Electrodiagnostic testing in back and extremity pain.

Objective: The usefulness of electrodiagnostic testing by the primary care provider is shown in two cases of suspected compression-type neural lesions of the lumbar spine.

Clinical Features: A 54-yr-old female with acute lumbar spine pain that radiated into the hip and a 26-yr-old male with sharp gluteal pain that radiated into the thigh and ankle were admitted into an inpatient care facility for intensive therapy. Plain film radiographs were obtained initially.

Treatment of facial muscles affected by Bell's palsy with high-voltage electrical muscle stimulation.

Objective: This report discusses high-voltage electrical muscle stimulation and chiropractic manipulation used to treat two patients who suffered from Bell's palsy.

Clinical Features: Case A: A 15-yr-old with left sided facial palsy was seen 2 days after the onset of symptoms. Upon observation, the left upper and lower eyelids were drooping and the left eye had excessive tearing.

Osteochondroma of the knee.

This article discusses a case of osteochondroma suffered by a female patient. The typical clinical and radiographic signs and symptoms are presented. Osteochondromas may be pedunculated or sessile.

Aneurysmal bone cyst of the hand.

This article discusses a case of an aneurysmal bone cyst in the finger of a male patient. Such tumors are rarely located in the hand. Although rare, an aneurysmal bone cyst is the only benign bone tumor which can extend across a growth plate into the epiphysis.

A comparison of outcome measures for use with back pain patients: results of a feasibility study.

Objective: To compare the reliability, validity and change in patient clinical status over time with treatment for six potential outcome questionnaires in a defined population of patients.

Setting: Physician based, multidoctor teaching practice.

Patients: Three hundred thirty-five consecutive patients presenting with new complaints were solicited.

The Hmax/Mmax ratio as an outcome measure for acute low back pain.

Objective: To evaluate the use of the Hmax/Mmax (H/M) ratio as an outcome measure for acute low back pain and to determine the change of this ratio in acute low back pain patients treated with spinal manipulation.

Design: Randomized clinical trial.

Setting: Chiropractic college teaching clinic.

Chronic fatigue syndrome.

A 36-yr-old white female presented with severe fatigue and symptoms consistent with immune deficiency, but was later found to be suffering from chronic fatigue syndrome. This article discusses the diagnostic criteria for this condition. Chiropractic manipulation afforded relief of some symptoms for this patient.

Thermographic imaging of myofascial trigger points: a follow-up study.

Thermographic evaluation was performed on 11 adult volunteers with myofascial trigger points and on 11 asymptomatic controls. Infrared thermography was used to obtain a series of images to compare the sensory referral areas of myofascial trigger points with their thermal referral patterns. A series of images was then taken at, and distal to, the sensory referral area of each trigger point during quantitative compression of the trigger point, and dynamic temperature changes were monitored.

The effect of spinal manipulation on pain and prostaglandin levels in women with primary dysmenorrhea.

Objective: The primary objectives of this study were to compare the effect of spinal manipulation vs. sham manipulation on a) circulating plasma levels of the prostaglandin F2a metabolite, 15-keto-13,14-dihydroprostaglandin (KDPGF2a), b) perceived abdominal and back pain and c) perceived menstrual distress in women with primary dysmenorrhea.

Design: This randomized clinical pilot study investigated the outcome measures before and after either a spinal manipulation treatment (SMT) or a sham manipulation.

The assessment of cervical intersegmental mobility before and after spinal manipulative therapy.

The objective of this study is to assess the changes in cervical intersegmental spinal mobility before and after the use of spinal manipulative therapy (SMT). Two systems of mensuration are utilized in 58 case studies. The results are then compared to previously defined normal values and the efficacy of SMT is objectively assessed.

Enhanced neutrophil respiratory burst as a biological marker for manipulation forces: duration of the effect and association with substance P and tumor necrosis factor.

A critical need in assessing the clinical utility of manipulative therapy for back pain is the identification of biological changes associated with the forces applied by spinal manipulation. Such changes could then serve as markers for both sham treatment and manipulation. We determined the priming of polymorphonuclear neutrophils for an enhanced respiratory burst and its duration, the priming of mononuclear cells for enhanced endotoxin-stimulated tumor necrosis factor production and plasma levels of substance P following a single thoracic spine manipulation.

Studies on the biomechanical effect of a spinal adjustment.

Manual treatment of spinal disorders is perhaps the most well-studied remedy for spine-related disorders. Clinical description and controlled studies provide only limited advances in knowledge because so little is known scientifically about manual treatment methods or the disorders to which they are directed. The common factor for all manual methods is that they apply an external load to the spine and its surrounding tissues.

Differences in treatment history with manipulation for acute, subacute, chronic and recurrent spine pain.

Preference for treatment protocols used in the care of spine disorders are based more upon clinical impressions than upon systematic study of the pathology or treatment efficacy. As social emphasis moves to cost containment strategies, quantitative data is necessary to give guidance for rational policy decisions. This study sets a description of the clinical experience obtained in a group practice, teaching clinic engaged in management of spine disorders.

Enhanced phagocytic cell respiratory burst induced by spinal manipulation: potential role of substance P.

The effect of spinal manipulation on the respiratory burst of polymorphonuclear neutrophils (PMN) and monocytes from treated adults was measured by zymosan-stimulated chemiluminescence (CL). Peripheral blood was collected 15 min before and 15 min after treatment (sham manipulation, thoracic spine manipulation, or soft tissue manipulation), the cells were isolated, challenged with a standardized, opsonized luminol-containing suspension of zymosan, and monitored for CL. Plasma from two subsets of subjects was radioimmunoassayed for Substance P (SP).

Comparison of computerized tomography with magnetic resonance imaging (MRI) in the evaluation of encephalic ventricular volume.

The volume of the encephalic ventricles was determined from computerized tomographic (CT) and magnetic resonance imaging (MRI) scans of seven subjects without apparent pathology and three subjects with enlarged ventricles. Since there are many conditions in which the encephalic ventricles become enlarged such as Alzheimer's disease and hydrocephalus, accurate measurement of these structures provides (1) a valuable and safe means of aiding in the diagnosis of such conditions and (2) important follow-up information on affected patients. This paper presents the data obtained from the second phase of a three phase study.

Volume determinations of the encephalic ventricles with CT and MRI.

The volume of the encephalic ventricles was determined from magnetic resonance imaging (MRI) scans. Since there are many conditions in which the encephalic ventricles become enlarged such as Alzheimer's disease and hydrocephalus, accurate measurement of the ventricles provides a valuable and safe means of aiding the diagnosis of such conditions and also provides important follow-up information in affected patients. The objective was pursued in a three phase study.

Rib fracture due to bench pressing.

Rib fractures are commonly associated with blunt trauma, but there are instances where this is not the case. In this case a patient fractured the second rib during a "bench press" weight lifting maneuver. The possible etiology is proposed, and the incidence, causes, diagnosis, complications, and treatment of rib fractures are discussed.

Evaluation of encephalic ventricular volume from the magnetic resonance imaging scans of thirty-eight human subjects.

Accurate volume determination of the encephalic ventricles is of importance in several clinical conditions, including Alzheimer's presenile dementia, schizophrenia, and benign intracranial hypertension. Previous studies have investigated the accuracy with which magnetic resonance imaging (MRI) can be used in clinical practice to evaluate the encephalic ventricles. However, adequate evaluation of pathological conditions depends on a sufficient amount of morphometric data from normal subjects.

Relative efficacy for radiation reducing methods in scoliotic patients.

Radiation dosages to sensitive organs in full spine radiography have in recent years been a concern of physicians as well as the general public. The spine is the prime target for exposure in scoliosis radiography, though the exposure usually necessitates irradiation of several radio-sensitive organs. In recent studies, various protection techniques have been used including various lead and aluminum filtration systems, altered patient positioning and varied tube-film distances.

Avascular necrosis of the femur head.

A case of avascular necrosis of the femur head is presented. Its clinical picture is similar to that of osteoarthritis of the hip. The examination should include plain film radiography and radionuclide scan.

Plain film assessment of spinal stenosis: method comparison with lumbar CT.

Methods to determine the sagittal diameter of spinal canal on plain film radiographs have been previously proposed by Eisenstein in 1975 and Buehler in 1978. The purpose of this study was to determine the accuracy of these methods as compared to computed tomography (CT) and to compare the accuracy of each method. The AP diameter of the lumbar canal was evaluated at the L3 through L5 levels.

Efficacy of various methods of sterilization of acupuncture needles.

The iatrogenic transmission of hepatitis B virus by inadequately sterilized acupuncture needles recently has been reported. Because some licensed chiropractors use acupuncture as a therapeutic modality, we have evaluated sterilization methods for these needles, which would be adaptable for use in a chiropractic office. Dry heat, boiling water, pressurized steam, sodium hypochlorite, and 70% alcohol were compared with a glass bead dry heat sterilizer originally developed for dental instruments.

Potential impact of colonic irrigation on the indigenous intestinal microflora.

Under normal physiological conditions, the indigenous intestinal microflora is stable. The stability protects the host from colonization of nonindigenous microorganisms, including pathogens. Indigenous microorganisms capable of producing toxins are held in check by competing microflora, but any accidentally absorbed toxins are efficiently detoxified by the liver in the absence of hepatic pathology.

Altered metabolic enzyme activities in fast and slow twitch muscles due to induced sciatic neuropathy in the rat.

A pilot study was conducted to examine enzymatic and metabolic alterations in end organs as a consequence of neuropathy. Silastic pellets were implanted transverse to the sciatic nerve of rats. Neurobehavioral evaluations based on hind limb gait were conducted at 2 and 4 weeks postoperatively.