Term
May be asymptomatic or may present with back pain and increased kyphosis
Prone Extension Test is positive
Investigations The classic triad includes Schmorl’s nodes, limbus bones and irregular endplates; affect three or more vertebrae
There must be a minimum of three vertebra involved. |
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Sudden back pain and increased kyphosis. Pain on percussion
Investigations X-ray is diagnostic and may show a step defect. If the posterior elements |
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Pain at the affected site is the most common presenting symptom
The pain may be worse at night and is characteristically relieved by aspirin
Investigations The typical x-ray picture is a small lucent area (nidus) [<2 cm] surrounded by dense sclerotic bone. Bone scan |
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Patient complains of constant and chronic aching mid-back pain. Worse with working at a desk and better with activity. Patient may present with a forward head carriage.
Examination will reveal trigger points in the upper and middle traps, rhomboids, levator scapulae and pectorals. The lower trapezius will be weak. |
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Complaints may include unilateral or bilateral upper chest or thoracic pain, paresthesia and/or vague pain in one of both upper extremities in a glove-like fashion that can involve only the hand, hand and forearm or the entire arm
In addition, some patients may complain of headaches, difficulty in breathing, swelling of the upper extremity or weakness of grip
Examination will reveal tender hypomobile segments between T2 and T7
Orthoneuro tests Springing [pushing on] T3 or T4 may result in the replication of the symptoms. Neurological examination is normal |
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Prodrome of unilateral chest, face or abdominal pain followed by the appearance of a vesiculo-pustular rash along a dermatome. The dermatome pattern may be patchy and incomplete.
Investigations Look for hidden neoplasia: Order the proper follow-up tests based on the full health history such as: Chest x-ray, Prostatic Specific Antigen, Fecal Occult Blood, CarcinoEmbryonic Antigen and HIV/ELISA |
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Asymptomatic unless there is an associated fracture which may present with backache or chest pain; gradual decrease in height and increasing kyphosis
Some patients will present with a dowager hump
Orthoneuro tests Tenderness on spinal percussion only if there is an underlying fracture
Investigations Typical x-ray findings include increase in radiolucency, osteopenia, thin cortices, wedge-shaped or biconcave vertebrae in compression fractures, Ward’s triangle
Dual Energy X-ray Absorptiometry [DEXA] provides a quantitative measure of bone density > -2.5 Standard Deviation; serum calcium and phosphate are normal and alkaline phosphatase will be elevated only if there is a fracture |
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ACR Diagnostic criteria: >3 months of widespread pain plus:
11 out of 18 possible tender points around the neck, shoulder, anterior chest, elbow, lower back, hip and knees often with fatigue, insomnia, stiffness and headache. Stress often worsens the symptoms.
Orthoneuro tests The “Wince reflex” will be positive each time they are touched during the exam |
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Nocturnal bone pain with or without unintentional weight loss
Orthoneuro tests Tenderness on spinal or bony percussion will be positive if there are fractures
Investigations 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 |
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| Co-manage with an orthopedist. Postural exercises focusing on strengthening back extensors, stretch anterior muscles and hamstrings. Milwaukee brace recommended for curves greater than 60 degrees, Surgery for curves greater than 80 degrees. |
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| Co-manage with an orthopedist. Adjust subluxations that are above and below the affected segments. Avoid flexion exercises. Healing should be within 3 months. |
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| Refer to an orthopedic surgeon and co-manage afterwards |
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| Chiropractic adjustments along with deep massage, postural advice and exercises are usually very helpful. Stretch tight muscles and strengthen the weak ones. Address work ergonomics. |
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| Chiropractic adjustments along with heat modalities, postural advice and exercises are usually very helpful |
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| Refer to the hospital if the ophthalmic division of the trigeminal nerve is involved. On average this condition lasts a week |
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Advise on diet supplementation with Calcium, Phosphorus, Vitamin D, exposure to sun and weight-bearing exercise
Stopping smoking might be useful in those who are smoking
Caution must be taken in adjusting a patient with osteoporosis in order to prevent serious injury to the patient [consider using low force techniques such as Activator, Logan Basic or Grostic]] |
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| A holistic approach with chiropractic adjustments, diet, Vitamin D supplements, exercise and stress management is helpful in some patients |
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Refer to an oncologist and co-manage afterwards
Do not adjust locally |
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