Australasian chiropractic & osteopathy : journal of the Chiropractic & Osteopathic College of Australasia最新文献

The following paper is a case study of a patient with a history of chronic headaches (originally diagnosed as migraine without aura) who was being treaded at the Macquarie University Chiropractic Outpatients Clinic for cervical spine dysfunction. The treatments successfully reduced the upper neck and thoracic pain that the patient was experiencing and for which they had initially presented at the clinic. During the treatments, the patient also showed a significant subjective reduction in prevalence and intensity of headaches over a four month period. Analysis of the outcome is complicated by the fact that it is not clear whether the patient's headaches were initially misdiagnosed as common migraine when in fact, they were cervicogenic. There may be some overlap between the two conditions, and a possible causative relationship between cervical spine dysfunction and common migraine. Furthermore, this case study discusses the validity of chiropractic treatment of organic disorders such as chronic headache or migraine.

Objectives: This research was designed to analyse the frequency spectra of joint crack sounds produced during spinal manipulative therapy applied to the upper cervical spine of 50 volunteers and to determine if the spectra differed between the sexes and or for those with a history of previous neck trauma compared with those without a history of trauma.

Design: Randomised experimental study.

Setting: Macquarie University, Centre for Chiropractic, Summer Hill, New South Wales.

Subjects: Fifty asymptomatic subjects were recruited from the students and staff of the above college.

Intervention: Single, unilateral "diversified", high velocity, low amplitude, rotatory thrust technique applied to the region of the C3/4 zygapophyseal joints.

Main outcome measures: Joint crack sound wave analysis of Digital Audio Tape (DAT) recordings, taken from two skin mounted microphones positioned on either side of the cervical spine and later analysed by the use of a computer equipped with professional quality frequency spectrum analysis software.

Results: All fifty manipulations resulted in at least one audible joint crack sound and in total the fifty subjects combined produced 123 individual joint cracks. Only 9 subjects (18%) produced a single joint crack, the majority of the subjects (82%) produced either two (22 subjects) or three (10 subjects) distinct joint crack signals, while seven subjects produced four and two subjects five separate joint crack signals. Frequency analysis was performed on a total of 122 individual wave forms. Peak frequencies for all analysed crack signals ranged from 1,830 Hz to 86 Hz with an mean of 333 Hz (95% C.I., 285-380 Hz), a mode of 215 Hz and a median of 215 Hz. Statistical analysis for recorded signals revealed 95% Confidence Interval for the mean of 285-380 Hz. No statistically significant differences were found for peak frequencies between the sexes or for a previous history of trauma and no trauma and for pre-manipulative and manipulative joint cracks.

This case report describes a relatively uncommon presentation of herpes zoster affecting the cutaneous distribution of the L2 spinal nerve. The coexistence of a previous history of leg pain, cortical thickening of the femoral shaft on plain film x-ray examination, and the absence, at the time of examination, of the tell tale rash of herpes zoster provided the clinician with a diagnostic challenge. Furthermore, this case stresses the importance of a thorough neurological and orthopaedic examination as well as careful visual inspection of the painful region.

In 1992, the High Court of Australia handed down a decision on consent to medical treatment. The case had widespread media publicity, and caused consternation among many members of the medical profession. This article explains the law on consent to treatment by health practitioners and considers the relevance of the law for chiropractors and osteopaths.

Objective: A pilot study was conducted to determine whether untrained examiners could agree on palpatory findings in the cervical spine.

Design: Fifty-three university students, (most of whom were chiropractic students), had their cervical spines examined by seven different chiropractors using their own clinical methods, of which motion palpation was a common, but not standard component.

Setting: Chiropractic Centre in Macquarie University.

Participants: Volunteer university students.

Main outcome measures: Individual clinical methods, which included static and/or motion palpation, vertebral springing, range of motion and applied kinesiology.

Results: Statistically, for the total group, there was poor interexaminer reliability. Of eight examiners, four did not disagree significantly, the next two examiners disagreed with each other but only at a single level and the remaining two examiners disagreed with most of the other examiners and each other.

Conclusion: In the cervical spine, it appears that C6 is the level of highest contention, followed by C1 and C5. Essentially the results suggest that combinations of examiners show reasonable consistency at identifying the same entity while using their own typical examination techniques. The nature of these palpable findings, leading to a diagnosis of subluxation or vertebral dysfunction is ill defined. Several issues were considered as important: expectations of examiners, research design, subject compliance, role of asymptomatic subjects and what the examiners were actually detecting.