1/13. Case study: acceleration/deceleration injury with angular kyphosis.OBJECTIVE: To discuss the case of a patient who received upper cervical chiropractic care after trauma-induced arcual kyphosis in the cervical spine. A practical application of conservative management for posttrauma cervical spine injury in the private office setting is described. Clinical Features: A 17-year-old female patient suffered an unstable C3/C4 motor segment after a lateral-impact motor vehicle collision. Additional symptoms on presentation included vertigo, tinnitus, neck and shoulder pain, and confusion. Intervention and Outcome: Conservative management consisted exclusively of upper cervical-specific adjustments guided by radiographic analysis and paraspinal bilateral skin temperature differential analysis of the cervical spine. During 10 weeks of care and 22 office visits, all symptoms subsided and the instability of C3/C4 motor segment appeared to be completely resolved. CONCLUSION: This study provides support for the use of upper cervical chiropractic management in cervical spine trauma cases. The clinical work-up consisted of physical examination, radiographic analysis, computer-administered and scored cognitive function testing, and audiometric examination. After conservative care, these examinations were repeated and demonstrated that the objective findings concurred with the subjective improvements reported by the patient.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/13. Spinal cord injury in children.The spinal injured child has speical needs owing to the processes of physical, mental and social growth. goals of physical treatment programs include prevention of: genitourinary complications; contractures; pressure sores; long bone fractures, hip subluxation and dislocation; spinal deformity. Nonoperative treatment of spinal deformity employing external support should be initiated when the potential for spinal deformity exists. External support delays the development of spinal deformity, improves sitting balance and allows free upper extremity use. The overall treatment programs must consider altered body proportions, immaturity of strength and coordination. Case examples of children with spinal injury are presented above to illustrate specific problems stemming from immaturity of physical, cognitive, and social development. Spinal surgery can be a conservative measure in the growing child when there is radiologic evidence of progressive spinal deformity. Posterior spinal fusion with Harrington instrumentation and external support permits immediate return to vertical activity.- - - - - - - - - - ranking = 0.65768023642265keywords = physical (Clic here for more details about this article) |
3/13. Exertional myelopathy in type 2 congenital kyphosis.STUDY DESIGN: A case of lower-extremity myelopathy induced by physical exertion in a patient with Type 2 (failure of segmentation) congenital kyphosis is reported. OBJECTIVE: To describe the uncommon presentation of neurologic sequelae in a patient with Type 2 congenital kyphosis. SUMMARY OF BACKGROUND DATA: Various reports have described neurologic sequelae in patients with Type 1 (failure of formation) congenital kyphosis. To the authors' knowledge, no case of Type 2 congenital kyphosis leading to neurologic symptoms has been reported. methods: A 17-year-old boy presented with a 3-year history of progressively worsening midthoracic back pain. During exertion, numbness developed along the posterior aspects of his legs, and he experienced a wobbly sensation in his lower extremities that prevented his participation in athletic activities. His static and dynamic neurologic examination was unremarkable. However, he developed a wide-based clumsy myelopathic gait when he was asked to run in the halls of the clinic. magnetic resonance imaging demonstrated that the spinal cord was draped over the posterior vertebral body of T10. Anterior thoracic spinal cord decompression and fusion were performed through a seventh rib thoracotomy using a structural rib graft to fill the defect. The anterior 1 cm of bone was left intact so as not to cause any additional instability. RESULTS: The patient tolerated the procedure well and had complete resolution of his exertionally dependent myelopathic symptoms. At this writing, 3 years after surgery, he is involved in the Navy ROTC program. CONCLUSIONS: Although Type 2 congenital kyphosis is a rare entity, it should be followed carefully and corrected surgically when appropriate. A history of exertional myelopathy may be an early sign of spinal cord impingement and is an indication for surgical decompression.- - - - - - - - - - ranking = 0.21922674547422keywords = physical (Clic here for more details about this article) |
4/13. chiropractic management of ehlers-danlos syndrome: a report of two cases.OBJECTIVE: To discuss 2 patients with ehlers-danlos syndrome seeking chiropractic evaluation and management of their disabling musculoskeletal pain and associated disorders. CLINICAL FEATURES: Two disabled patients diagnosed with Ehlers-Danlos syndrome had spinal pain, including neck and back pain, headache, and extremity pain. Commonalities among these 2 cases included abnormal spinal curvatures (kyphosis and scoliosis), joint hypermobility, and tissue fragility. One patient had postsurgical thoracolumbar spinal fusion (T11-sacrum) for scoliosis and osteoporosis. The other patient had moderate anterior head translation. INTERVENTION AND OUTCOME: Both patients were treated with mechanical force and manually assisted spinal adjustments delivered to various spinal segments and extremities utilizing an Activator II Adjusting Instrument and Activator methods chiropractic Technique. patients were also given postural advice, stabilization exercises, and postural corrective exercises, as indicated in chiropractic biophysics Technique protocols. Both patients were able to reduce pain and anti-inflammatory medication usage in association with chiropractic care. Significant improvement in self-reported pain and disability as measured by visual analog score, Oswestry Low-Back Disability Index, and neck pain Disability Index were reported, and objective improvements in physical examination and spinal alignment were also observed following chiropractic care. Despite these improvements, work disability status remained unchanged in both patients. CONCLUSION: chiropractic care may be of benefit to some patients with connective tissue disorders, including ehlers-danlos syndrome. Low-force chiropractic adjusting techniques may be a preferred technique of choice in patients with tissue fragility, offering clinicians a viable alternative to traditional chiropractic care in attempting to minimize risks and/or side effects associated with spinal manipulation. Psychosocial issues, including patient desire to return to work, were important factors in work disability status and perceived outcome.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/13. superior mesenteric artery syndrome following correction of kyphosis in an adult.Superior mesenteric artery (SMA) syndrome is well described in the pediatric literature; however, to date, it has not been described in an adult individual undergoing correction of thoracic kyphosis. Medical history, physical findings, and the results of imaging studies were analyzed to describe the patient's onset of gastrointestinal obstruction following surgical correction of thoracic kyphosis. The postoperative course was marked by the onset of nausea and vomiting on postoperative day 24. The patient was admitted to the hospital, and the small bowel follow-through study showed blockage of the third portion of the duodenum at the level of the SMA. Oral intake was restricted, and total parenteral nutrition was instituted with complete resolution of her symptoms. At 1 year postoperatively, the patient was symptom-free. Although vascular compression of the duodenum with subsequent nausea and vomiting and electrolyte imbalance, caused by the relative lengthening of the spine, is most commonly associated with surgical correction of coronal plane deformities (ie, scoliosis), it may occur in patients undergoing correction of thoracic kyphosis as well. SMA syndrome is a well known potential complication in adolescents, and it should also be taken into consideration in adults undergoing deformity correction. Early institution of general medical measures of nasogastric suction, oral intake restriction, and intravenous alimentation can be successful.- - - - - - - - - - ranking = 0.21922674547422keywords = physical (Clic here for more details about this article) |
6/13. Conservative treatment of a patient with previously unresponsive whiplash-associated disorders using clinical biomechanics of posture rehabilitation methods.OBJECTIVE: To describe the treatment of a patient with chronic whiplash-associated disorders (WADs) previously unresponsive to multiple physical therapy and chiropractic treatments, which resolved following Clinical Biomechanics of posture (CBP) rehabilitation methods. CLINICAL FEATURES: A 40-year-old man involved in a high-speed rear-impact collision developed chronic WADs including cervicothoracic, shoulder, and arm pain and headache. The patient was diagnosed with a confirmed chip fracture of the C5 vertebra and cervical and thoracic disk herniations. He was treated with traditional chiropractic and physical therapy modalities but experienced only temporary symptomatic reduction and was later given a whole body permanent impairment rating of 33% by an orthopedic surgeon. INTERVENTION AND OUTCOME: The patient was treated with CBP mirror-image cervical spine adjustments, exercise, and traction to reduce forward head posture and cervical kyphosis. A presentation of abnormal head protrusion resolved and cervical kyphosis returned to lordosis posttreatment. His initial neck disability index was 46% and 0% at the end of care. Verbal pain rating scales also improved for neck pain (from 5/10 to 0/10). CONCLUSION: A patient with chronic WADs and abnormal head protrusion, cervical kyphosis, and disk herniation experienced an improvement in symptoms and function after the use of CBP rehabilitation protocols when other traditional chiropractic and physical therapy procedures showed little or no lasting improvement.- - - - - - - - - - ranking = 0.65768023642265keywords = physical (Clic here for more details about this article) |
7/13. Cervico-oculo-acousticus syndrome with pregnancy.Cervico-oculo-acousticus syndrome is a very rare entity with only 21 cases described in the world literature. A study of a case of this syndrome with pregnancy is presented. This primigravida, in addition to the classical triad of the syndrome, had other dysmorphic features such as short stature (141 cm), and marked thoracic kyphosis with restricted ventilatory capacity. Her physical activity during pregnancy was guided according to her respiratory status. In spite of marked thoracic kyphosis the cephalo-pelvic relationship was found to be adequate for a vaginal delivery. A healthy male baby weighing 3.8 kg was delivered by an outlet forceps at term. Puerperium was uneventful. The child was clinically normal at the age of 2 years.- - - - - - - - - - ranking = 0.21922674547422keywords = physical (Clic here for more details about this article) |
8/13. zollinger-ellison syndrome with Marden-Walker syndrome. association of two rare diseases in a 5-year-old girl.A 5-year-old girl had the symptom of vomiting for four years. Gastric analysis showed elevated basal acidity unaffected by betazole stimulation. Roentgenographic examinations of the upper gastrointestinal tract showed two ulcers in the lesser curvature of the stomach. fasting serum gastrin values were remarkably elevated and a calcium infusion test resulted in noticeable increases in serum gastrin levels. These data were consistent with the zollinger-ellison syndrome. In addition, the patient demonstrated such anomalies as retarded physical and mental development, kyphoscoliosis, median cleft palate, joint contracture and unusual facies due to blepharophimosis, and malformed low-set ears. These clinical features were in accord with the Marden-Walker syndrome. To our knowledge, the present case presents the first case of the combination of these two rare entities in the literature.- - - - - - - - - - ranking = 0.21922674547422keywords = physical (Clic here for more details about this article) |
9/13. Compressive myelopathy associated with type VI mucopolysaccharidosis (Maroteaux-Lamy syndrome).spinal cord compression with resultant myelopathy is a frequent occurrence in patients with mucopolysaccharidoses. Etiological factors include developmental abnormalities of the cervical spine and infiltration of the dura mater by the accumulated products of mucopolyssacharide metabolism. Compression at the thoracolumbar junction is rare, but was found in a child with the characteristic physical and biochemical stigmata of the Maroteaux-Lamy syndrome (mucopolysaccharidosis vi). An anterolateral approach to remove the compressing bony elements resulted in symptomatic improvement. Careful radiological evaluation is required so that all surgical options can be considered. patients with metabolic storage diseases and the capacity for normal intellectual function warrant aggressive surgical care to optimize neurological function.- - - - - - - - - - ranking = 0.21922674547422keywords = physical (Clic here for more details about this article) |
10/13. Neurological symptoms in achondroplastic dwarfs--surgical treatment.Fourteen patients who had neurological symptoms associated with achondroplastic dwarfism and who had spine surgery were analyzed, as were an additional twenty-nine cases reported in the literature. Four types of neurological patterns emerged, based on the onset, symptoms, and physical examination. Some etiological correlation between the anatomical lesion and the result was made in each category, and a reliable prognosis related to the pattern is now possible. Early and appropriately extensive surgery may well be recommended, based on the patients treated.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
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