Case Study

A 68-year-old female patient underwent surgery on her right lateral malleolus for a fracture she suffered 4 months previously. As well as ankle pain the patient also suffered from recurrent backache which had worsened in the previous weeks. This symptom was explained by her compensatory asymmetrical gait shifting her weight onto her left leg. The ankle was furthermore swollen and movements of eversion were limited. A first session for treatment of the most tender points of the right auricle resulted in relief from pain for some days; however, a second session brought no further relief. A tender point was still present in a fixed position from one session to the other (Fig. 9.6). Suspecting the scar to be responsible for this tenderness I examined it thoroughly along its entire length. On palpation I found a very tender spot of about 10 mm (see arrows in Fig. 9.7). A 30 second massage of the scar evoked referred pain in the whole area, overlapping with the bothersome sensation the patient had become used to feeling. I obtained a reduction in tenderness of the auricular point but not its total relief. Therefore I proposed to the patient the infiltration of the scar with a few drops of mepivacaine hydrochloride 1%. Immediately after the injection the auricular point completely lost its tenderness and the patient felt some relief. After a second infiltration 2 weeks later the patient was finally free of her symptoms and able to benefit fully from her rehabilitation program.

Fig. 9.6 Tender point of the ipsilateral anthelix in a 68-year-old female patient who 4 months previously had experienced a fracture of the lateral malleolus and who still suffered after-effects of surgery.
Fig. 9.7 The arrows indicate the sensitive part of the scar at palpation; the infiltration of the scar with mepivacaine made the tenderness of the point shown in Figure 9.6 disappear.

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