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Clinical Presentation of a Patient with Thoracic Myelopathy

By Frank M. Painter|October 15, 2014|Continuing Education, Myelopathy|

Clinical Presentation of a Patient with Thoracic Myelopathy at a Chiropractic Clinic

SOURCE: J Chiropractic Medicine 2012 (Sep); 11 (2): 115–120

Charles W. Gay, Mark D. Bishop, and Jacqueline L. Beres

Graduate Research Assistant,
Rehabilitation Science Doctoral Program,
University of Florida, Gainesville, FL.

INTRODUCTION: The purpose of this case report is to describe the clinical presentation, examination findings, and management decisions of a patient with thoracic myelopathy who presented to a chiropractic clinic.

CASE REPORT/METHODS: After receiving a diagnosis of a diffuse arthritic condition and kidney stones based on lumbar radiograph interpretation at a local urgent care facility, a 45-year-old woman presented to an outpatient chiropractic clinic with primary complaints of generalized low back pain, bilateral lower extremity paresthesias, and difficulty walking. An abnormal neurological examination result led to an initial working diagnosis of myelopathy of unknown cause. The patient was referred for a neurological consult.

RESULTS: Computed tomography revealed severe multilevel degenerative spondylosis with diffuse ligamentous calcification, facet joint hypertrophy, and disk protrusion at T9-10 resulting in midthoracic cord compression. The patient underwent multilevel spinal decompressive surgery. Following surgical intervention, the patient reported symptom improvement.

CONCLUSION: It is important to include a neurologic examination on all patients presenting with musculoskeletal complaints, regardless of prior medical attention. The ability to recognize myelopathy and localize the lesion to a specific spinal region by clinical examination may help prioritize diagnostic imaging decisions as well as facilitate diagnosis and treatment.

KEYWORDS: Spinal stenosis; Thoracic vertebrae

From the FULL TEXT Article:

Introduction

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Manipulative and Rehabilitative Therapy as a Treatment of Idiopathic Scoliosis Without Psychological Sequelae

By Frank M. Painter|October 10, 2014|Continuing Education, Scoliosis|

Manipulative and Rehabilitative Therapy as a Treatment of Idiopathic Scoliosis Without Psychological Sequelae

The Chiro.Org Blog

SOURCE: J Chiropractic Medicine 2012 (Jun); 11 (2): 109–114

Jorge H. Villafañe, PT, MSc, PhD, Guillermo B. Silva, MSc, PhD, Andrea Dughera, MSc

Physical Therapist, Department of Physical Therapy,
Residenze Sanitarie Assistenziali
“A. Maritano,” Sangano, Italy.

OBJECTIVE: The purpose of this case report is to describe management and outcomes of a patient with scoliosis.

CLINICAL FEATURES: A 9-year-old female patient with a double curve pattern with Cobb angles of 18° and 24° (thoracic/thoracolumbar) compatible with scoliosis presented for physical therapy treatment.

INTERVENTION AND OUTCOME: Physiotherapy treatment with a combination of manipulative and rehabilitation techniques was used. After finishing the treatment, the patient had Cobb angles of 7° and 11°, an improvement of 55% and 54%, respectively. After 6 months, these effects were maintained, as the patient had Cobb angles of 11° and 11°. The clinical appearance of the patient improved after the course of care. The patient was evaluated for psychological outcomes by applying the following tests: Scoliosis Research Society 22, Bad Sobernheim Stress, and the Brace Questionnaire The patient had the maximum score in all tests at the conclusion of therapy.

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Scoliosis and Chiropractic Page

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Pulmonary Embolism in a Female Collegiate Cross-country Runner Presenting as Nonspecific Back Pain

By Frank M. Painter|October 9, 2014|Continuing Education, Pulmonary Embolism|

Pulmonary Embolism in a Female Collegiate Cross-country Runner Presenting as Nonspecific Back Pain

The Chiro.Org Blog

SOURCE: J Chiropractic Medicine 2012 (Sep); 11 (3): 215–220

Warren H. Landesberg, DC, DACBSP

Doctor of Chiropractic, Private Practice,
Briarcliff Manor, NY.

OBJECTIVE: The purpose of this case report is to describe a female athlete with back and right scapular pain due to pulmonary embolism.

CLINICAL FEATURES: A 20-year-old female collegiate cross-country runner presented to a chiropractic clinic with pain in the right scapular area that was severe, stabbing, and worsened with respiration. She had a cough and experienced difficulty lying on her right side. She had an elevated d-dimer. Chest radiograph demonstrated pleural effusion, prompting a thoracic computed tomographic angiogram that showed a large right lower lobe embolus and pulmonary infarct.

INTERVENTION AND OUTCOME: The patient was hospitalized, prescribed anticoagulant therapy, and monitored for 6 months. She was able to return to competitive running 8 months later.

CONCLUSION: This case raises awareness of the occurrence of birth control medication for the purpose of enhanced performance in female athletes and the associated risks of using this medication for enhanced performance.

From the FULL TEXT Article:

Introduction

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Resolution of Hearing Loss After Chiropractic Manipulation

By Frank M. Painter|October 8, 2014|Chiropractic Care, Hearing Loss|

Resolution of Hearing Loss After Chiropractic Manipulation

The Chiro.Org Blog

SOURCE: Topics in Integrative Health Care 2014 (Sep 30); 5 (3)

Melissa Ferranti, DC, Kimberly Keene, DC,
Chelsea Prothero, DC

Assistant Professor and Faculty Clinician
Palmer College of Chiropractic
Port Orange, FL, USA

Introduction: While chiropractic care is often associated with the treatment of musculoskeletal conditions, there are other, non-musculoskeletal conditions which may benefit from spinal manipulation (SM). This paper reports on the return of hearing in a woman treated with chiropractic adjustments after 8 months of lack of improvement through allopathic care. Pre and post audiograms were used for comparison.

Case Presentation: In this report, a 46 year old white female with neck pain, tinnitus, and hearing loss was treated with cervical spinal manipulation with positive results. A pre-treatment audiogram indicated low-frequency hearing loss, worse in the left ear.

Intervention and Outcomes: After being unsuccessfully medically treated over an 8 month period, she sought chiropractic care for the above symptoms. After 3 chiropractic adjustments, her hearing and associated symptoms were significantly improved. She received 12 treatments over a 4-month period. When asked to rate her hearing and fullness sensation in the ear on a Patient Specific Functional Scale with a 0-10 measure, where 0 is no deficits and 10 is completely impaired, initially she rated her symptoms as 7, and 5 months after the conclusion of care, her rating dropped to 1. Following treatment her audiogram was normal.

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Deafness and Chiropractic Page

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Exploring Patient Satisfaction

By Frank M. Painter|September 24, 2014|Chiropractic Care, Patient Satisfaction|

Exploring Patient Satisfaction: A Secondary Analysis of a Randomized Clinical Trial of Spinal Manipulation, Home Exercise, and Medication for Acute and Subacute Neck Pain

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther 2014 (Sep 5)

Brent D. Leininger, DC, Roni Evans, DC, PhD,
Gert Bronfort, DC, PhD

Research Fellow, Integrative Health & Wellbeing Research Program,
Center for Spirituality & Healing, University of Minnesota,
Minneapolis, MN.
lein0122@umn.edu

OBJECTIVE: The purpose of this study was to assess satisfaction with specific aspects of care for acute neck pain and explore the relationship between satisfaction with care, neck pain, and global satisfaction.

METHODS: This study was a secondary analysis of patient satisfaction from a randomized trial of spinal manipulation therapy (SMT) delivered by doctors of chiropractic, home exercise and advice (HEA) delivered by exercise therapists, and medication (MED) prescribed by a medical doctors for acute/subacute neck pain. Differences in satisfaction with specific aspects of care were analyzed using a linear mixed model. The relationship between specific aspects of care and (1) change in neck pain (primary outcome of the randomized trial) and (2) global satisfaction were assessed using Pearson’s correlation and multiple linear regression.

RESULTS: Individuals receiving SMT or HEA were more satisfied with the information and general care received than MED group participants. Spinal manipulation therapy and HEA groups reported similar satisfaction with information provided during treatment; however, the SMT group was more satisfied with general care. Satisfaction with general care (r = -0.75 to -0.77; R2 = 0.55-0.56) had a stronger relationship with global satisfaction compared with satisfaction with information provided (r = -0.65 to 0.67; R2 = 0.39-0.46). The relationship between satisfaction with care and neck pain was weak (r = 0.17-0.38; R2 = 0.08-0.21).

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Patient Satisfaction With Chiropractic Page

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The Cellular and Molecular Biology of the Intervertebral Disc:A Clinician’s Primer

By Frank M. Painter|September 21, 2014|Continuing Education, Disc Injury|

The Cellular and Molecular Biology of the Intervertebral Disc: A Clinician’s Primer

The Chiro.Org Blog

SOURCE: J Can Chiropr Assoc. 2014 (Sep); 58 (3): 246–257

W. Mark Erwin, DC, PhD and Katherine E. Hood, DC

Assistant Professor, Divisions of Neurological and Orthopaedic Surgery,
University of Toronto, Toronto Western Hospital;
Scientist, Toronto Western Research Institute;
Associate Professor, Research Canadian Memorial Chiropractic College.

Clinicians routinely encounter patients suffering from both degenerative and acute spinal pain, often as a consequence of pathology affecting the intervertebral disc (IVD). The IVD is a complex structure essential to spinal function and is subject to degenerative disease and injury. However, due to the complexity of spinal pain syndromes it is often difficult to determine the extent of the IVD’s contribution to the genesis of spinal pain. The location of the IVD is within close proximity to vital neural elements and may in the event of pathological change or injury compromise those structures. It is therefore important that clinicians performing manual therapy understand the cellular and molecular biology of the IVD as well as its clinical manifestation of degeneration/injury in order to safely manage and appreciate the role played by the disc in the development of mechanical spinal pain syndromes.

Keywords: spine, degenerative, pain, disc, intervertebral

The Full-Text Article:

Introduction:

The intervertebral disc (IVD) is a complex structure positioned between two adjacent vertebrae where in addition to protecting the spinal cord and segmental spinal nerves it confers flexibility, multi-axial spinal motion and load transmission to the spine. The IVD is vulnerable to injury and degeneration often leading to pain syndromes however much remains to be discovered concerning the development of axial and radicular pain syndromes, the biology of the disc and the capacity of the IVD to repair itself after injury. [1] From the clinician’s perspective, familiarity with the biology of the IVD is vital in order to understand the natural history of disc-related injury/illness and to develop appropriate therapeutic strategies. The purpose of this review is to provide an overview of the salient characteristics of IVD pathology with a particular emphasis upon degenerative disease and its role in the generation of clinical spinal pain syndromes.

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Disc Herniation and Chiropractic Page

The disc as an organ:

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