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Case-Study 6

 

 
 
“C.P.” is a 25 year old, right-handed, female, administrative assistant in a pain rehabilitation clinic.

History:

On May 8, 2004, “C.P.” was involved in a motor vehicle accident. The vehicle’s bumper hit her right knee and compressed it against the side of her motorcycle. She has permanent knee pain that reaches high levels (three-to-four out of four) with prolonged standing or walking. She uses two canes to ambulate and manage the pain. The pain last until she had the PST therapy (47 months).

The x-ray did not reveal any joint effusion or problems with bony alignment, but defined a subtle cortical irregularity along the medial aspect of the tibial plateau. The MRI revealed a subtle curva-linear hypo-intense signal posteriorally in the lateral tibial plateau, which could represent a healing response to a subchondral infarction. There was no evidence of a loose bony fragment. There was a possible subtle tear in the posterior horn of the lateral meniscus.


Physical Examination:

On examination, there was tenderness with pressure over the joint lines of the right knee (medial and lateral) but no ligament laxity. There was definite weakness and a knee extensor lag.


Previous Therapies:

  • Physiotherapy was ineffective.


Diagnosis:

The history and physical findings are consistent with an injury to the subchondral tibial plateau of the right knee joint.


Pulsed Signal Therapy (PST):

Pain Scale:


Before PST

Right after PST

6 weeks after PST

6 months after PST

Date of treatment

April 01, 2008

April 11, 2008

May 25, 2008

Nov 11, 2008

Intensity of pain

4

4

2

1

Frequency of pain

3

3

3

1

Rest. of Mov.

2

2

2

1

Swelling

1

1

1

0

Warming

1

1

0

0

Discolouring

0

0

0

0

Paresthesic

1

1

1

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

2

1

1

0

Sitting

0

0

0

0

Standing

4

4

3

2

Driving

NA

NA

NA

NA

Walking

4

4

3

2 without cane

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 75%, the frequency of pain decreased 75%, the swelling decreased 100%, the warming decreased 100%, paresthesiae decreased 100% while the restriction of movement improved 50%.
  • Patient had improvements of 100% sleeping, 50% standing and 50% walking.



 

 

 
 
 
 
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