Conservative management of a suspected triangular fibrocartilage complex injury utilizing strength training exercises: A case report.

OBJECTIVE: The purpose of this case report is to describe the conservative chiropractic management of a patient with a suspected triangular fibrocartilage complex (TFCC) injury. CLINICAL PRESENTATION: A 36-year-old Brazilian Jiu-Jitsu black belt athlete sought care for left-sided diffuse ulnar pain (numeric pain scale 5/10) with a notable bump over the ulna and weakness when grappling. A working diagnosis of suspected TFCC injury was made. INTERVENTION AND OUTCOME: The patient was treated with forearm and grip strength exercises to rehabilitate the pain and strength loss. Following 6 visits and a home exercise program for 8 weeks, his numeric pain scale decreased to 0/10. CONCLUSION: In this case, it is evident that Triangular fibrocartilage complex injury was successfully treated conservatively without the need for surgical intervention or passive care modalities.

Conservative management of distal bicipital tendinopathy with lateral antebrachial nerve entrapment: A case report.

INTRODUCTION: Kettlebell snatches are an efficient and effective exercise. If the kettlebell being utilized is too heavy or too many repetitions are executed, this can lead to an overuse injury such as a tendinopathy. Multiple orthopedic tests exist to evaluate for a distal biceps tendon rupture. At present, there are no publications utilizing shockwave and active rehabilitation to treat distal bicipital tendinopathy with Lateral Antebrachial Cutaneous Nerve (LABCN) entrapment. Currently, no published manuscripts are reporting distal bicipital tendinopathy with LABCN nerve entrapment being treated successfully with shockwave and active rehabilitation over the course of 5 weeks. METHODS: The objective of this case report is to examine the conservative management of a 37-year-old male with a diagnosis of distal bicipital tendinopathy and LABCN entrapment. The patient presents with discomfort originated weeks prior after an intense block of kettlebell training. The patient was diagnosed with brachioradialis tendinopathy due to the specifics of his injury. Following the initial evaluation, the patient was unable to supinate the forearm past 45° actively, yet he can passively achieve 90°, although this is done with minor discomfort. DISCUSSION: The patient's rehab began with the execution of wrist, elbow, and shoulder controlled articular rotation (CARS). The concept of CARs is to train the joint and soft tissues to respond to full range activity. A progressive approach utilizing isometric to eccentric exercise with extracorporeal shockwave was used. The authors studied forty-eight patients with chronic distal biceps tendinopathy. After five shockwave therapy treatments over three months, there was a significant decrease in symptomology without complications (Furia et al., 2017). CONCLUSION: This case report demonstrates that active rehabilitation and shockwave therapy effectively resolved the patient's symptoms with no adverse reactions. Additionally, the case report can be a suggested management protocol for successful conservative management for patients with suspected distal bicipital tendinopathy with LABCN entrapment going forward.

Diagnosis and management of medial epicondyle avulsion fracture in a 27-year-old female: A case report.

OBJECTIVE: The purpose of this case report is to describe the diagnosis and management of an adult patient presenting with a rarely reported avulsion fracture of the medial epicondyle of the humerus. CLINICAL PRESENTATION: A 27-year-old female sought care following an injury sustained when the elbow gave out on an attempted back flip. The clinical assessment found an indication of elbow fracture with a diagnosis of medial epicondyle avulsion fracture made on radiographic examination. INTERVENTION AND OUTCOME: Following in-house imaging, the patient was referred for an orthopedic consultation. An MRI was ordered and revealed numerous internal joint derangements. The orthopedist prescribed a hinged brace and followed up in 4 weeks. Physical therapy was ordered by the surgeon with follow-up again in 4 more weeks. CONCLUSION: Medial epicondyle avulsion fractures are extremely rare in adults, and in this case, were accompanied by extensive internal joint derangements in the elbow. Chiropractors should be able to diagnose this condition from x-ray and can be of assistance with rehabilitation therapies.

Chiropractic management of toe-walking in an eight-year-old male diagnosed with autism spectrum disorder utilizing a functional approach: A case study.

OBJECTIVE: The objective of this paper is to discuss the treatment of idiopathic toe-walking utilizing cognitive-motor dual-tasking and primitive reflex integration exercises. METHODS: An eight-year-old child with the previous diagnosis of autism spectrum disorder and idiopathic toe-walking presents for chiropractic care. The patient had previously received eight months of physical therapy in which his results plateaued after three months of care. RESULTS: On the initial visit, the child was evaluated for primitive reflexes. The patient retained the asymmetrical tonic neck reflex and palmer grasp. He was prescribed exercises to integrate these reflexes. In the second visit and onwards, the patient was tasked with walking while performing a cognitive or motor task. The patient's performance of primitive reflex attenuation exercises significantly improved in form and timing, and the patient achieved proper gait mechanics with most interventions used. CONCLUSION: Due to the limited number of visits, the patient was prescribed a cognitive task to help facilitate the retention of proper gait mechanics; however, these findings suggest that chiropractic management may prove useful in children who toe walk and that further investigation into treatment utilizing primitive reflex integration exercises for children with psychomotor delays is warranted. We suggest that the integration of primitive reflex testing for the chiropractor can yield many answers and serve as a valuable rehabilitation approach.

Clinical application of the Turkish Get-Up to an acute shoulder injury in a competitive Brazilian Jiu-Jitsu athlete.

INTRODUCTION: The rationale for this case report was to identify the strengths and weaknesses associated with prescribing the Turkish Get-Up as an isometric shoulder and neck exercise. The Turkish getup is an effective tool for isometrically loading the cervical spine and shoulder and can be used with minimal space and equipment. DISCUSSION: The Turkish Get-Up was selectively applied as a therapeutic corrective intervention to a patient suffering a mild to moderate cervical, acromio-clavicular and sterno-clavicular joint sprain with associated facet syndrome and muscle spasm. There were concerns that initially gave a guarded prognosis with the realization that further imaging may be warranted after an initial trial. CONCLUSION: The Turkish getup is an effective tool for isometrically loading the cervical spine and shoulder and can be used with minimal space and equipment. This exercise allowed the injured patient to integrate full body movement and conditioning with an emphasis on pain free isometric shoulder and cervical spine contractions to re-establish strength and motor control. The patient now has the ability to add to his training and rehabilitation an exercise that can be endlessly progressed to build continuous strength, endurance and motor control.

Improved Performance After Gluteus Complex Activation in a CrossFit Athlete Presenting With Knee Pain.

OBJECTIVE: To describe the case management of a female CrossFit athlete presenting for a functional movement assessment. She had knee pain after 2 months of training for a competition. CLINICAL FEATURES: After her assessment, it was determined that the patient had difficulty using her gluteus maximus musculature in various positions including standing, lying, and quadruped positions despite being a competitive athlete. It was determined via biomechanical testing that the patient's posterior chain firing pattern was predominantly erector spinae vs gluteus complex and hamstrings muscles. INTERVENTION AND OUTCOME: Continuation of reactive neuromuscular training gluteus medius/activation exercise was prescribed to establish motor control, endurance, and preactivation while decreasing erector spinae overload for this patient. CONCLUSION: This patient was someone with exceptional strength but poor motor control. Regressing back to the most basic activation exercises, we were able to simulate the proper activation and motor control to decrease pain and improve performance. The athlete's function seemed to improve after a course of care that included basic exercises.