Term
Low back pain radiating into the back of the thigh and leg, worse with
bending and twisting
There might be paresthesia along the affected dermatome and decreased or absent deep tendon reflexes (patella-[L4] or hamstring [L5] or achilles [S1]), as well as decreased muscle strength (tibialis anterior [L4] or extensor hallicus longus [L5] or peroneus longus and brevis [S1]) |
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Definition
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Term
Chiropractic treatment 4 weeks unless there is evidence of cauda equina syndrome [urinary retention, decreased anal sphincter tone or saddle anesthesia]
If evidence of cauda equina syndrome is present, refer at once to the hospital
Avoid rotational adjustments; Flexion distraction and other gentle techniques
have been shown to be beneficial |
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Definition
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Unilateral back pain that is better on lying down and worse on extension or
rotating the spine. Pain is usually localized but may radiate above the knee
Neurological tests and nerve root tension tests should be normal
Orthoneuro tests Kemp’s test will be positive [pain on lateral bending followed by extension]
Investigations X-rays may reveal evidence of degenerative joint disease [joint space narrowing, subchondral sclerosis and osteophytes]. McNab’s line and Hadley’s S Curve may show facet imbrication on x-ray |
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Definition
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| Chiropractic adjustments are superior to medical treatment |
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Definition
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Extremity pain worse with activity; if located in the lumbar region, there will be “neurogenic” claudication-lower limb pain with activity, relieved by bending forward or sitting down (+Bicycle Test). Symptoms may be unilateral or bilateral and may not follow specific dermatomes. Signs and symptoms vary
If located in the cervical region, there will be upper limb pain with activity, lower motor neuron weakness in the upper limb [diminished or absent reflexes] and upper motor neuron weakness in the lower limb [with hyperreflexia with a positive Babinski’s sign]
Orthoneuro tests Lhermitte’s [electrical sensations into the arms and legs with neck flexion] sign might be positive suggesting cervical myelopathy [damage of the spinal cord] |
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Definition
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Term
Chiropractic adjustment if there is no contra-indication
Flexion-distraction is helpful in the short term
Refer to a neurologist if chiropractic care is not helpful
Refer to the hospital if there is evidence of cauda equina syndrome: bladder or bowel problem or saddle anesthesia |
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Definition
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Often asymptomatic; may present with low backache worse with extension and a step sign if it is severe; there is no change in the muscle power, sensation or reflexes. On exam there may be a prominent spinous process on palpation
Investigations Lateral lumbar x-rays will show the anterior slippage of L5 on S1 [most common] or L4 on L5 [second most common]
Use the Meyerding Grading method to quantify degree of slippage by dividing the A/P width of the base of the sacrum into fourths
Oblique x-ray will diagnose fracture in pars but NOT used to diagnose the spondylolisthesis
An inverted Napoleon hat sign may be present on the AP view if severe |
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Definition
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Term
Chiropractic management directed on the segment below the segment may improve the biomechanics; avoid adjustments in progressive unstable types; avoid extension exercises and an anti-lordotic brace may be necessary
Refer to an orthopedic surgeon if it is a Grade 3 or 4 slippage
SPECT test is used to see early stress reactions in the bone |
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Definition
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Buttock and posterior leg pain
Orthoneuro tests Bonnet Test [SLR with internal rotation of the foot and adduction of the leg] may be positive with pain; MRS is normal, pain may increase on palpation of the piriformis muscle; trigger points and muscle spasm of the piriformis |
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Definition
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Term
Adjustments, myofascial release techniques and stretching
If neurological signs appear order MRI for a possible disc herniation |
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Definition
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Pain over the SI region that may radiate down the back of the leg; usually made worse when getting up from a bent or stooped position; made better by sitting or lying down
Orthoneuro tests Gaenslen’s test [patient is supine and examiner flexes unaffected knee and thigh to the chest while the examiner extends the affected leg off the side of the table] positive is pain at the SI joint
Yeoman’s test [patient is prone with the knee bent to 90 degrees. Examiner hyperextends the thigh of the affected side and applies pressure to the SI joint] positive is pain at the SI joint
MRS is normal; pain may increase or decrease on compression or distraction of the SI joint |
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Definition
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Term
| Chiropractic adjustments are superior to medical treatment. In an acute sprain, light adjusting is needed to avoid further strain, and an SI support brace may be helpful. |
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Definition
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Term
Complete Blood Count may show a normocytic, normochromic anemia; Comprehensive Metabolic Profile will reveal hypercalcemia, elevated serum proteins, reversed Albumin/Globulin ratio [1:2 instead of 2:1]
However the alkaline phosphatase will be normal usually unless there is a healing fracture
Bence Jones proteins [IgG] may be found in the urine
Serum electrophoresis will show a typical M [myeloma] spike due to high IgG
X-rays in 70% of patients might show multiple lytic bone lesions [punched out or rain-drop lesions] mainly in the skull, long bones and vertebrae; osteoporosis and blastic lesions may also be present
Bone marrow biopsy will confirm the diagnosis and will show malignant plasma cells |
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Definition
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Term
| Refer to a hematologist for further investigation and management |
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Definition
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Term
Fatigue, nocturnal backache, recurrent infections, constipation, blurred vision, constipation, nerve root compression and mental changes
Orthoneuro tests Tenderness on percussion of spinous process might be positive |
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Definition
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Term
Nocturnal bone pain with or without unintentional weight loss
Orthoneuro tests Tenderness on spinal or bony percussion will be positive if there are fractures |
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Definition
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X-rays may show osteolytic or osteosclerotic lesions in the affected bone in 60% of patients with proven metastatic disease-look for missing pedicles (“owl-winking sign”)
At least 40% of the bone must be destroyed before changes will be seen on the x-rays; Elevated alkaline phosphatase in the presence of normal AST [SGOT] and ALT [SGPT] is seen
Bone scans with Technetium 99 will show hot spots in osteoblastic tumors |
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Definition
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Term
Refer to an oncologist and co-manage afterwards
Do not adjust locally |
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Definition
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Term
Fever, chills, generalized malaise, nocturnal pain and swelling in the affected region; may present with joint pain, swelling and tenderness if in an extremity
Orthoneuro tests Percussion of related bony prominence might be tender |
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Definition
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X-ray is usually normal in the initial stage
Initial changes consist of subperiosteal elevation and soft tissue swelling
These are followed by lytic changes; Brodie’s abscess formation only appears 3-4 weeks later
A sequestrum of dead bone may later appear within a rim of new bone [involucrum]
In the vertebra there is loss of the disc space and destruction of the vertebral endplates
Complete Blood Count will show an elevated WBC and raised neutrophils |
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Definition
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Term
| Refer to the hospital for admission and antibiotics |
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Definition
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Term
Refer to a vascular surgeon for an opinion regarding surgery
The risk of rupture increases exponentially after the diameter exceeds 5 cm
Do not adjust in this area as this is contraindication to rotational chiropractic adjustment [consider the use of “non-force” chiropractic techniques]
Call 911 if there is Pain, Pulsatile abdominal mass and Hypotension |
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Definition
| ABDOMINAL AORTIC ANEURYSM |
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Term
Often asymptomatic; however may present with backache or abdominal pain, perhaps with intermittent claudication in the lower limb or impotence
Abdominal palpation may reveal an expansile pulsatile mass in the midline above the umbilicus with a bruit in 50% of patients with AAA
May rupture and present with sudden onset of severe backache and hypotension [low BP and rapid pulse rate]
Investigations Lateral lumbar x-ray may show curvilinear radio-opaque densities located anterior to the anterior border of the lumbar vertebrae > 3.8 cm and may also show erosion of the anterior vertebral bodies
Ultrasonography is the preferred initial imagining modality |
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Definition
| ABDOMINAL AORTIC ANEURYSM |
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