MANAGEMENT OF A PATIENT WITH CALCIUM PYROPHOSPHATE DEPOSITION DISEASEAND MENISCAL TEAR OF THE KNEE - A CASE-REPORT

Objective:To describe the chiropractic management of a patient sufferi ng from a right lateral meniscus tear concurrent with calcium pyrophos phate dihydrate (CPPD) deposition disease. Clinical Features: A 51-yr- old bus driver suffered from right knee pain (7 on a 1-10 pain scale). The onset of the pain was gradual and increased during braking and ac celerating. Palpatory tenderness was noted at the right lateral knee j oint line and the inferior lateral margin of the patella. Active resis tive range of motion (ROM) in the knee during extension was painful th roughout the full ROM, whereas passive ROM was restricted in flexion a t 110 degrees. A positive McMurray's test reproduced pain at the knee. Radiographic analysis revealed CPPD deposition disease, and magnetic resonance imaging revealed a probable ''parrot's beak'' tear in the po sterior horn of the right lateral meniscus. Intervention and Outcome: The patient was treated conservatively. He was instructed not to put w eight on the knee and not to return to work for 5 days. Initial treatm ents involved the use of ice and interferential electrical stimulation along with glucosamine sulfate supplements. Bicycling, weight lifting for general fitness and general knee strengthening exercises were pre scribed. Approximately 5 months after initial treatment, the patient w as lost to follow-up; 12 months later, he returned for treatment becau se of a recurrence. Physical examination at that time revealed knee pa in rated at 3/10 but there was no pain upon palpation, McMurray's test was negative and right knee ROM was full without pain. Conclusion: A patient suffering from CPPD can be managed by conservative means. The pathophysiology, clinical features and management considerations in th e treatment of the patient's condition(s) are also discussed.