Objective: The purpose of this case report is to describe chiropractic management of a patient with arm and hand numbness and who was suspected to have ulnar nerve compression. Clinical Features: A 41-year-old woman presented with hand weakness and numbness along the medial aspect of her right forearm and the 3 most medial fingers. The onset of symptoms presented suddenly, 3 weeks prior, when she woke up in the morning and assumed she had "slept wrong." The patient's posture showed protracted shoulders and moderate forward head carriage. Orthopedic assessment revealed symptomatic right elevated arm stress test, grip strength asymmetry, and a Tinel sign at the right cubital tunnel. Intervention and Outcome: The patient was treated using chiropractic care, which consisted of manipulative therapy, myofascial therapy, and elastic therapeutic taping. Active home care included performing postural exercises and education about workstation ergonomics. She demonstrated immediate subjective improvement of her numbness and weakness after the first treatment. Over a series of 11 treatments, her symptoms resolved completely; and she was able to perform work tasks without dysfunction. Conclusion: Chiropractic treatment consisting of manipulation, soft tissue mobilizations, exercise, and education of workstation ergonomics appeared to reduce the symptoms of ulnar nerve compression symptoms for this patient.
Objective: The purpose of this case report is to describe a case where calcium pyrophosphate dehydrate crystal deposition disease (CPPD) simulated osteoarthritis of the knee. Clinical Features: A 78-year-old woman had a 2-week history of severe right knee pain accompanied by mild swelling. The onset was sudden and did not involve a history of trauma or previous injury to the right knee. Inspection and palpation revealed pain along the medial joint line and marked difficulty ambulating. Results of Lachman's test, anterior drawer test, and posterior sag sign were negative upon orthopedic assessment. Diagnostic imaging was performed and showed degenerative changes with diffuse calcification of the fibrocartilage and hyaline articular cartilage within the knee joint and the medial collateral ligament consistent with the appearance of CPPD crystal deposition. Intervention and Outcome: Low-level laser therapy was performed to the affected medial joint line of the knee, and knee stabilization exercises were given. Lower Extremity Function Scale changed from 34% to 60% after 4 weeks of care. Conclusion: Although knee osteoarthritis is much more common than knee CPPD, it is important to consider both diagnoses in elderly patients who present with unilateral knee pain. Diagnosis should be based on clinical presentation, history, and radiographic or histological means to ensure accuracy and proper diagnosis. (J Chiropr Med 2016;15:219-223)
This case illustrates the importance of considering leg length inequality in patients with amputations as a possible cause of lower back pain, and that proper management may include adjusting the length of the prosthetic device and strengthening of the hip flexors and abductors, in addition to trigger point therapy and chiropractic manipulation.
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