPICONDYLOSIS (OR) TENNIS ELBOW. It is a combination of chronic
exhaustion and irritation in muscles and tendons on back of forearm
and outside of elbow today this condition is better called as
‘’COMPUTER ELBOW’’
  FARADIC CURRENT:

 Faradic current is a low frequency pulsed current which is

asymmetrically biphasic of frequency between 30 and 70 HZ.
This faradic current in both unipolar and bipolar does the
great deal in reducing pain, swelling, increasing venous and
lymphatic drainage. Comparative to galvanic current this is
best in stimulating long muscles and creating lot of
advantages to patients

SURGING:

The process of giving relaxation to the tetanic contraction

produced by faradic current is called surging.

i. Trapezoidal surging:

The impulses increases and decreases gradually forming

trapezoidal shape

ii. Triangular surging:

The impulses increases and decreases gradually forming
triangular shape

iii. Saw Tooth:

 The impulses increases gradually but suddenly fall.
In this study I am going to find the efficacy of electrical stimulation with
surged faradic currents in tennis elbow
 NEED FOR STUDY:

It is generally a work related or sport related pain disorder usually

caused by excessive quick, monotonous, repetitive eccentric
contractions and gripping activities of the wrist. Many of the studies are
done on effective of electrotherapy in tennis elbow but none had a
practical based study on surged faradic current efficacy on tennis so this
study proves that.
  AIM OF STUDY:

To find the efficacy of surged faradic current stimulation in tennis elbow.

 .Objectives of the Study:

 To reduce pain
 To improve range of motion of elbow and wrist
 To improve ADL’S
 HYPOTHESIS

 Null Hypothesis
There is no significant reduction of pain and improvement of range of
motion in tennis elbow with surged faradic currents

 Alternative Hypothesis
There is significant reduction of pain and improvement of range of
motion in tennis elbow with surged faradic currents
AETIOLOGY
The major aetiology of tennis elbow are divided into extrinsic and
intrinsic factors

TENNIS ELBOW

EXTRENSIC FACTORS INTRENSIC FACTORS

Repetitive stress anatomical factors

Forceful activity age related factors

Manual labour systemic factors

Other:

 Epicondilitis
 Calcific deposits
 Painful annular ligament

 PERSONS IN RISK:
 -athletes
 -plumbers
 Painters
 cooks
  -butchers
 Carpenters
 House wife
 Person works on computer

RISK FACTORS:

 Obesity
 Manual labour
 Repetitive movements
 Forceful activities
EPIDEMIOLOGY
An epidemiological study of the incidence and recurrence of the
tennis elbow among over 500 tennis players (278 men, 254
women age range between 20 & 50 years) that is 39.7%oftennis
players and total annual incidence is 1 – 3%

persons affected

male
48% female

52%
ANATOMY
The main joint here is Elbow joint which is synovial joint of hinge type

 Lower end of humerus:

The lower end of humerus formed the condyle which is

expanded from two sides and has articular and non-articular parts. In
articular part includes “capitulum” or “trochela” where as in non-articular
part includes lateral epicondyle, lateral supracondular, medial supra
condylar ridge, coronoid fossa, radial fossa, olecranon fossa.

 Lateral epicondyle

It is smaller than the medical epicondyle. Its antero- lateral part has a
muscular impression.
  Ligaments of the elbow joint:

 CAPSULAR LIGAMENT:
Superiorly it is attached to lower end of humerus in such a
way that the capitulum, trochled, the medial fossa, coronoid fossa
& olecranon fossa is intracapsular

 ANTERIOR AND POSTERIOR LIGAMENTS:

These ligaments are thickening of capsule

 ULNAR COLLETERAL LIGAMENT:

It is triangular in shape. Its apex of attached to medial

epicondyle of humerus and its base to ulna.

 RADIAL COLLTERAL LIGAMENT:

It is a foot shaped band extending from lateral epicondyle to
angular ligament.
 Relationships of the elbow joint:
 Anteriorly : Brachialis and median nerve
 Posteriorly: Triceps and anconeus
 Medially: Ulnar nerve
 laterally: Supinator muscles

 Blood supply:
 Brachial artery
 Radial artery
 Ulnar artery

 Nerve supply:
 Median nerve
 radial nerve
 musculo cutaneous nerve
 Muscles originated:
 Brachioradialis
 Anconeus
 Extensor Carpi radialis longus
 Extensor Carpi radialis brevis
 Extensor digitorum
 Extensor digiti minimi
 Extensor Carpi ulnaris
PATHOPHYSIOLOGY
Due to repetitive stress or over use the tendinous origin of extensors get
damaged followed by tear which occurs at teno periosteal junction
resulting in inflammation producing exudates granulation tissue finally
tenodesis.

Injury or repeated stress

granulation tissue and degenerative changes at teno
microrupture peri osteal junction

calcification as a result of hypovascularisation

intrasubstance tear tendinitis

irregularities of epicondyle
Lateral epicondylitis
BIOMECHANICS
Elbow stability and stabilizing structures:

Stabilizers

Passive stabilizers Active stabilizers

Passive bony stabilizers

Passive soft tissue stabilizers

Force transmission through

Interplay between passive stabilizers elbow

(1)PASSIVE STABILIZERS:

The passive and active stabilizers provide biomechanical stability in the

elbow joint.

(a)PASSIVE BONY STABILIZERS:

The ulna humeral joint is a highly congruous joint and is a dominant

factor as a passive bony stabilizer. The contact areas in the elbow joint
vary with the type of applies stress. Contact areas occur at four facets in
the sigmoid fossa, 2 at coronoid and 2 at the olecranon with virus and
valgus, the contact changes medially laterally. 4 separate areas of
contact in sigmoid fossa. Contact moves towards the centre of the
sigmoid during flexion. The carrying angle orientation changes from a
valgus orientation in extension to varus orientation in flexion.
(b) Passive soft tissue stabilizers:

It is include the medial & lateral collateral ligament complexes and the
anterior capsule.

(C)INTERPLAY BETWEEN PASSIVE STABILIZERS:

 The contributions of the articular geometry and ligaments to varus

& valgus loads were studied.

(2)ACTIVE STABILIZERS:

 These balanced forces likely function as dynamic stabilizers of the

joint.
 From the muscles crossing the elbow joint, the brachialis and
triceps muscles have the largest work capacity and contractile
strength.

(3)MOVEMENTS:

 SUPINATION AND PRONATION:

The 1* motion of the forearm is supinaton and pronation, with the axis of
rotation passing from the proximal radial head to the convex articular
surface of the ulna at the distal radio Ulnar joint (in ADL 50* pronation &
50* supinaton).

 FLEXION AND EXTENSION:

In elbow flexion and extension (in ADL 30* and 130*), the deviation of
joint rotation is minimal, and elbow motion can be thought of as a
uniaxial joint
(4)RANGE OF MOTION:

Normal range of motion is from 0-150 degrees and forearm rotation

averages 75 degrees pronation and 85 degrees supinaton.
PATHOMECHANICS
Due to hyper vascularisation and degenerative process there is
pyramidal slope formation by deformation of lateral epicondyle, resulting
in pulling of origin of extensor Carpi radialis brevis resulting inactive
insufficiency. Muscle spasm resulting in limited extension movements

granulation tissue
degenrative changes
formation

deformation of
shape of lateral
muscle spasm
epicondye to
pyramidal shape

limited randge of
active insufficiency
extension and
of ECRB
supination
EXTENSORS OF ELBOW:

 Triceps is main extensor of elbow weakness of triceps has

profund effect on elbow extension. Functional implications of
zero elbow extension strength must be considered carefully in
upright position weight of fore arm and hand causes elbow to
extent pushing an object or using the upper extremity to
assist in raising from a chair requires active contraction of
triceps
 Tightness of triceps results in limited elbow flexion and
contribute to diminished shoulder elevation

SUPINATOR:

 Weakness of supinator results in weakened supination where

as tightness causes limited movement
CLASSIFICATION

OF

TENNIS ELBOW
There are two types of classification of lateral epicondilitis

1. PATTERNS BASIS:

a) PATTERN 4 D: there is impaired joint mobility, motor

function and range of motion associated with connective
tissue dysfunction
b) PATTERN 4 E: there is impaired joint mobility, motor function
and range of motion associated with localised inflammation

2. SEVEARITY BASIS:

a. ACUTE LATERAL EPICONDYLITIS

b. CHRONIC LATERAL EPICONDILITIS

CLINICAL FEATURES
 The most common presenting features are

1. Pain
2. Spasm on dorsal fore arm muscles
3. Fatigue
4. Restricted extension and supinaton movements
5. Tenderness
6. Effusion

 Common complaints are:

1. Diffuse pain
2. Morning stiffness
3. Occasional night pain
4. Dropping of objects
5. Pain at resisted extension
6. Popping or clicking sound heard on movement
INVESTIGATIONS
  SPECIAL TESTS:

1. COZEN’S TEST:

The patient is asked to make a fist, pronate the forearm, radially

deviated and the wrist against resistance.

-A positive test is indicated by pain in the lateral epicondyle

region or muscle weakness and may be indicative of lateral epicondilitis.

2, MILL’S TEST:

Therapist palpates the lateral epicondyle and pronates the patients

forearm, flexes the wrist and extends the elbow.

-A positive test is indicated by pain in the lateral epicondyle S

3, MAUDSLEYS LATERAL EPICONDYLITISN TEST:

Therapist resists extension of 3rd digit of the hand, stressing the extensor
digitorum muscle and tendon, while palpating the patient’s lateral
epicondyle.

A positive test is indicated by pain over the lateral epicondyle.

 REGULAR INVESTIGATIONS:

 X – RAY
 CT SCAN
 MRI SCAN
 NERVE CONDUCTION STUDIES
 ULTRASONOGRAPHY
MEDICAL MANEGEMENT
 DRUGS:

 NSAIDS
 ANALGESIS
 CORTICOSTEROIDS

 INJECTIONS:

 BOTULIN
 CORTICOSTEROIDS
 PLATELET RICH PLASMA INJECTIONS
 CORTISONE

 CONSERVATIVE BRACING

 DRY NEEDLING/ ACUPUNCTURE

 NITRATE PATCHES
SURGICAL MANAGEMENT
  OPEN SURGERY:

This is most common approach; this involves making an

incision over the elbow. Open surgery is usually performed as an
outpatient surgery.

 ARTHROSCOPIC SURRGERY:

Tennis elbow can also be repaired using tiny instruments and

small incisions.
PHYSIOTHERAPY MANAGEMENT
 SURGED FARADIC CURRENTS:

Surged faradic currents are low frequency currents used to

stimulate muscle groups nerve trunks. Due to surging property
patient is most comfortable without any burning sensation or
irritation which in a mean while produces relaxation

 THERAPEUTIC EFFECTS OF FARADICS CURRENTS:

 Stimulation of sensory nerves by vasodilatation

 Stimulation of motor nerves and produces repeated tetanic
conctrations of muscles supplied by corresponding nerve.
 Reduces swelling and pain
 Increases venous and lymphatic drainage
 Prevention and loosening of adhesions

The technique we are following here group muscle stimulation. As

we discussed earlier 4D PATTERN cases need to attend session
6-24 weeks and 4E PATTERN CASES should attend 3-36 weeks
of physiotherapy with other interventions but by use of surged
faradic currents the time period reduces by 6- 8 weeks
MATERIALS AND METHODS
 . METHOD OF COLLECTING DATA:

 Sampling technique : Random sampling technique.

The purpose of study was explained to all the subjects and an

informed concert was taken followed by demographic data from
each subject.

 Research design : Experimental study.

 Source of data : Narayana College of physiotherapy,

outpatient department.

 Sampling size : This study includes sample of 40

subjects.

 Study duration : Total duration of study is 4-15weeks.

 Study population : Both male and female 35-55 years of age

 SELECTION CRITERIA:

 INCLUSIVE CRITERIA:
 Both male and female.
 Patient with age group of 35-45 years.
 Patients with tennis elbow diagnosis will confirm by special
tests.
 Patient with tennis elbow diagnosed by orthopeadician.
 Lateral elbow chronic pain.
 Positive Cozens test and Mill’s test.
 Unilateral case (dominant extremity)

 EXCLUSION CRITERIA:

 Cases with bilateral symptoms.

 All extraneous cases like shoulder and cervical involvement.
 Recent history of trauma in upper limb.
 Recent history of surgery in upper limb.
 History of immobilization of elbow.
 History of inflammatory arthritis like rheumatoid arthritis.
 Recent steroid injection and anti-inflammatory drugs.
 Fibromyalgia.
 Myositis ossificans.
 Radial and posterior interrosseus nerve entrapment syndrome.
 Joint pathology like elbow arthritis.
 Carpal tunnel syndrome.
 Malignancy.
 Cardiovascular disease.
 Systemic disease such DM

 OUTCOME MEASURES:
 Pain
 ROM
 Muscle strength

 OUTCOME MEASUREMENTS SCALES:

 Visual analogue scale
 Goniometry
 Manual muscle testing.
 MATERIALS USED:

 Functional electrical stimulator

 Chair
 Goniometer
 Cotton
 Water
 Pillows
 Velcro’s
 Cotton
  METHODOLOGY:

 STEP 1: all the patients were assessed with a pre assessment

sheet and were informed about the study and got a consent
form
 STEP 2: all the patients were given surged faradic currents for a
session of 15- 20 min
 STEP 3 : for every 3 weeks assessment of outcome measures
were taken
 STEP 4: treatment is continued and final post assessment is
taken
All the patients were given treatment for 15- 20 minutes stimulating each
and every muscle for 25-30 times with weekly four days excluding
holidays and patients comfort until 4-15 weeks
CASE STUDY
 CASE 1
SUBJECTIVE ASSESMENT:

 NAME : K. ravi kumar

 AGE : 28
 SEX : Male
 Occupation : soft ware engineer
 ADDRESS : Subedarpet Nellore

CHIEF COMPLAINTS:

 Restricted movements
 Lateral elbow pain
 swelling

 MEDICAL HISTORY : elbow fracture

SUBJECTIVE ASSESMENT:

PAIN:

 Site of pain :lateral epicondyle

 Side of pain :right elbow
 Character of pain :pricing pain
 Aggravating factors :actives , prolonged compression
 Relieving factors : rest medications

ON OBSERVATION:
  Redness : present
 Swelling : present
 Posture : normal

ON PALPATION:

 Tempature : normal
 Tenderness : present
 Muscle spasm : present

ON EXAMINATION:

 Range of motion
Movement Active ROM Passive ROM
Elbow extension 135 - 50 135- 0
Supination 0 - 70 0 -90
Wrist extension 0 - 40 0 - 70

CASE 2
SUBJECTIVE ASSESMENT:
  NAME : v.parandammaiah
 AGE : 50
 SEX : Male
 Occupation : carpenter
 ADDRESS : sarvepalli

CHIEF COMPLAINTS:

 Restricted movements
 Lateral elbow pain
 Swelling

 MEDICAL HISTORY : nil

SUBJECTIVE ASSESMENT:

PAIN:

 Site of pain :lateral epicondyle

 Side of pain :right elbow
 Character of pain :pricing pain
 Breveting factors :activies , prolonged compression
 Relieving factors : rest medications

ON OBSERVATION:

 Redness : present
 Swelling : present
  Posture : normal

ON PALPATION:

 Tempature : normal
 Tenderness : present
 Muscle spasm : present

ON EXAMINATION:

 Range of motion
Movement Active ROM Passive ROM
Elbow extension 135 - 60 135- 0
Supination 0 - 50 0 -90
Wrist extension 0 - 50 0 - 70

CASE 3
SUBJECTIVE ASSESMENT:

 NAME : v.ramanaiah
  AGE : 54
 SEX : Male
 Occupation : butcher
 ADDRESS : dicous road , Nellore

CHIEF COMPLAINTS:

 Restricted movements
 Lateral elbow pain
 swelling

 MEDICAL HISTORY : nil

SUBJECTIVE ASSESMENT:

PAIN:

 Site of pain :lateral epicondyle

 Side of pain :right elbow
 Character of pain :pricing pain
 Breveting factors :activites , prolonged compression
 Relieving factors : rest medications

ON OBSERVATION:

 Redness : present
 Swelling : present
 Posture : normal

ON PALPATION:
  Tempature : normal
 Tenderness : present
 Muscle spasm : present

ON EXAMINATION:

 Range of motion
Movement Active ROM Passive ROM
Elbow extension 135 – 40 135- 0
Supination 0 – 70 0 -90
Wrist extension 0 – 50 0 - 70
DATA ANALYSIS

ELBOW EXTENSION
S.NO PRE TEST POST TEST

1 135 - 40 135 - 0

2 135 - 50 135 – 0

3 135 – 30 135 – 0

4 135 – 60 135 – 10

5 135 – 70 135 – 10

6 135 – 40 135 – 10

7 135 - 80 135 – 20

8 135 – 50 135 – 0

9 135 – 30 135 – 0

10 135 - 40 135 – 10

AVERAGE PRE TEST POST TEST

MEAN 49.0 6.0
MEDIAN 45 5
MODE 40 0,10
 SUPINATION
S.NO PRE TEST POST TEST

1 0 – 70 0 – 90

2 0 – 60 0 – 90

3 0 – 70 0 – 90

4 0 – 65 0 -90

5 0 – 50 0 – 82

6 0 – 50 0 – 85

7 0 – 48 0 – 80

8 0 – 60 0 – 90

9 0 – 80 0 – 90

10 0 – 60 0 – 90

AVERAGE PRE TEST POST TEST

MEAN 61.3 87.7
MEDIAN 60 90
MODE 60 90

WRIST EXTENSION
S.NO PRE TEST POST TEST

1 0 – 60 0 – 70

2 0 – 40 0 – 68

3 0 – 50 0 – 70

4 0 – 30 0 -50

5 0 – 30 0 – 50

6 0 – 60 0 – 70

7 0 – 46 0 – 60

8 0 – 38 0 – 50

9 0 – 60 0 – 70

10 0 – 52 0 – 70

AVERAGE PRE TEST POST TEST

MEAN 46.6 62.8
MEDIAN 48 69
MODE 60 70
% OF IMPROVEMENT FOR ELBOW EXTENSION =

Pre mean- post mean/ pre mean x 100

49.0-6/49 x 100 = 36.755

100

90 87.7

80

70
61.3 62.8
60
movement
50 46.6 pre mean

40 post mean

30

20

10

0
RESULT:

The pre and post mean values for elbow extension is 40.9 & 6.0. For
Supination pre mean and post mean is 61.3 and 87.7 where as for wrist
extension is 46.6 and 62.8.
DISCCUSSION:

Surged faradic current has got great improvement in improving

range of motion and reducing pain there is great improvement in many
subjects with in short time for both 4E & 4D PATTERNS. There is a clear
evidence of reduction in tissue inflammation and gradual improvement
by correcting biomechanics of joint without causing any discomfort to
patient.
CONCLUSION:

 To identify the varying results in two different regimes in all

patients were selected using simple random sampling technique

and were taken

 The VISUAL ANALOUGE SCAL FOR PAIN & GONOIOMETRY

reports were taken after their respective protocols, to expose the

facts regarding their effectiveness

 The study was experimental design. The collected data was

analyzed and interpreted, which showed a significant variation in
both scales
 Finally my study concluded that surged faradic currents are
effective in lateral epicondilitis patients
BIBILOGRAPHY:

 B D CHAURASIA’S TEXT BOOK OF HUMAN ANATOMY

 JOHN EBNEZAR text book of orthopaedics

 JOHN LOW ANN REED text book of electrotherapy

 CLATON’S text book of electro therapy

 APLEY’S text book of orthopaedic surgery