Diagnosis

Multiple Venous Thromboses Presenting as Mechanical Low Back Pain in an 18-Year-Old Woman

By Frank M. Painter|July 28, 2015|Diagnosis|

Multiple Venous Thromboses Presenting as Mechanical Low Back Pain in an 18-Year-Old Woman

SOURCE: Journal of Chiropractic Medicine 2015 (Jun); 14 (2): 83–89

Andrée-Anne Marchand, DC, Jean-Alexandre Boucher, DC,
Julie O’Shaughnessy, DC, MSc

Université du Québec à Trois-Rivières,
3351 Boul. Des Forges. C.P 500, Trois-Rivières,
Québec, Canada, G9A 5H7

Objective The purpose of this case report is to describe a patient who presented with acute musculoskeletal symptoms but was later diagnosed with multiple deep vein thrombosis (DVT).

Clinical Features An 18-year-old female presented to a chiropractic clinic with left lumbosacral pain with referral into the posterior left thigh. A provisional diagnosis was made of acute myofascial syndrome of the left piriformis and gluteus medius muscles. The patient received 3 chiropractic treatments over 1 week resulting in 80% improvement in pain intensity. Two days later, a sudden onset of severe abdominal pain caused the patient to seek urgent medical attention. A diagnostic ultrasound of the abdomen and pelvis were performed and interpreted as normal. Following this, the patient reported increased pain in her left leg. Evaluation revealed edema of the left calf and decreased left lower limb sensation. A venous Doppler ultrasound was ordered.

Intervention and Outcomes Doppler ultrasound revealed reduction of the venous flow in the femoral vein area. An additional ultrasonography evaluation revealed an extensive DVTs affecting the left femoral vein and iliac axis extending towards the vena cava. Upon follow-up with a hematologist, the potential diagnosis of May-Thurner syndrome was considered based on the absence of blood dyscrasias and sustained anatomical changes found in the left common iliac vein at its junction with the right common iliac artery. A week following discharge, she presented with chest pain and was diagnosed with venous thromboembolism. The patient was successfully treated with anticoagulation therapy and insertion of a vena cava filter.

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Identification of Internal Carotid Artery Dissection

By Frank M. Painter|February 27, 2015|Carotid Artery Dissection, Diagnosis|

Identification of Internal Carotid Artery Dissection in Chiropractic Practice

The Chiro.Org Blog

SOURCE: J Can Chiropr Assoc. 2004 (Sep); 48 (3): 206-210 ~ FULL TEXT

Michael T Haneline, DC, MPH and Gary Lewkovich, DC

Palmer College of Chiropractic West,
Palmer Center for Chiropractic Research,
90 E. Tasman Drive,
San Jose, CA 95134
michael.haneline@palmer.edu

Internal carotid artery dissection (ICAD) is a condition involving separation of the artery’s intimal lining from its medial division, with subsequent extension of the dissection along varying distances of the artery, usually in the direction of blood flow. ICAD may produce cerebral ischemia due to occlusion of the involved artery. This occlusion may occur at or near the site of the dissection, or “downstream” as a result of embolization from a dislodged thrombus fragment. The problem any chiropractic physician faces in identifying ICAD patients is that the condition may present without any symptoms or the symptoms may appear benign (e.g., headache, neck pain or cervicogenic dizziness). Consequently, it may be impossible to identify some ICAD patients, especially in the early stages of the pathology. As the ICAD progresses and neural blood flow is compromised, the symptom picture typically manifests more completely. The chiropractic physician must be alert to characteristic findings of a progressing ICAD, since an immediate referral to a medical specialist may be required.

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From the FULL TEXT Article:

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The Etiology of Cervical Artery Dissection

By Frank M. Painter|February 26, 2015|Diagnosis, Vertebral Artery|

The Etiology of Cervical Artery Dissection

The Chiro.Org Blog

SOURCE: J Chiropr Med. 2007 (Summer); 6 (3): 110-120 ~ FULL TEXT

Michael T. Haneline [a], and Anthony L. Rosner [b]

a Professor,
Palmer College of Chiropractic West,
Department of Research, San Jose, CA 95134
michael.haneline@palmer.edu

b Professor,
Parker College of Chiropratic,
Brookline, MA 02446

The etiology of cervical artery dissection (CAD) is unclear, although a number of risk factors have been reported to be associated with the condition. On rare occasions, patients experience CAD after cervical spine manipulation, making knowledge about the cervical arteries, the predisposing factors, and the pathogenesis of the condition of interest to chiropractors. This commentary reports on the relevant anatomy of the cervical arteries, developmental features of CAD, epidemiology of the condition, and mechanisms of dissection. The analysis of CAD risk factors is confusing, however, because many people are exposed to mechanical events and known pathophysiological associations without ever experiencing dissection. No cause-and-effect relationship has been established between cervical spine manipulation and CAD, but it seems that cervical manipulation may be capable of triggering dissection in a susceptible patient or contributing to the evolution of an already existing CAD. Despite the many risk factors that have been proposed as possible causes of CAD, it is still unknown which of them actually predispose patients to CAD after cervical spine manipulation.

From the FULL TEXT Article:

Introduction

The etiology of cervical artery dissection (CAD) is, for the most part, unclear; and what has been proposed as an explanation for its pathogenesis is largely hypothetical. [1] Furthermore, when dealing with a particular case of CAD, the pathogenesis is especially speculative. [2] Nevertheless, a number of risk factors have been reported to be associated with the condition, including connective tissue abnormalities, hypertension, recent infection, migraine headache, the use of oral contraceptives, and others. Of special interest to chiropractors is the role cervical spine manipulation (CSM) plays, if any, in the pathogenesis of CAD. Indeed, patients do experience CAD on rare occasions after CSM, making knowledge about the cervical arteries, the predisposing factors, and the pathogenesis of the condition important for chiropractors.

Anatomy of the cervical arteries

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Recognition of Spontaneous Vertebral Artery Dissection

By Frank M. Painter|February 25, 2015|Diagnosis, Vertebral Artery|

Recognition of Spontaneous Vertebral Artery Dissection Preempting Spinal Manipulative Therapy: A Patient Presenting With Neck Pain and Headache for Chiropractic Care

The Chiro.Org Blog

SOURCE: J Chiropr Med. 2014 (Jun); 13 (2): 90-95 ~ FULL TEXT

Ross Mattox, DC, [a], Linda W. Smith, DC, [b] and
Norman W. Kettner, DC, DACBR, FICC [c]

a Diagnostic Imaging Resident,
Department of Radiology,
Logan University, Chesterfield, MO
ude.nagol@xottam.ssor

b Chiropractic Physician,
Private Practice, St. Louis, MO

c Chair, Department of Radiology,
Logan University, Chesterfield, MO

OBJECTIVE: The purpose of this case report is to describe a patient who presented to a chiropractic physician for evaluation and treatment of neck pain and headache.

CLINICAL FEATURES: A 45-year-old otherwise healthy female presented for evaluation and treatment of neck pain and headache. Within minutes, non-specific musculoskeletal symptoms progressed to neurological deficits, including limb ataxia and cognitive disturbances. Suspicion was raised for cerebrovascular ischemia and emergent referral was initiated.

INTERVENTION AND OUTCOME: Paramedics were immediately summoned and the patient was transported to a local hospital with a working diagnosis of acute cerebrovascular ischemia. Multiplanar computed tomographic and magnetic resonance imaging with contrast revealed vertebral artery dissection of the V2 segment in the right vertebral artery. Anticoagulation therapy was administered and the patient was discharged without complications after 5 days in the hospital.

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Elongated Styloid Processes and Calcified Stylohyoid Ligaments in a Patient With Neck Pain: Implications for Manual Therapy Practice

By Frank M. Painter|February 23, 2015|Diagnosis, Vertebral Artery|

Elongated Styloid Processes and Calcified Stylohyoid Ligaments in a Patient With Neck Pain: Implications for Manual Therapy Practice

The Chiro.Org Blog

SOURCE: J Chiropr Med. 2014 (Jun); 13 (2): 128–133 ~ FULL TEXT

Bart N. Green, DC, MSEd,a,b, LCDR Kristin M. Browske, MD,
and CAPT Michael D. Rosenthal, PT, DSc, ATC

a Chiropractor,
Department of Physical and Occupational Therapy,
Naval Medical Center, San Diego, CA

b Associate Editor,
Publications Department,
National University of Health Sciences,
Lombard, IL

Corresponding author at:
Marine Corps Air Station Miramar,
Branch Health Clinic,
PO Box 452002,
San Diego, CA 92145-2002. Tel.: + 1 858 577 9948
lim.yvan.dem@neerg.traB

Objective The purpose of this paper is to present a case of a patient with neck pain, tinnitus, and headache in the setting of bilateral elongated styloid processes (ESP) and calcified stylohyoid ligaments (CSL), how knowledge of this anatomical variation and symptomatic presentation affected the rehabilitation management plan for this patient, and to discuss the potential relevance of ESPs and CSLs to carotid artery dissection.

Clinical features A 29-year-old male military helicopter mechanic presented for chiropractic care for chronic pain in the right side of his neck and upper back, tinnitus, and dizziness with a past history of right side parietal headaches and tonsillitis. Conventional radiographs showed C6 and C7 spinous process fractures, degenerative disc disease at C6/7, and an elongated right styloid process with associated calcification of the left stylohyoid ligament. Volumetric computerized tomography demonstrated calcification of the stylohyoid ligaments bilaterally.

Intervention and outcome Given the proximity of the calcified stylohyoid apparatus to the carotid arteries, spinal manipulation techniques were modified to minimize rotation of the neck. Rehabilitation also included soft tissue mobilization and stretching, corrective postural exercises, and acupuncture. An otolaryngologist felt that the symptoms were not consistent with Eagle syndrome and the tinnitus was associated with symmetric high frequency hearing loss, likely due to occupational noise exposure. Initially, the patient’s symptoms improved but plateaued by the fifth visit.

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Life-Threatening Conditions That Walk: A Clinician’s Review

By Frank M. Painter|January 27, 2015|Diagnosis|

Life-Threatening Conditions That Walk: A Clinician’s Review

The Chiro.Org Blog

SOURCE: J Amer Chiropr Assoc 2013 (Sept); 50 (5): 8-17

David J. Schimp, DC, DACNB, DAAPM

Clinician and Associate Professor
Texas Chiropractic College

Dr. Schimp describes the six most common undiagnosed life-threatening conditions encountered by chiropractors.

ABSTRACT

Chiropractors are hybrid physicians with a broad skill set. DCs need the diagnostic acumen of orthopedists and neurologists, a fine manual therapist’s hands, a psychologist’s insights, and the capacity to instantly respond to the unexpected. As front-line health care professionals, we may find ourselves serving as ER physicians. When a previously undiagnosed life- threatening condition shows up, we must recognize the problem and triage the patient appropriately. This article will review the six most common undiagnosed life-threatening conditions encountered by chiropractors.

Keywords: cancer, abdominal aortic aneurysm, deep-vein thrombosis, pulmonary embolism, venous thromboembolism, stroke, cerebrovascular accident, subdural hematoma, myocardial infarction, red flag assessment, life- threatening conditions, chiropractor, chiropractic physician

INTRODUCTION

Daniel, et al., have identified the six most common life-threatening conditions that a chiropractic physician is likely to encounter in clinical practice. [1] The goal of this article is to translate the current evidence-based knowledge of these conditions into a quick-scan diagnostic and management reference for cancer, abdominal aortic aneurysm, venous thromboembolism, stroke, myocardial infarction, and subdural hematoma.

I. CANCER

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