Editor's Note: The following is the first of three case studies by Dr. Wong on conservative management of lower-extremity complaints.
History & Subjective Complaints
Patient reports with pain in the front part of her right knee, especially during and after her weekly Zumba class. She states there has been no injury of which she is aware. No outward sign of injury is observed.
Objective Findings & Vitals
Patient is an African-American female, 42 years old. Height: 5'8." Weight: 140 lbs.
Objective Orthopedic and Neurological Findings
Patient is a non-smoker and non-drinker, and her blood pressure and pulse rate fall within normal range. BMI is healthy. She shows moderate calcaneal eversion with hyperpronation on the right and mild bilateral knee valgus. There is a limitation in lumbosacral motion with tenderness and loss of mobility to the right; compensating subluxation is noted.
Range-of-motion tests in knees demonstrate ROM to be full and bilaterally pain-free. Muscle testing shows no abnormal weakness. Neurologic testing is negative.
Radiology
No abnormalities detected.
Clinical Impressions and Working Diagnosis
Elevated Q-angle foot pronation leading to patellofemoral arthralgia on the right. This is accompanied by lumbosacral joint motion restriction and compensatory lower thoracic subluxation.
Treatment
Response to Care and Discussion
The patient responded well to adjustments and reported a significant decrease in symptoms. Within two weeks of beginning to wear orthotics, she reported further decrease in pain and limitation. She recently completed a weekend-long Zumba "camp," throughout which she remained pain free.
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As chiropractors, we observe signs and symptoms as colors on an artist’s palette, melding them together to determine how they affect the speed, fluency, quality, and ease of activities of daily living. We communicate this vision to our patients in a report of findings. However, converting that vision into the International Classification of Diseases Clinical Modification (ICD-CM) coding language presents challenges.
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