Pathologic fracture of metacarpal enchondroma: case study and differential diagnosis.

Objective: To discuss a case of enchondroma initially appearing as a pathologic fracture in a metacarpal bone. The recommended treatment for a pathologic fracture of an enchondroma in the hand is reviewed. Additionally, a reasonable list of differential considerations is presented with accompanying radiographic and advanced imaging characteristics.

Delayed posttraumatic vertebral collapse with intravertebral vacuum cleft.

Objective: To discuss the case of a 79-year-old man who had a delayed posttraumatic vertebral collapse and an intravertebral vacuum cleft. The patient had been on long-term corticosteroid therapy. A discussion of Kummell's disease and the controversy surrounding the etiology of the condition is also presented.

Ganglioneuroma masquerading as spinal pain.

Objective: To discuss the clinical features of ganglioneuroma and to propose it as a differential diagnosis for a young patient suffering from chronic back pain.

Clinical Features: A 25-year-old patient suffered from chronic mid-thoracic pain and a history of scoliosis. The physical examination result was unremarkable; thus radiographs were obtained.

Stiffness and neuromuscular reflex response of the human spine to posteroanterior manipulative thrusts in patients with low back pain.

Background: Studies investigating posteroanterior (PA) forces in spinal stiffness assessment have shown relationships to spinal level, body type, and lumbar extensor muscle activity. Such measures may be important determinants in discriminating between patients who are asymptomatic and those who have low back pain. However, little objective evidence is available concerning variations in PA stiffness and their clinical significance.

Electromyographic reflex responses to mechanical force, manually assisted spinal manipulative therapy.

Study Design: Surface electromyographic reflex responses associated with mechanical force, manually assisted (MFMA) spinal manipulative therapy were analyzed in this prospective clinical investigation of 20 consecutive patients with low back pain.

Objectives: To characterize and determine the magnitude of electromyographic reflex responses in human paraspinal muscles during high loading rate mechanical force, manually assisted spinal manipulative therapy of the thoracolumbar spine and sacroiliac joints.

Summary Of Background Data: Spinal manipulative therapy has been investigated for its effectiveness in the treatment of patients with low back pain, but its physiologic mechanisms are not well understood.

Neurophysiologic response to intraoperative lumbosacral spinal manipulation.

Background: Although the mechanisms of spinal manipulation are poorly understood, the clinical effects are thought to be related to mechanical, neurophysiologic, and reflexogenic processes. Animal studies have identified mechanosensitive afferents in animals, and clinical studies in human beings have measured neuromuscular responses to spinal manipulation. Few, if any, studies have identified the basic neurophysiologic mechanisms of spinal manipulation in human beings or animals.

Tortuosity of the vertebral artery resulting in vertebral erosion.

Objective: To discuss the case of a patient with unilateral vertebral artery tortuosity and dilatation resulting in vertebral body and transverse foramen erosion. An emphasis is placed on diagnostic imaging.

Clinical Features: A 45-year-old man had a frozen shoulder and headaches.

A proposed etiology of cervicogenic headache: the neurophysiologic basis and anatomic relationship between the dura mater and the rectus posterior capitis minor muscle.

Objective: To examine the neurophysiologic basis and anatomic relationship between the dura mater and the rectus capitis posterior minor muscle in the etiologic proposition of cervicogenic headache.

Data Sources: On-line searches in MEDLINE and the Index to Chiropractic Literature, manual citation searches, and peer inquiries.

Results: Connective tissue bridges were noted at the atlanto-occipital junction between the rectus capitis posterior minor muscle and the dorsal spinal dura.

The empty sella.

Objective: To discuss the diagnostic imaging findings of an empty sella in a chiropractic patient with emphasis on magnetic resonance imaging (MRI) of normal and abnormal pituitary appearances.

Clinical Features: A 44-year-old woman started having headache, dizziness, nausea, vomiting, and diarrhea after an argument with her boyfriend. She had been treated for acute torticollis for three weeks when the new symptoms began.

Chiropractic treatment of coccygodynia via instrumental adjusting procedures using activator methods chiropractic technique.

Objective: To discuss a case of coccygodynia that responded favorably to conservative chiropractic adjusting procedures with the Activator Methods Chiropractic Technique (AMCT) and the Activator II Adjusting Instrument (AAI II).

Clinical Features: A 29-year-old woman had unremitting coccygeal pain of 3 weeks' duration. The problem began after she had moved heavy boxes while at work.

Radiographic evaluation of weight-bearing orthotics and their effect on flexible pes planus.

Objective: To determine whether any positive change in the alignment of the bones of the feet occur with the use of custom-made flexible orthotics, cast by weight bearing, in individuals having flexible pes planus.

Methods: Anteroposterior and lateral radiographs were obtained with and without orthotics in place. The anteroposterior and lateral talocalcaneal angles and the lateral pitch of both the left and right foot were assessed.

Changes in brain function after manipulation of the cervical spine.

Objective: To ascertain whether manipulation of the cervical spine is associated with changes in brain function.

Design: Physiological cortical maps were used as an integer of brain activity before and after manipulation of the cervical spine in a large (500 subjects), double-blind controlled study.

Setting: Institutional clinic Participants: Adult volunteers.

Meningovertebral ligaments and their putative significance in low back pain.

Objective: To determine the presence and morphology of the meningovertebral ligaments (ligaments of Hofmann) as well as postulate their possible contribution to low back pain.

Design: Sagittal dissections were performed on 12 embalmed cadaver specimens including the L5/S1 intervertebral level cephalad to T1. Meningovertebral ligaments were labeled and documented in both the lumbar and thoracic regions.

Solitary osteochondroma of the cervical spine.

Objective: To discuss a case of cervical spine osteochondroma found incidentally during evaluation of a rib injury. To demonstrate diagnostic imaging, including plain film radiography, radionuclide bone scan, computed tomography and magnetic resonance imaging.

Clinical Features: This article presents the second reported case of osteochondroma associated with the C6 vertebral body.

Absence of symmetry in superior articular facets on the first cervical vertebra in humans: implications for diagnosis and treatment.

Objective: Little attention has been given to the craniovertebral articulations. Specifically, gross observations of variations of the superior articular facets on the atlas have not been described with respect to static and motion palpation findings. This study describes the anatomical variations of these facets and the clinical implications associated with asymmetrical structure.

Myositis ossificans traumatica.

Objective: To present a case of myositis ossificans traumatica (MOT) in a hockey player. Serial X-ray studies allow the reader an opportunity to observe MOT in its earliest through fulminated stages.

Clinical Features: A 20-yr-old hockey player was subjected to an acute blow to the lateral thigh.

Neglected spinal cord, brain stem and musculoskeletal injuries stemming from birth trauma.

Objective: A review of the medical literature was undertaken to determine cause, diagnosis, prognosis, treatment and prevention of injuries resulting from birth trauma. The primary focus was the neonate, though infant, child and adult were also considered because the effects of birth trauma can be life-long.

Data Source: A compilation of case studies and review articles were extracted from numerous "MEDLINE" literature searches.

Magnetic resonance imaging of the wrist: occult osseous lesions.

This article illustrates the magnetic resonance imaging (MRI) features of occult osseous lesions in three different patients. All three patients suffered from a history of wrist trauma, but had negative plain film radiographs. The three types of occult lesions (bone bruise, microfracture and chronic osseous damage) are described, and their MRI characteristics are demonstrated by proton density and T2 weighted images.

Leg length inequality.

Objective: The (Pacific) Consortium for Chiropractic Research has taken the initiative to research, investigate and provide information directed toward health care accountability, including evaluation of health care measures and practices. This article is a review of the literature pertaining to leg length inequality (LLI). Leg length measures are utilized by various health care providers as an indicator of biomechanical imbalance and necessity for care.

Stability of paraspinal tissue compliance in normal subjects.

Objective: The following studies were performed in order to evaluate the stability of paraspinal tissue compliance measurements. Tissue compliance is a measure of the consistency or firmness of soft tissue and is determined by a hand-held tissue compliance meter.

Design: Descriptive and blinded time course intervention measurements.

The radiology of cervical spine injury.

Cervical spine injury is a frequent sequelae of accidental trauma. Clinical evaluation often fails to raise adequate suspicion of an underlying injury. Radiologic assessment frequently reveals recognizable signs of damage ranging from fractures to joint and soft tissue injuries.

Chiropractic adjustive manipulation on subjects with acute low back pain: visual analog pain scores and plasma beta-endorphin levels.

The purpose of this study was to evaluate pain scores and plasma beta-endorphin levels following a single spinal adjustive manipulation in subjects with acute low back pain. Eighteen subjects were randomly assigned to either a control group, which received no treatment; a sham group, which received only light physical contact (touch); or an experimental group, which received an adjustive manipulation at a specific lumbar segment. Following a standard protocol, all subjects were administered visual analog pain scales and venous blood was drawn 5 min prior to, 5 min after, and 30 min after intervention.

An analytical survey of structural aberrations observed in static radiographic examinations among acute low back cases.

For many years, static standing x-ray views of the lumbar spine and pelvis have been evaluated to identify variations in the positional attitude of the osseous segments and to relate such findings with possible causes of low back pain and disability. This study of 110 cases of acute low back pain identified the frequency of occurrence of intervertebral disc-space wedging, the level where it most frequently occurred and the associated alterations in the attitude of the pelvis and adjacent vertebral segments. Correlation of the location of pain with the distorted structural positions was also attempted.

Inter- and intra-examiner reliability of palpation for sacroiliac joint dysfunction.

The purpose of this study was to operationally define and evaluate inter- and intra-examiner reliability of the standing sacroiliac mobility (Gillet) test on 53 college students. Both inter- and intra-examiner reliability data showed high mean percentages of agreement (85.3% and 89.