Intervertebral Disc Magnetic Resonance Spectroscopy Changes After Spinal Manipulative Therapy for Lumbar Discogenic Pain.

This study investigates the use of magnetic resonance spectroscopy (MRS) to identify the intervertebral disc (IVD) as a pain generator, explore the pathophysiology of the biochemical and structural components of discogenic low back pain (DLBP), and present potential evidence of physiological responses to spinal manipulation therapy (SMT). A 29-year-old male presented with uncomplicated low back pain (LBP). The non-specific presentation and clinical examination findings were consistent with an initial working diagnosis of non-specific LBP with the clinician suspecting IVD as a likely pain generator.

Evaluation of chiropractic students' knowledge and attitudes following pain interventions: A randomized educational trial at 2 institutions.

Objective: To examine chiropractic students' attitudes regarding knowledge of pain neuroscience, chronic pain, and patient-centered care before and after educational interventions. Secondarily, this study aimed to compare measures of these skills between cohorts at different timepoints throughout training programs.

Methods: Using stratified randomization, 281 Year 3 chiropractic students at 2 institutions were allocated into 1 of 3 educational interventions and served as active-control comparison groups: pain neuroscience education, chronic pain education, or patient-centered care.

[ 11 C]-PBR28 positron emission tomography signal as an imaging marker of joint inflammation in knee osteoarthritis.

Although inflammation is known to play a role in knee osteoarthritis (KOA), inflammation-specific imaging is not routinely performed. In this article, we evaluate the role of joint inflammation, measured using [ 11 C]-PBR28, a radioligand for the inflammatory marker 18-kDa translocator protein (TSPO), in KOA. Twenty-one KOA patients and 11 healthy controls (HC) underwent positron emission tomography/magnetic resonance imaging (PET/MRI) knee imaging with the TSPO ligand [ 11 C]-PBR28.

Causal influence of brainstem response to transcutaneous vagus nerve stimulation on cardiovagal outflow.

Background: The autonomic response to transcutaneous auricular vagus nerve stimulation (taVNS) has been linked to the engagement of brainstem circuitry modulating autonomic outflow. However, the physiological mechanisms supporting such efferent vagal responses are not well understood, particularly in humans.

Hypothesis: We present a paradigm for estimating directional brain-heart interactions in response to taVNS.

Cine gastric MRI reveals altered Gut-Brain Axis in Functional Dyspepsia: gastric motility is linked with brainstem-cortical fMRI connectivity.

Background: Functional dyspepsia (FD) is a disorder of gut-brain interaction, and its putative pathophysiology involves dysregulation of gastric motility and central processing of gastric afference. The vagus nerve modulates gastric peristalsis and carries afferent sensory information to brainstem nuclei, specifically the nucleus tractus solitarii (NTS). Here, we combine MRI assessment of gastric kinematics with measures of NTS functional connectivity to the brain in patients with FD and healthy controls (HC), in order to elucidate how gut-brain axis communication is associated with FD pathophysiology.

Baseball Injury Resulting in Type III Salter-Harris Fracture of the First Proximal Phalangeal Base: A Case Report.

Objective: The purpose of this report is to describe the clinical, radiographic, and diagnostic ultrasound findings in a patient who sustained a type III Salter-Harris fracture of the first proximal phalanx.

Clinical Features: A 14-year-old male baseball player presented to a chiropractic clinic with a 2-day history of proximal thumb pain, which began following a forceful hyperabduction injury while sliding into base. Thenar swelling was evident on clinical examination, and both active and passive thumb motions were painful in all directions.

S1 Brain Connectivity in Carpal Tunnel Syndrome Underlies Median Nerve and Functional Improvement Following Electro-Acupuncture.

Carpal Tunnel Syndrome (CTS) is a median nerve entrapment neuropathy that alters primary somatosensory cortex (S1) organization. While electro-acupuncture (EA), a form of peripheral neuromodulation, has been shown to improve clinical and neurophysiological CTS outcomes, the role of EA-evoked brain response during therapy (within and beyond S1) for improved outcomes is unknown. We investigated S1-associated whole brain fMRI connectivity during both a resting and sustained EA stimulation state in age-matched healthy controls ( = 28) and CTS patients ( = 64), at baseline and after 8 weeks of acupuncture therapy (local, distal, or sham EA).

Non-uniform gastric wall kinematics revealed by 4D Cine magnetic resonance imaging in humans.

Background: Assessment of gastric function in humans has relied on modalities with varying degrees of invasiveness, which are usually limited to the evaluation of single aspects of gastric function, thus requiring patients to undergo a number of often invasive tests for a full clinical understanding. Therefore, the development of a non-invasive tool able to concurrently assess multiple aspects of gastric function is highly desirable for both research and clinical assessments of gastrointestinal (GI) function. Recently, technological advances in magnetic resonance imaging (MRI) have provided new tools for dynamic (or "cine") body imaging.

Sonographic measures and sensory threshold of the normal sciatic nerve and hamstring muscles.

Purpose: The sciatic nerve innervates the hamstring muscles. Occasionally, the sciatic nerve is injured along with a hamstring muscle. Detailed biomechanical and sensory thresholds of these structures are not well-characterized.

Increased Salience Network Connectivity Following Manual Therapy is Associated with Reduced Pain in Chronic Low Back Pain Patients.

Chronic low back pain (cLBP) has been associated with changes in brain plasticity. Nonpharmacological therapies such as Manual Therapy (MT) have shown promise for relieving cLBP. However, translational neuroimaging research is needed to understand potential central mechanisms supporting MT.

Neural Arch Bone Marrow Edema and Spondylolysis in Adolescent Cheerleaders: A Case Series.

Objective: Spondylolysis is 1 of the most common sources of low back pain in children and adolescents; however, there is still a great deal of confusion in regard to etiology, clinical presentation, and diagnostic imaging findings. It is imperative for clinicians to recognize that persistent low back pain is strongly indicative of spondylolysis, especially in high-performance athletes. This case series demonstrates a comprehensive diagnostic spectrum of spondylolysis and its treatment in 2 competitive adolescent cheerleaders.

Effort Thrombosis in 2 Athletes Suspected of Musculoskeletal Injury.

Objective: This case series describes the clinical presentation of effort thrombosis and the utility of sonography in its diagnosis.

Clinical Features: Two young male athletes presented to separate chiropractic clinics with suspected musculoskeletal shoulder injury. The first complained of dull shoulder pain after pitching in a baseball game and had no other signs or symptoms.

Stimulus frequency modulates brainstem response to respiratory-gated transcutaneous auricular vagus nerve stimulation.

Background: The therapeutic potential of transcutaneous auricular VNS (taVNS) is currently being explored for numerous clinical applications. However, optimized response for different clinical indications may depend on specific neuromodulation parameters, and systematic assessments of their influence are still needed to optimize this promising approach.

Hypothesis: We proposed that stimulation frequency would have a significant effect on nucleus tractus solitarii (NTS) functional MRI (fMRI) response to respiratory-gated taVNS (RAVANS).

Diagnosing acetabular labral tears with hip traction sonography: a case series.

Purpose: Three cases of acetabular labral tear (ALT) diagnosed with sonography (US) are reported. We aim to show utility for US with the addition of manual hip traction as an adjunctive modality to the current diagnostic imaging of choice, magnetic resonance arthrography (MRA), for diagnosing ALT.

Methods: Three cases of young athletic patients with similar clinical presentations are reported.

Rectus abdominis muscle tear diagnosed with sonography and its conservative management.

Purpose: This is a rare case of a post-traumatic rectus abdominis muscle tear in an adolescent female diagnosed by ultrasonography (US). Conservative management is also described.

Methods: A 14-year-old female presented to a chiropractic clinic with extreme pain and tenderness in the right lower quadrant (RLQ) after post-plyometric power kneel box jumps.

Sonoelastography of the trunk and lower extremity muscles in a case of Duchenne muscular dystrophy.

Duchenne muscular dystrophy (DMD) is a rare genetic disorder typically presenting with muscle weakness and reduced tone of trunk and lower extremities. The sonoelastographic properties of DMD are poorly understood. We describe sonoelastographic characteristics of a patient's trunk and lower extremity musculature.

Ulnar nerve instability in the cubital tunnel of asymptomatic volunteers.

Purpose: Ulnar nerve instability (UNI) in the cubital tunnel is defined as ulnar nerve subluxation or dislocation. It is a common disorder that may be noted in patients with neuropathy or in the asymptomatic. Our prospective, single-site study utilized high-resolution ultrasonography (US) to evaluate the ulnar nerve for cross-sectional area (CSA) and measures of shear-wave elastography (SWE).

Neural Mobilization in a 54-Year-Old Woman With Postoperative Spinal Adhesive Arachnoiditis.

Objective: This case report describes the clinical features, complications, imaging characteristics, and management of postoperative spinal adhesive arachnoiditis.

Clinical Features: A 54-year-old woman presented with right posterior thigh and leg pain after a lumbar spine fusion surgery to correct a degenerative spondylolisthesis of L3/4. Her pain was sharp and shooting and worsened with knee extension.

The influence of respiration on brainstem and cardiovagal response to auricular vagus nerve stimulation: A multimodal ultrahigh-field (7T) fMRI study.

Background: Brainstem-focused mechanisms supporting transcutaneous auricular VNS (taVNS) effects are not well understood, particularly in humans. We employed ultrahigh field (7T) fMRI and evaluated the influence of respiratory phase for optimal targeting, applying our respiratory-gated auricular vagal afferent nerve stimulation (RAVANS) technique.

Hypothesis: We proposed that targeting of nucleus tractus solitarii (NTS) and cardiovagal modulation in response to taVNS stimuli would be enhanced when stimulation is delivered during a more receptive state, i.

Brain Mechanisms of Anticipated Painful Movements and Their Modulation by Manual Therapy in Chronic Low Back Pain.

Heightened anticipation and fear of movement-related pain has been linked to detrimental fear-avoidance behavior in chronic low back pain (cLBP). Spinal manipulative therapy (SMT) has been proposed to work partly by exposing patients to nonharmful but forceful mobilization of the painful joint, thereby disrupting the relationship among pain anticipation, fear, and movement. Here, we investigated the brain processes underpinning pain anticipation and fear of movement in cLBP, and their modulation by SMT, using functional magnetic resonance imaging.

Post-traumatic Scapholunate Advanced Collapse of the Wrist: A Case Report.

Objective: The purpose of this report is to describe a patient with scapholunate advanced collapse (SLAC) of the wrist.

Clinical Features: A 38-year-old man presented to a chiropractic teaching clinic with right wrist pain after falling off of the tailgate of a truck 7 years prior. The mechanism of injury was a fall on an outstretched hand.

Occult isolated fracture of the trapezoid diagnosed by ultrasonography.

Purpose: To describe a patient with an occult isolated trapezoid fracture of the wrist. Isolated trapezoid fractures are very difficult to detect without advanced radiological imaging, since the fragment displacement does not occur in the sagittal plane. A discussion regarding the investigation of trapezoid fractures utilizing multiple imaging modalities includes the first demonstration of its detection via ultrasonography (US).

Neuroinflammation of the spinal cord and nerve roots in chronic radicular pain patients.

Numerous preclinical studies support the role of spinal neuroimmune activation in the pathogenesis of chronic pain, and targeting glia (eg, microglia/astrocyte)- or macrophage-mediated neuroinflammatory responses effectively prevents or reverses the establishment of persistent nocifensive behaviors in laboratory animals. However, thus far, the translation of those findings into novel treatments for clinical use has been hindered by the scarcity of data supporting the role of neuroinflammation in human pain. Here, we show that patients suffering from a common chronic pain disorder (lumbar radiculopathy), compared with healthy volunteers, exhibit elevated levels of the neuroinflammation marker 18 kDa translocator protein, in both the neuroforamina (containing dorsal root ganglion and nerve roots) and spinal cord.