Disclosures: Marcos R. Henriquez, MD: No financial relationships or conflicts of interest

Case Diagnosis: Quadriceps arthrogenic muscle inhibition

Case Description: A 42-year-old male patient with a five-week post-surgical right meniscus repair comes to our office with right knee functional limitation, assisted with crutches. He describes that his right knee “gives away” on weight-bearing and refers to difficulty climbing or running downstairs, followed by anterior knee pain. There is edema on his right knee on the physical exam. After several attempts, the patient cannot step up to a 22-cm stool, describing weakness and difficulty. When stepping down with his right leg from the stool, there’s increased femoral adduction, followed by instability and sensation that the “knee is giving away”. We treated our patient with one session of electrohydraulic focal extracorporeal shockwave therapy (F-ESWT) with the following protocol: Right quadriceps: 0.1mJ/mm2, 600 impulses. Right hamstring: 0.1mJ/mm2, 300 impulses. Gluteus medius: 0.1mJ/mm2, 300 impulses. Tibialis anterior: 0.1mJ/mm2, 200.

Setting: PM&R, Sports Medicine, Outpatient ClinicAssessment/

Results: Immediately after the first session of F-ESWT, the patient can step up the 22-cm stool with his right knee without pain and can step down without pain or sensation that the “knee is giving away”. The patient is able to walk without crutches and does not describe pain or weakness.

Discussion: After reviewing current literature, to our knowledge, this is the first case describing the use of focal extracorporeal shockwave therapy in arthrogenic muscle inhibition.

Conclusion: Arthrogenic muscle inhibition surely can prolong a rehabilitation process and lead to functional impairment. The use of focal extracorporeal shockwave therapy could accelerate and meet the patient’s goal.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/focal-extracorporeal-shockwave-therapy-muscle-enhancement-in-a-patient-with-arthrogenic-muscle-inhibition-a-case-report/