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Selected Case Studies
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Lumbar Degenerative Disc Disease
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Low Back Pathology
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Dancer S/P Multiple Trauma
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Carpal Tunnel, Post Release
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Cervical Pathology
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Charo-Marie Tooth Disease
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Degenerative Medial Meniscus
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Femur Fracture - IM Rod
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Hip Pathology
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Knee Pathology
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Systemic Lupus Erythematosus
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Pitcher's Shoulder
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Rotator Cuff Pathology
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Shoulder Tendonitis
Functional Capacity Evaluations

CASE STUDIES - Systemic Lupus Erythematosus

History: The patient is a 33 year old female school teacher with a long history of Systemic Lupus Erythematosus. Her subjective complaints include bilateral ankle stiffness, bilateral elbow contractures, bilateral wrist stiffness/ankylosis. The goal of this evaluation was to determine objective functional disability and recommend appropriate bracing intervention, if necessary.


Analysis: Kinematic data exhibited gait parameters asymmetry. A slight limping pattern in the right lower extremity with a shortened step length of two inches compared to the left foot was found. A right knee terminal extension deficit of 2-3 degrees during the terminal stance phase was detected. A dysfunctional weight-bearing pattern was also noted for the stance phase of the Left Knee [Graph I].




Graph I
Dynamic Knee Range of Motion




Analysis of multiple trials of left and right foot ground reaction forces indicated a prolonged period for the loading response. The initial force peak of weight- bearing is narrowed, indicating rapid transfer of weight to the forefoot. This is true for both the right and left stance curves [Graphs II and III].


Discussion: The patient ambulates with a right side limp and the right knee demonstrates a terminal extension deficit. Her bilateral ankle stiffness translate into a narrower heel strike and a prolonged loading response on the force platform. This finding is compatible with functional heel cord contractures.

Graph II
Left Stance Phase Ground Reaction Forces



Graph III
Right Stance Phase Ground Reaction Forces


It is noted that the dysfunctional heel strike has a minimal effect on gait quality. The subject's center of gravity passes over the weight-bearing point on center for the left stance. The right stance exhibits a somewhat more forward center of gravity neutral point as demonstrated by an anterior skewed post anterior shear force [Graph III]. These ankle dysfunctions were deemed minimal and did not warrant orthotic intervention at the time of the test.

Recommendation: Stretching and strengthening exercises were recommended for the right knee with emphasis on vastus medialis and terminal active extension. A Pro Stretch home exercise device was recommended to increase bilateral heel cord flexibility.

Outcome: Biomechanical testing resulted in great savings in unnecessary orthotics and braces in a chronically ill yet very active and functionally young patient.



© 2008 Kinematic Consultants, Inc.