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Case-Study 4

 

 
 
“E.G.” is a 64 year old, right-handed, female, lawyer.

History:

“E.G.” presents with an approximate 32-month history of intermittent neck pain and loss of range of neck movements. The pain is triggered primarily by sudden forces through the neck or by movements of the neck.

X-rays of the neck were normal.

An MRI showed at C5/6 an evidence of a disc bulge and moderate disc height loss, with the focal left postero-lateral and foraminal disc herniation causing significant left neural foraminal stenosis. At C6/7, a moderate disc bulge and disc height loss was noted, but with only slight narrowing of the central spinal canal and mild narrowing of the neural foramina bilaterally.


Physical Examination:

The movements of the head and neck were tight and stiff. “E.G.” was unable to attain full range in either direction on rotation. She attained about 70% of the range on rotation to the right, and only about 30% on rotation to the left. Similarly, she was unable to attain 50% of the range in extension. She was able to bring her chin to her chest and could do normal lateral tilting, however. Palpation of muscle structures revealed abnormal tightness and tenderness in both upper trapeziis (especially on the left side)


Previous Therapies:

  • Massage therapy treatments were temporarily effective in pain relief.
  • Acupuncture treatments were temporarily helpful in managing the pain.


Diagnosis:

She has a soft tissue injury. The major soft tissue affected is muscle and the locus of the neck and upper shoulders (upper trapezius).


Pulsed Signal Therapy (PST):

Pain Scale:


Before PST

Right after PST

6 weeks after PST

6 months after PST

Date of treatment

Feb 25, 2008

Feb 29, 2008

May 26, 2008

Oct 28, 2008

Intensity of pain

4

3

2

0

Frequency of pain

3

3

3

1

Rest. of Mov.

3

3

2

0

Swelling

0

0

0

0

Warming

0

0

0

0

Discolouring

0

0

0

0

Paresthesic

0

0

0

0

Explanation of ratings: 
0 = none or never
1 = slight or seldom
2 = moderate or sometimes
3 = severe or often
4 = extreme or always 
NA= Not applicable


Daily Function Scale:


Before PST

Right after PST

6 weeks after PST

6 months after PST

Sleep

0

0

0

0

Sitting

0

0

0

0

Standing

0

0

0

0

Driving

1

1

1

0

Walking

0

0

0

0

Mood

NA

NA

NA

NA

Explanation of ratings: 
0 = six or more hours before the pain increases and disturbs function. 
1 = around 4 hours before the pain increases and disturbs function. 
2 = around 2 hours before the pain increases and disturbs function. 
3 = 20 min to 1 hour before the pain increases and disturbs function. 
4 = 5 min to 20 min before the pain increases and disturbs function. 
NA = not applicable


Conclusions:

  • Six months after PST, the intensity of the pain decreased 100%, frequency of pain decreased 75%, while the restriction of movement improved 100%.
  • Patient had improvements of 100% driving.



 

 

 
 
 
 
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