Journal of the Canadian Chiropractic Association最新文献

Background: Distal bimelic amyotrophy (DBMA) also known as Hirayama disease, is a rare, self-limiting motor neuron disease manifesting as atrophy of C7-T1 innervated muscles. We present a case report describing the chiropractic management of neck and thoracic pain in a patient with known DBMA.

Case presentation: A 30 year-old black male U.S. veteran with DBMA presented with myofascial pain of the neck, shoulder, and back. A trial of chiropractic care was undertaken involving spinal manipulation of the thoracic spine and cervicothoracic region, manual and instrument-assisted soft tissue mobilization, and home exercise prescription. The patient reported modest improvement in pain intensity and did not experience any adverse events.

Summary: This case presents the first documentation of chiropractic services in musculoskeletal pain management of a patient with concurrent DBMA. At this time there is no guidance in the existing body of literature for the safety and effectiveness of manual therapy in this population.

Objective: The purpose of this study was to determine the practicality of using a teleconferencing platform to assess the effect of hype on clinicians' evaluations of reports of clinical trials in spinal care.

Methods: Twelve chiropractic clinicians were interviewed via a videoconferencing application. Interviews were recorded and timed. Participant behaviour was monitored for compliance with the protocol. Differences between participants numerical ratings of hyped and non-hyped abstracts based on four measures of quality were analysed using pairwise comparisons (Wilcoxon signed rank test for independent samples). In addition, a linear mixed effects model was fitted with condition (i.e. hype vs. no hype) as a fixed effect and participant and abstract as random effects.

Results: The interviews and data analysis were conducted without significant technical difficulty. Participant compliance was high, and no harms were reported. There were no statistically significant differences in the quality rankings of hyped versus non-hyped abstracts.

Conclusion: The use of a videoconferencing platform to measure the effects of hype on clinicians' evaluations of abstracts of clinical trials is practical and an adequately powered study is justified. Lack of statistically significant results may well be due to low participant numbers.

A 47-year-old female presented to a chiropractic clinic with known diagnosis of systemic lupus erythematosus. Radiographic examination demonstrated multiple splenic calcifications, an uncommon, yet important finding. The patient was subsequently referred to her primary care physician for co-management and further evaluation.

Objective: To describe the differential diagnosis, diagnosis, and chiropractic management of a case of chronic upper extremity paresthesia.

Clinical features: A 24-year-old woman presented with recent neck stiffness, along with a primary complaint of chronic upper extremity paresthesia and hand weakness of insidious onset.

Intervention and outcome: Results of previous electro-diagnostic and advanced imaging studies were combined with clinical assessment to diagnose thoracic outlet syndrome (TOS). Discontinuing after five weeks of chiropractic management, the patient reported significant improvement of paresthesia but less improvement of her hand weakness.

Summary: Several etiologies can give rise to symptoms in common with TOS. It is imperative to rule out mimicking conditions. A battery of clinical orthopedic tests has been proposed in the literature for the diagnosis of TOS but with reported questionable validity. As a result, TOS is mostly a diagnosis of exclusion. Chiropractic treatment shows potential for effective management of TOS, but research is required.

Objective: To review and summarize the recent literature, increase awareness and provide guidance for chiropractic physicians regarding the diagnosis of spinal gout.

Methods: A search of PubMed was undertaken for recent case reports, reviews and trials relating to spinal gout.

Results: Our analysis of 38 cases of spinal gout revealed that 94% of spinal gout patients presented with back or neck pain, 86% displayed neurological symptoms, 72% had a history of gout, and 80% had raised serum uric acid levels. Seventy-six percent of cases proceeded to surgery. A combination of clinical findings, laboratory tests and appropriate utilization of Dual Energy Computed Tomography (DECT) has the potential to improve early diagnosis.

Conclusion: Gout is an uncommon cause of spine pain; however, it must be considered in the differential diagnosis as outlined in this paper. Increased awareness of the signs of spinal gout and earlier detection and treatment has the potential to improve the quality of life of patients and reduce the need for surgery.

Objective: Following sports injury, a timely and accurate diagnosis is important, so as to initiate appropriate care as soon as possible. This is perhaps even more paramount in pediatric athletic trauma, particularly during the pre-puberty through adolescent years of rapid skeletal growth. This paper presents the diagnosis and management of osteochondritis dissecans in its third most common location, the elbow, a presentation of which chiropractors should be aware, including the importance of timely diagnosis and appropriate treatment.

Clinical features: A 9-year-old elite gymnast presented at a chiropractic clinic with elbow pain and restricted range of motion after a fall during training. Following multidisciplinary involvement, the diagnosis was eventually made as osteochondritis dissecans.

Intervention and outcomes: The patient underwent successful arthroscopic surgery in order to remove the osteochondral fragment, followed by a specific regimen of rehabilitation exercises, which helped to enhance and accelerate optimal healing for her return to athletic activity.

Summary: This case reminds the practicing chiropractor of the valuable role he/she can play in a multidisciplinary management of pediatric sports trauma, particularly in diagnosis and post-surgical care. A literature review presents a synopsis of the reported clinical presentations, diagnostic assessment and therapeutic options for capitellar osteochondritis dissecans.

Objective: To highlight a case of an athlete with a symptomatic pretibial cyst 4-years post-ACL reconstruction surgery.

Case presentation: A 23-year-old female soccer athlete presented with right-sided knee pain, locking and catching, and diminished sensation along the anteroinferior knee. She had a history of an ipsilateral ACL hamstring autograft four years prior. Physical evaluation revealed a visible and palpable swelling medial to the patellar tendon, limited and painful range, and hypoesthesia within the infrapatellar branch of the saphenous nerve. MRI revealed a tubular ganglion cyst along the anterior aspect of the tibial tunnel, medial to the patellar tendon, and anterior to the ACL graft.

Summary: Post-surgical ganglion cyst formation in the reconstructed ACL is a rare complication that can present years following ACL surgery. This case aims to bring awareness to this condition as a potential long-term complication in the ACL-reconstructed athlete.

Background: Shoulder problems are common in swimmers. Previous research has focused on elite swimmers. Our research questions were: 1) what is the prevalence of shoulder problems among Ontario age group swimmers and 2) how does prevalence relate to age, sex and years of experience?

Methods: A cross sectional survey was administered to youth swimmers from two Ontario clubs. Oslo Sports Trauma Research Centre Overuse Injury Questionnaire (OSTRC) was used to assess four-week prevalence of shoulder problems. Prevalence (%) with 95% confidence intervals (95% CI) was constructed and prevalence across age, sex and years of experience was investigated using cross-tabulations and chi-square tests.

Results: There were 83 surveys completed (response rate 50%). The 4-week prevalence of shoulder pain was 35% (95% CI 25%, 45%). Shoulder problems were not significantly related to age, sex or years of experience.

Conclusion: These results can inform future studies on injury prevention and risk mitigation strategies in swimmers.

Objectives: To identify and prioritize research to inform research agenda development for Canadian chiropractors working in sport.

Methods: Clinicians, researchers and leaders from the Canadian sports chiropractic field were invited to participate in 1) a survey to refine a list of research priorities, 2) a Delphi procedure to determine consensus on these priorities, and 3) a prioritization survey.

Results: The top three research priorities were 1) effects of interventions on athletic outcomes, 2) research about sports healthcare teams, and 3) clinical research related to spinal manipulative and mobilization therapy. The three highest ranked conditions to research were 1) low back pain, 2) neck pain, and 3) concussion. Collaborations with sports physicians and universities/ colleges were rated as important research collaborations to pursue.

Conclusions: These results represent the Canadian sports chiropractic perspective to research priority setting and will be used alongside stakeholder input to set the first research agenda for the Canadian sports chiropractic field.