Conservative management of Achilles Tendinopathy: a case report

OBJECTIVE

To chronicle the conservative treatment and management of a 77-year old female patient presenting with chronic pain of 8 months duration in the midportion of the achilles tendon diagnosed as achilles tendinopathy.

CLINICAL FEATURES

The main clinical feature was pain in the midportion of the achilles tendon, 2 to 6 cm proximal to the calcaneal insertion. Symptom onset was gradual and unrelated to any acute trauma or overt injury mechanism.

INTERVENTION AND OUTCOME

The conservative treatment approach consisted of medical acupuncture with electrical stimulation, Graston Technique®, eccentric calf training, and rehabilitative exercise prescription. Outcome measures included verbal pain rating scale, lower extremity functional scale (LEFS), and a return to activities of daily living (ADLs). The patient attained long-term resolution of her complaint and at 12 month follow-up reported no recurrence of symptoms.

CONCLUSION

A combination of conservative rehabilitation strategies may be used by chiropractors to treat midportion achilles tendinopathy and allow an individual to return to pain free ADLs in a timely manner.

Two cases of work-related lateral epicondylopathy treated with Graston Technique® and conservative rehabilitation

OBJECTIVE

To chronicle the conservative treatment and management of two work-related cases of lateral elbow pain diagnosed as lateral epicondylopathy.

CLINICAL FEATURES

PATIENT 1: A 48-year old female presented with gradual onset of right lateral elbow pain over the course of six weeks related to work activities of repetitive flexion/extension movements of the wrist and finger keying. PATIENT 2: A 47-year old female presented with gradual onset of left lateral elbow pain over the course of four weeks related to work activities of repetitive squeezing and gripping.

INTERVENTION AND OUTCOME

The conservative treatment approach consisted of activity modification, bracing, medical acupuncture with electrical stimulation, Graston Technique®, and rehabilitative exercise prescription. Outcome measures included verbal pain rating scale (VPRS), QuickDASH Work Module Score (QDWMS), and a return to regular work activities. Both patients attained resolution of their complaints, and at eight month follow-up reported no recurrence of symptoms.

CONCLUSION

A combination of conservative rehabilitation strategies may be used by chiropractors to treat work-related lateral epicondylopathy and allow for individuals to minimize lost time related to this condition.

Conservative management of De Quervain's stenosing tenosynovitis: a case report

OBJECTIVE

To chronicle the conservative treatment and management of a 32-year old female patient presenting with radial wrist pain of 4 months duration, diagnosed as De Quervain's stenosing tenosynovitis.

CLINICAL FEATURES

The primary clinical feature is wrist pain at the radial styloid with resultant impairment of wrist, hand, and thumb function.

INTERVENTION AND OUTCOME

The conservative treatment approach consisted of activity modification, Graston Technique(®), and eccentric training. Outcome measures included verbal pain rating scale, QuickDASH Disability/Symptom Score, and a return to activities of daily living (ADLs). The patient attained symptom resolution and at 6 month follow-up reported no recurrence of wrist pain.

CONCLUSION

A combination of conservative rehabilitation strategies may be used by chiropractors to treat De Quervain's stenosing tenosynovitis and allow for an individual to return to pain free ADLs in a timely manner.

Conservative management of a lumbar compression fracture in an osteoporotic patient: a case report

OBJECTIVE

To chronicle the conservative treatment and management of an osteoporotic patient presenting with acute back pain resulting from a lumbar compression fracture.

CLINICAL FEATURES

A 74-year old male presented with acute back pain in the thoracolumbar region after an episode of lifting. Radiographic evaluation revealed generalized demineralization and a moderate wedge compression fracture at L1.

INTERVENTION AND OUTCOME

The conservative treatment approach included postural education, activity modification, interferential current, taping into extension, Graston Technique(®), and rehabilitative exercise prescription. Outcome measures included verbal pain rating scale, medication use, and a return to activities of daily living (ADLs). The patient attained long-term symptom resolution with no recurrence of pain at 12 month follow-up.

SUMMARY

A combination of conservative rehabilitation strategies may be successfully implemented to treat osteoporotic patients with mild to moderate osteoporotic vertebral compression fracture of the lumbar spine.

Pantalar and tibiotalocalcaneal arthrodesis for post-traumatic osteoarthrosis of the ankle and hindfoot

Twenty-one patients had a unilateral extended arthrodesis of the ankle and hindfoot (a tibiotalocalcaneal procedure in thirteen patients and a pantalar procedure in eight) for post-traumatic osteoarthrosis or deformity, or both. The operation was performed through a transfibular extended lateral approach, and autogenous bone graft and rigid internal fixation was used. A final alignment of 0 to 5 degrees of valgus, 0 to 5 degrees of calcaneus, and external rotation equal to that of the contralateral side was sought. Subjective and objective evaluation, including a personal interview, physical examination, and radiographic and dynamic pedobarographic analysis, was performed at a mean interval of thirty-two months (range, twenty-four to fifty-four months) after the operation. A solid fusion was achieved in eighteen (86 per cent) of the twenty-one patients. There were five malunions (24 per cent) and two superficial wound problems (10 per cent). Of the seventeen patients who were not retired from work, eleven returned to work: nine to an occupation that involved standing and two to a sedentary occupation. Although seventeen (81 per cent) of the twenty-one patients reported that they were much improved, twenty (95 per cent) had some pain, and most benefited from modifications in shoe-wear. Patients who had had a tibiotalocalcaneal arthrodesis were more mobile and functioned at a higher level than those who had had a pantalar arthrodesis. Extended arthrodesis of the ankle and hindfoot is a complex, technically demanding procedure, and should be regarded as a salvage operation capable of producing a satisfactory result and usually providing a reasonable alternative to amputation.