Abstract
Background and purpose Neuromuscular electrical stimulation (NMES) is a modality sometimes used to help
strengthen weak muscles. On occasion, however, the targeted muscles do not respond
to the current delivered. No response to electrical stimulation should raise the consideration
of unsuspected peripheral nerve damage. Two case studies are presented showing how
absence of response was due to unsuspected peripheral neuropathy, which had not been
considered in either of the original referral diagnoses.
Case descriptions The first individual sustained head trauma and did not respond to NMES to facilitate
finger flexor contractions in the left hand. This prompted a reaction of degeneration
test (R/D test) which revealed evidence of a median nerve lesion. The second individual
presented with right ankle dorsiflexor and evertor paralysis following a right total
hip replacement. The R/D test helped rule out a central nervous system lesion by revealing
evidence of right peroneal nerve degeneration.
Conclusion The case reports show how clinical suspicion followed by simple R/D testing can be
used to screen for nerve damage, prompting further electrodiagnostic work up of individuals
with profound weakness and or paralysis.
Keywords
Peripheral nerve lesion - Reaction of degeneration test - Electrodiagnosis
