Entrapment of the saphenous nerve at the adductor canal affecting the infrapatellar branch - a report on two cases.

OBJECTIVE: To present 2 cases of entrapment of the saphenous nerve at the adductor canal affecting the infrapatellar branch, and to provide insight into the utilization of nerve tension testing for the diagnosis of nerve entrapments in a clinical setting. RATIONALE: Saphenous nerve entrapments are a very rare condition within today's body of literature, and the diagnosis remains controversial. CLINICAL FEATURES: Two cases of chronic knee pain that were unresponsive to previous treatment. The patients were diagnosed with an entrapment of the saphenous nerve at the adductor canal affecting the infrapatellar branch using nerve tension techniques along with a full clinical examination. INTERVENTION AND OUTCOME: Manual therapy and rehabilitation programs were initiated including soft tissue therapy, nerve gliding techniques and gait retraining which resulted in 90% improvement in one case and complete resolution of symptoms in the second. CONCLUSION: Nerve tension testing may prove to be an aid in the diagnosis of saphenous nerve entrapments within a clinical setting in order to decrease time to diagnosis and proper treatment.

OBJECTIF: présenter 2 cas de compression du nerf saphène interne au niveau du canal adducteur affectant la branche sous-rotulienne, et donner un aperçu de l'utilisation des tests de tension nerveuse pour le diagnostic des compressions nerveuses dans un cadre clinique. JUSTIFICATION: les compressions du nerf saphène interne sont une affection très rare dans les documents scientifiques actuels, et le diagnostic reste controversé. CARACTÉRISTIQUES CLINIQUES: deux cas de douleur chronique au genou qui ne répondaient pas au traitement précédent. Le diagnostic des patients souffrant d'une compression du nerf saphène interne au niveau du canal adducteur affectant la branche sousrotulienne a été réalisé grâce à des techniques de tension nerveuse et un examen clinique complet. INTERVENTION ET RÉSULTAT: des programmes de thérapie manuelle et de réadaptation ont été lancés, y compris le traitement des tissus mous, les techniques de glissement nerveux et la rééducation de la démarche, qui se sont traduits par une amélioration de 90 % dans un cas et la disparition complète des symptômes dans le second. CONCLUSION: les tests de tension nerveuse peuvent s'avérer être une aide au diagnostic des compressions du nerf saphène dans un milieu clinique permettant de réduire le temps de diagnostic et de traitement.

Traumatic hyoid bone fracture - a case report and review of the literature.

OBJECTIVE: To present a case of traumatic hyoid bone fracture and a review of the literature RATIONALE: Traumatic hyoid bone fractures are rare, however with the increasing popularity of martial arts the incidence of traumatic hyoid bone fracture may increase in prevalence. CLINICAL FEATURES: A thirteen year old taekwondo athlete collapsed after receiving a kick to the anterior neck. Following first aid emergency care the athlete reported pain with speaking and swallowing and was suffering from dyspnea. Ecchymosis and tenderness were noted over the hyoid bone. INTERVENTION AND OUTCOME: Lateral radiographs revealed fracture of the hyoid. Patient was sent home with analgesics and instructed to rest. The athlete was cleared for sport at 4 weeks post injury. CONCLUSION: Ensuring airway integrity and screening for signs of laryngeal laceration are essential in the management of suspected hyoid bone fractures. Observation for 48-72 hours is highly recommended.

Avulsion fractures of the pelvis - a qualitative systematic review of the literature.

OBJECTIVE: To assess a causal relationship between physical activity or boney surgical intervention and the occurrence of avulsion fracture in the pelvis. Secondarily to assess the average age at which avulsion fracture occurs in cases associated with physical activity or boney surgery. METHOD: A literature search was performed on a variety of databases using text words and MeSH terms. Results were limited to English language. Cases involving trauma or pathological disease were excluded. Causation Criteria scores were calculated for each paper to establish a link between the suspected mechanism of injury and avulsion fracture. RESULTS: 48 papers were retrieved encompassing 66 cases of avulsion fracture. 88% of cases were associated with physical activity while 12% were associated with a history of surgery. Average age in the physical activity cases was 16.8(range 13-43) and 56.4(range 31-74) in the surgery related cases. Causation Criteria scores were definite in 76% of activity related cases and probable in 60% of boney surgery related cases. CONCLUSIONS: Avulsion fractures of the pelvis represent a highly prevalent pathology among the adolescent athletic population. A population of skeletally mature patients with history of boney surgical intervention are also at risk.

A survey of wellness management strategies used by Canadian doctors of chiropractic.

OBJECTIVE: The purpose of this study was to investigate if Canadian doctors of chiropractic consider using wellness strategies after functional recovery in acute and chronic conditions. This study also attempted to determine if there is a difference in the use of wellness management strategies between broad and narrow scope practitioners. METHODS: Forty-one practicing, licensed chiropractors were recruited to complete an interview survey regarding 2 mock clinical case presentations. Interviews were recorded, and influential words or word pairings were identified. Investigators formulated criteria to divide practitioners into broad scope (mixers) and narrow scope (straights). Data were analyzed using Crawdad Analysis Software (version 1.2). RESULTS: All subjects indicated that they would provide information regarding public health and wellness strategies to a patient after functional resolution of the presenting chronic or acute complaints. The responses of broad scope (mixer) chiropractors appeared to be focused on the patient specifically, whereas narrow scope (straight) responses appeared to be more varied when analyzed for noun and noun-pair influence. CONCLUSION: This study of practicing, licensed Canadian chiropractors suggests that wellness strategies may be commonly considered in practice. All subjects in this study reported a number of strategies to educate patients regarding wellness after functional recovery of a complaint.

Neuromusculoskeletal disorders following SARS: a case series.

OBJECTIVE: To detail the presentation of three health care workers diagnosed with sudden acute respiratory syndrome (SARS) who later presented to a CMCC teaching clinic with neuromusculoskeletal sequelae and underwent conservative treatments. This case series aims to inform practitioners of the potential pathogenesis of these neuromuscular complaints and describes their treatment in a chiropractic practice. CLINICAL FEATURES: Three patients presented with a variety of neurological, muscular and joint findings. Conservative treatment was aimed at decreasing hypertonic muscles, increasing joint mobility, and improving ability to perform activities of daily living. INTERVENTION AND OUTCOME: The conservative treatment approach utilized in these cases involved spinal manipulative therapy, soft tissue therapy, modalities, and rehabilitation. Outcome measures included subjective pain ratings, disability indices, and return to work. CONCLUSION: Three patients previously diagnosed with SARS presented with neuromusculoskeletal complaints and subjectively experienced intermittent relief of pain and improvement in disability status after conservative treatments.