Age of Patient: 46
Non-surgical treatment options for labral tear of the hip.
Age of Patient: 29
29 yom, 170 # 5' 6" (corpulent, but has been working on weight loss since beginning care in office with simple "clean" diet - no system food, and has lost 6#), initially came in for non-descript but alarming S/S for which he'd gone to the ER on 2 occasions (Lt arm numbness and facial tingling), only to be "cleared" medically on both occasions. Fearing he was dying, as he kept getting symptoms of arm tingling and facial numbness he sought care in the office and had improvement in Back Pain and BP (I put him on a careful CV routine, as his MDs could find nothing wrong and decided to put him on BP Rx as that was the only "finding" they could note at the time of his ER visits. He did improve his BP and soon weaned himself off the BP meds.) His S/S are manifold, and when his progress stalled, and then he reported bilateral symptomatology, I referred him to a neurologist, asking for an MRI of his upper T spine (as this was the region where much of his initial S/S seemed to be related to) but his major CURRENT complaint is M "pain" which he describes as "the Ms feel "EXTREMELY tired" after only minimal work. Eg, lifting a table is no problem, but when he has set the table down, the Ms in his arm/s feel like they "freeze" on him (his words). When showering, his calves get SO tired (from just standing) that they do not respond to his will, and his LEGS start to shake as "though they were exhausted." Then, after 5-6" this S/S will clear up. Obviously, this is affecting his (construction) work. He can hold a tool for a moment, but then his hand and arm are "exhausted" for several minutes afterwards. His S/S can and do "change sides" (of his body). Ortho-Neuro Clinic providers did MRI exams of his head and neck (and skipped the the requested T spine, alas) and found "nothing." At least one of his "providers" has now suggested it is "mental," which confounds the pt, as he can SEE his Ms spasm (eg on his antebrachium) at times.
My initial impression of this case would be to rule out what I think of as a classic upper cervical chiropractic subluxation complex.
As there is no mention of chiropractic x-rays, I would get standing cervical spine x-rays, especially the A-P open mouth and the utilize chiropractic line drawing analysis looking for any misalignments in the upper cervical spine. I would also perform a chiropractic examination and analysis including static and motion palpation. I would do a chiropractic prone and supine leg check. If a short let presents itself, especially in the prone position, I would then have the patient turn their head one direction, then recheck leg length, then the opposite direction, and again recheck leg length. Finally, I would perform a prone gluteal muscle test. For this, I have the patient prone, bend one knee 90º, have them raise the knee then muscle test by pushing down on the patients posterior thigh while the patient resists. Then perform the same test on the opposite glute. If any of these test are positive, this may be an indication of an upper cervical subluxation complex. If so, I would then adjust the upper cervical - using the method of the doctors choice, although a forward motion prone drop toggle on palpatory findings in the upper cervical may be the preferred method. I would then recheck any previous findings in leg length or gluteal weakness post treatment.
- Dale Morgan, DC, CCSP
I would continue to share the patient with the medical doctor. From the chiropractic standpoint, I might try different chiropractic techniques, using evidence-based assessments to monitor neurological progress (or lack thereof), particularly as it relates to autonomic function. Heart rate variability would be one such assessment. When there is a hint of progress, even though only a hint, I would tread lightly and not adjust. The other missing ingredient here may be time, for the patient to heal himself.
-John Hart, DC, MHSc
This clinically sounds like a patient that may have multiple sclerosis. Lesions would be most common in his brain and cervical cord but can occur anywhere in the spinal cord. These scan should also be done with contrast to look for active lesions.
- Alicia Yochum, RN, DC, DACBR, RMSK
This patient may be suffering the “T4 Syndrome” (aka, upper thoracic syndrome) which is described as a chronic stimulation of the sympathetic system producing symptoms such as bilateral arm tingling/numbness, tingling/numbness over the head, mental confusion, anxiety, increased blood pressure, stomach “heartburn” and indigestion, restlessness, sleeplessness, adrenal fatigue, and muscle “weakness.” Imaging of this area is usually negative.
A quick Google search revealed the following: What is T4 syndrome? T4 syndrome is a clinically rare pattern of symptoms that was originally described in 1986 textbook entries by both Maitland and McGuckin.1,2 T4 syndrome has been described as a collection of symptoms resulting from autonomic dysfunction of the upper thoracic spine.
The following article elaborates on the syndrome: Clinical Presentation, Quantitative Sensory Testing, and Therapy of 2 Patients with Fourth Thoracic Syndrome Gary A. Mellick, DOa,,Correspondence information about the author DO Gary A. MellickEmail the author DO Gary A. Mellick; Larry B. Mellick, MS, MDb
The aim of the study was to describe 2 representative cases of patients presenting to an osteopathic pain practice with signs and symptoms consistent with the fourth thoracic (T4) syndrome. In addition, this article reports the application of quantitative thermosensory testing and dynamometer strength testing to confirm associated sensory and motor strength changes. Nonmanipulative therapeutic interventions are reported for the first time.
Two patients experienced paresthesias in all digits of the hands, glove-like numbness of the hands and forearm, weakness (unable to open jars), hand clumsiness, upper extremity coldness, fullness or tightness, deep aching pain, and other signs and symptoms consistent with T4 syndrome. The patients were evaluated using quantitative thermosensory testing and handgrip dynamometry before and after treatment.
Intervention and Outcome
Relief of bilateral arm pain, numbness, and paresthesias occurred after intramuscular injections of 1 to 2 mL of 0.5% bupivacaine at the fourth thoracic paraspinal level. Additional therapy for associated signs and symptoms was provided using an anticonvulsant (gabapentin).
The clinical presentation of the patients reported in this article provides a description and additional information regarding T4 syndrome.
The medical intervention was described above. The chiropractic intervention would include “proper” and “full” correction of the damaged mechanoreceptors of the connective tissues in the upper thoracic spine that are causing the “subluxation” that continually stimulates the sympathetic nervous system. The April issue of the American Chiropractor contains an article by Studin and Owens that describes the “subluxation” complex as proposed by Panjabi.
- James Gudgel, DC, Instructor for Neuromechanical Innovations
Age of Patient: 40
Special Considerations: Patient presents with severe back spasms. Upon examination the patient's primary complaint is caused by a strained QL. Electrical stimlulation and adjustments were administered to the symptomatic areas. Patient responded well to first visit, but upon subsequent visits only finds temporary relief from care (several hours).
The pain usually gets worse as the day goes on. Patient's job consists of lifting and twisting. Has difficulty getting in and out of his vehicle, and when standing from a seated position has difficulty standing up straight. Massage therapy was recommended, and while I would like to recommend rehabilitative exercises, the patient's back is too painful for the patient to maneuver at this point.
I guess I am looking for ways to treat the QL that leads to symptomatic relief and, once out of the acute phase of treatment, what can be done to rehabilitate the patient and help them gain independence from care.
Age of Patient: 38
I have a patient who had an acoustic neuroma (vestibular schwannoma) removed from the right side of her brain approximately a year ago. She has complete hearing loss on the right side as a result of her surgery. Most of her pre- and post-op symptoms have gone away, but she still has tinnitus in her right ear. Adjustments haven't been helping with the tinnitus so I was wondering if there is anything that you can recommend (specific techniques, supplements, etc.) to help decrease the tinnitus. Thank you!
Age of Patient:
Special Considerations: PROTOCOL HANDLING A ACUTE EXACERBATION OF A CHRONIC CONDITION
Doctors could you give us your protocol for handling acute exacerbations of a chronic condition, for example a chronic condition that becomes aggravated above the normal degree, due to an injury or aggravation (event)? Chiropractic adjustments will return the patient back to a normal functional level, and without the CMT will get worse . I realize there will become a point when the care will become supportive and no longer active by Medicare, what criteria do you best determine when it becomes supportive care, for example what documentation do you use?. ….Especially in a Medicare setting ...….thank you
February 18, 2019
Age of Patient: 10
She is a 10 year old girl. Cerebral palsy. Zero cervical tone. Still cannot lift or actively turn her head and relies on being in a stroller at all times and utilizes cervical collar when upright. No capacity to stand and not ambulatory. Left hip is "out of socket" as it has never even developed and acetabulum is too shallow.
She is non verbal and actually spent whole initial visit eyes closed and would not communicate in any manner. Lying her on her stomach really upset her. She was ok on side and back. Babinski and palmar reflexes retained, but not tonic.
Child has had several years of PT, but was just released due to "lack of progress". Only recommendations by PT was for parents to place her on stomach and continue to straighten legs out. Other previous treatment of botox in the bottoms of feet due to the hyper flaring, now toes curl too much and she had breathing issues associated with those injections. Being released from PT with no future recommendations to help her child has the mother a bit distraught and so she ended up here based on recommendation from the special ed teacher. She will of course continue to be monitored by her medical doctor and other specialists as well.
Tough case. I would think some upper cervical work might be of some help. Perhaps the use of laser therapy might also help. I wouldn't give the parents too high an expectation. My heart aches for this lovely 10 year old and her parents. I also have a disabled daughter. As a parent it is devastating.
Terry Yochum, DC, DACBR
Regarding the case of a 10 year old girl with Cerebral Palsy. The first thing that comes to mind is birth trauma to the upper cervical spine. I would try to obtain a complete history of the birth process and method, first signs and diagnosis of cerebral palsy, when treatment was first initiated and results of previous treatment.
A complete chiropractic analysis is in order including spinal x-rays, especially on the upper cervical spine. There is much positive research and anecdotal findings regarding chiropractic SMT for cerebral palsy. Much of the research and articles indicates upper cervical, especially the occipital / atlantal subluxation as being the most common finding.
Googling "chiropractic and cerebral palsy" shows a number of positive articles which can help the mother better understand our chiropractic approach.
You will definitely want to discuss and have signed "informed consent" regarding treatment of the child. No guarantee of promises of successful treatment.
Dale Morgan, DC
There is some evidence that chiropractic care in general can be helpful for Cerebal Palsy. https://www.cerebralpalsyguidance.com/cerebral-palsy/treatment/chiropractic-care/
The evidence presented is not specific to technique, but chiropractic care in general. Generally, I would recommend following standard chiropractic guidelines. 3 visits per week for 6 visits and re-evaluate. If the patient is progressing that is great. If not, change approach to care (technique). Follow standards of reducing frequency as the child progresses.
We have a clinic in Oklahoma City called Oklahaven that has a lot of experiance in that area.
Brad Hayes, DC
The patient is under medical care for the cerebral palsy condition.
From the chiropractic standpoint, I would examine the patient’s spine to see if there were any chiropractic problems (e.g., chiropractic subluxation). If areas were found that needed chiropractic adjustment, then gentle spinal adjustment would be recommended for the offending segment(s).
The exam and adjustment would be modified as needed, depending on the positions the patient would be able to tolerate.
John Hart, DC
January 21, 2019
January 7, 2019
Gender: Male Age of Patient: 65
Special Considerations: Compression fractures, T12 and L2
Your Case or Question: 65 year old female initially consulted for back pain due to compression of T12. I use an instrument, and worked above and below, and she tolerated it well. However, upon resuming weight bearing the pain was severe. This was the first treatment. She opted not to continue care on account of this, and also had abdominal surgery shortly after. Subsequently she developed a compression of L2. She returned for chiropractic care while waiting for evaluation of the spinal surgeon. She never was "cemented" for the collapsed vertebrae. So far treatments are going well and she is gaining some function (endurance for house chores, general mobility). At this point we are wondering if spinal consultation is necessary, and if it is too late to reinforce the compressions. Also, any advice on bone strengthening will be appreciated, I heard diathermy can help circulation.
Gender: Male Age of Patient: 70
Special Considerations: Spinal stenosis of thoracic and lumbar spine
Your Case or Question: I have a Medicare patient who has spinal stenosis in the thoracic and lumbar spine, I have worked with him for years he has a stimulator implanted in the lower back and into the thoracic spine. It helps some but he also has severe balance problems and still has a huge amount of pain in the thoracic and lumbar spine. He comes in weekly, I try to get him to go longer between visits but when he does his symptoms increase and he will become immobile without coming in every week to 9 days. I am a walk-in clinic and file this with Medicare but am afraid of having issues with Medicare if the visits remain too frequent. I believe this is not maintenance care, he cannot function he says without CMT, he gets injections in the low back through pain management on a regular basis.