Sanchez Belinda J, Baker Russell T
WWAMI Medical Education Program, University of Idaho, Moscow, Idaho.
Department of Movement Sciences, University of Idaho, Moscow, Idaho.
J Chiropr Med. 2017 Dec;16(4):308-315. doi: 10.1016/j.jcm.2017.08.005. Epub 2017 Dec 7.
The purpose of this case study was to report on the immediate effects of the combined use of mobilizations with movement and the "squeeze" technique on a patient with knee stiffness, popping, and swelling.
The patient presented with right knee stiffness, swelling, and a popping sensation of insidious onset. Clinical examination revealed pain with terminal knee extension and flexion, joint line tenderness, a positive Apley's compression test, and a positive Thessaly's test at 20° of knee flexion. A working diagnosis was established of a meniscal pathology with the differential diagnoses of meniscal derangement and synovial plica.
The patient received 3 total treatments using the Mulligan concept over the course of 11 days. The treatments included the application of a tibia internal rotation mobilization with movement and the "squeeze" technique to the affected knee. Patient outcomes, including the Disablement in the Physically Active Scale, the Patient-Specific Functional Scale, and the Numeric Rating Scale for pain, were collected throughout the course of treatment. The patient reported a minimal clinically important difference on the Numeric Rating Scale for pain after each treatment and on all outcomes after the third treatment. The patient reported improvement on her follow-up visit 4 days after the third treatment; the results of a clinical exam and patient outcomes supported a complete discharge after 3 treatments.
This patient responded favorably to use of the Mulligan concept as a manual therapy technique for the treatment of symptoms related to possible meniscal derangement.
本病例研究的目的是报告关节松动术与运动结合以及“挤压”技术联合应用于一名存在膝关节僵硬、弹响和肿胀患者的即时效果。
该患者表现为右膝关节僵硬、肿胀，并有隐匿性发作的弹响感。临床检查发现膝关节终末伸展和屈曲时疼痛、关节线压痛、阿普利氏挤压试验阳性以及膝关节屈曲20°时塞萨利试验阳性。初步诊断为半月板病变，鉴别诊断包括半月板紊乱和滑膜皱襞。
患者在11天内接受了3次基于穆利根概念的治疗。治疗包括对患膝应用胫骨内旋关节松动术与运动以及“挤压”技术。在整个治疗过程中收集患者的结果，包括身体活动能力障碍量表、患者特定功能量表以及疼痛数字评定量表。患者报告每次治疗后疼痛数字评定量表上有最小临床重要差异，第三次治疗后所有结果均有改善。患者在第三次治疗后4天的随访中报告病情有所改善；临床检查结果和患者结果支持3次治疗后完全出院。
该患者对使用穆利根概念作为一种手法治疗技术来治疗可能与半月板紊乱相关的症状反应良好。
