Twitch-obtaining intramuscular stimulation (TOIMS) in acute partial radial nerve palsy

Twitch Obtaining Intramuscular Stimulation (TOIMS) is useful in the management of chronic nerve-related pain. The best understanding of the mechanism of action of TOIMS can occur on treating acute nerve-related symptoms. An opportunity to use TOIMS treatments in an acute, partial left radial palsy within 24 hours of onset did occur. Following treatment to the affected triceps and brachioradialis muscles, there was an immediate improvement in the amplitude, area and conduction velocity of the left radial motor and sensory nerves at the lower arm level. There was also improvement in numbness and all symptoms abolished after four treatments. Serial multiple motor unit action potential (multi-MUAP) analysis performed in the triceps and extensor communis (EDC) showed signs of motor unit enlargement. The triceps MUAPs showed an increase in duration and size index (area/amplitude) by the 3rd month. Both parameters stabilized at 18 months. Phases increased at the 6th month only. In EDC, the size index increased progressively by the 3rd month. The duration increased at the 6th month with stabilization by the 18th month. Phases and turns increased on day 3 examination only. EDC showed reduction in the firing rate with time. By relaxing the muscles through the effects of intramuscular exercise and also by improving local ischemia, TOIMS averted prolonged conduction abnormalities and probably a more serious axonal injury.