NAIL-PATELLA SYNDROME: DIAGNOSIS AND MANAGEMENT IN A CHIROPRACTIC SETTING– A CASE REPORT

Main Article Content

Katherine Clark
Colin Bench
Cameron Daniels

Keywords

Nail-Patella Syndrome, Exercise

Abstract

Objective: To describe the conservative management of a 6.5-year-old with chronic knee pain



Clinical Features: A 6.5-year-old boy had consistent right knee pain primarily at night with no known mechanism of injury. He was evaluated using history, orthopedic and neurologic examination, and x-ray. He was 3rd-percentile, and had frequent urinary tract infections, headaches, visual disturbances, and constipation. His fingernails and toenails appeared normal. Overall knee function was normal. The lateral femoral and tibial condyles were prominent and tender. X-rays revealed agenesis of the patella. Family history revealed no known members with this condition. Additional family history included glaucoma, elbow joint dislocation and kidney health disorders.


 


Intervention and Outcome: Home exercise recommendation to address continued biomechanical change in the knees was initiated. He responded to chiropractic intervention and age-appropriate exercises, with a reported decrease in pain and dysfunction. We monitored him at each treatment visit for concurrent health issues. We also recommended referral for co-management of his visual disturbance and urinary tract infection.


 


Conclusion: Early detection from portal-of-entry physicians may help improve patient health outcomes when appropriate diagnosis and referral is used.


Objective: To describe the conservative management of a 6.5-year-old with chronic knee painClinical Features: A 6.5-year-old boy had consistent right knee pain primarily at night with no known mechanism of injury. He was evaluated using history, orthopedic and neurologic examination, and x-ray. He was 3rd-percentile, and had frequent urinary tract infections, headaches, visual disturbances, and constipation. His fingernails and toenails appeared normal. Overall knee function was normal. The lateral femoral and tibial condyles were prominent and tender. X-rays revealed agenesis of the patella. Family history revealed no known members with this condition. Additional family history included glaucoma, elbow joint dislocation and kidney health disorders.


Intervention and Outcome: Home exercise recommendation to address continued biomechanical change in the knees was initiated. He responded to chiropractic intervention and age-appropriate exercises, with a reported decrease in pain and dysfunction. We monitored him at each treatment visit for concurrent health issues. We also recommended referral for co-management of his visual disturbance and urinary tract infection.


Conclusion: Early detection from portal-of-entry physicians may help improve patient health outcomes when appropriate diagnosis and referral is used.

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References

1. Sweeney E, Hoover-Fong JE, McIntosh I. Nail-patella syndrome. In: Adam MP (Ed). GeneReviews®. University of Washington, Seattle, WA; 2003.

2. López-Arvizu C, Sparrow EP, Strube MJ et al. Increased symptoms of attention deficit hyperactivity disorder and major depressive disorder symptoms in Nail-patella syndrome: potential association with LMX1B loss-of-function. Am J Med Genetics 2011;156B(1):59–66. https://doi.org/10.1002/ajmg.b.31138

3. Towers A., Clay CA, Sereika SM, McIntosh I, Greenspan, S. L. Skeletal integrity in patients with nail patella syndromeJ Clin Endocrinol Metabolism 2005;90(4):1961–1965. https://doi.org/10.1210/jc.2004-0997

4. Geerts-Crabbé L, Antoine P, Brugallé E et al. Difficulties adapting to Nail-Patella syndrome: A qualitative study of patients' perspectives. J Genetic Counseling 2019;28(5):1011–1020. https://doi.org/10.1002/jgc4.1153

5. Figueroa-Silva O, Vicente A, Agudo A, et al (2016), Nail–patella syndrome: report of 11 pediatric cases. J Eur Acad Dermatol Venereol 2016;30: 1614-1617. https://doi-org.palmer.idm.oclc.org/10.1111/jdv.13683