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Monthly Archives: February 2015

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Identification of Internal Carotid Artery Dissection

By |February 27, 2015|Carotid Artery Dissection, Diagnosis|

Identification of Internal Carotid Artery Dissection in Chiropractic Practice

The Chiro.Org Blog


SOURCE:   J Can Chiropr Assoc. 2004 (Sep);   48 (3):   206-210 ~ FULL TEXT

Michael T Haneline, DC, MPH and Gary Lewkovich, DC

Palmer College of Chiropractic West,
Palmer Center for Chiropractic Research,
90 E. Tasman Drive,
San Jose, CA 95134
michael.haneline@palmer.edu


Internal carotid artery dissection (ICAD) is a condition involving separation of the artery’s intimal lining from its medial division, with subsequent extension of the dissection along varying distances of the artery, usually in the direction of blood flow. ICAD may produce cerebral ischemia due to occlusion of the involved artery. This occlusion may occur at or near the site of the dissection, or “downstream” as a result of embolization from a dislodged thrombus fragment. The problem any chiropractic physician faces in identifying ICAD patients is that the condition may present without any symptoms or the symptoms may appear benign (e.g., headache, neck pain or cervicogenic dizziness). Consequently, it may be impossible to identify some ICAD patients, especially in the early stages of the pathology. As the ICAD progresses and neural blood flow is compromised, the symptom picture typically manifests more completely. The chiropractic physician must be alert to characteristic findings of a progressing ICAD, since an immediate referral to a medical specialist may be required.

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From the FULL TEXT Article:

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The Etiology of Cervical Artery Dissection

By |February 26, 2015|Diagnosis, Vertebral Artery|

The Etiology of Cervical Artery Dissection

The Chiro.Org Blog


SOURCE:   J Chiropr Med. 2007 (Summer);   6 (3):   110-120 ~ FULL TEXT

Michael T. Haneline [a], and Anthony L. Rosner [b]

a   Professor,
Palmer College of Chiropractic West,
Department of Research, San Jose, CA 95134
michael.haneline@palmer.edu

b   Professor,
Parker College of Chiropratic,
Brookline, MA 02446


The etiology of cervical artery dissection (CAD) is unclear, although a number of risk factors have been reported to be associated with the condition. On rare occasions, patients experience CAD after cervical spine manipulation, making knowledge about the cervical arteries, the predisposing factors, and the pathogenesis of the condition of interest to chiropractors. This commentary reports on the relevant anatomy of the cervical arteries, developmental features of CAD, epidemiology of the condition, and mechanisms of dissection. The analysis of CAD risk factors is confusing, however, because many people are exposed to mechanical events and known pathophysiological associations without ever experiencing dissection. No cause-and-effect relationship has been established between cervical spine manipulation and CAD, but it seems that cervical manipulation may be capable of triggering dissection in a susceptible patient or contributing to the evolution of an already existing CAD. Despite the many risk factors that have been proposed as possible causes of CAD, it is still unknown which of them actually predispose patients to CAD after cervical spine manipulation.


From the FULL TEXT Article:

Introduction

The etiology of cervical artery dissection (CAD) is, for the most part, unclear; and what has been proposed as an explanation for its pathogenesis is largely hypothetical. [1] Furthermore, when dealing with a particular case of CAD, the pathogenesis is especially speculative. [2] Nevertheless, a number of risk factors have been reported to be associated with the condition, including connective tissue abnormalities, hypertension, recent infection, migraine headache, the use of oral contraceptives, and others. Of special interest to chiropractors is the role cervical spine manipulation (CSM) plays, if any, in the pathogenesis of CAD. Indeed, patients do experience CAD on rare occasions after CSM, making knowledge about the cervical arteries, the predisposing factors, and the pathogenesis of the condition important for chiropractors.

Anatomy of the cervical arteries

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Recognition of Spontaneous Vertebral Artery Dissection

By |February 25, 2015|Diagnosis, Vertebral Artery|

Recognition of Spontaneous Vertebral Artery Dissection Preempting Spinal Manipulative Therapy: A Patient Presenting With Neck Pain and Headache for Chiropractic Care

The Chiro.Org Blog


SOURCE:   J Chiropr Med. 2014 (Jun);   13 (2):   90-95 ~ FULL TEXT

Ross Mattox, DC, [a], Linda W. Smith, DC, [b] and
Norman W. Kettner, DC, DACBR, FICC [c]

a   Diagnostic Imaging Resident,
Department of Radiology,
Logan University, Chesterfield, MO
ude.nagol@xottam.ssor

b   Chiropractic Physician,
Private Practice, St. Louis, MO

c   Chair, Department of Radiology,
Logan University, Chesterfield, MO


OBJECTIVE:   The purpose of this case report is to describe a patient who presented to a chiropractic physician for evaluation and treatment of neck pain and headache.

CLINICAL FEATURES:   A 45-year-old otherwise healthy female presented for evaluation and treatment of neck pain and headache. Within minutes, non-specific musculoskeletal symptoms progressed to neurological deficits, including limb ataxia and cognitive disturbances. Suspicion was raised for cerebrovascular ischemia and emergent referral was initiated.

INTERVENTION AND OUTCOME:   Paramedics were immediately summoned and the patient was transported to a local hospital with a working diagnosis of acute cerebrovascular ischemia. Multiplanar computed tomographic and magnetic resonance imaging with contrast revealed vertebral artery dissection of the V2 segment in the right vertebral artery. Anticoagulation therapy was administered and the patient was discharged without complications after 5 days in the hospital.

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Elongated Styloid Processes and Calcified Stylohyoid Ligaments in a Patient With Neck Pain: Implications for Manual Therapy Practice

By |February 23, 2015|Diagnosis, Vertebral Artery|

Elongated Styloid Processes and Calcified Stylohyoid Ligaments in a Patient With Neck Pain: Implications for Manual Therapy Practice

The Chiro.Org Blog


SOURCE:   J Chiropr Med. 2014 (Jun);   13 (2):   128–133 ~ FULL TEXT

Bart N. Green, DC, MSEd,a,b, LCDR Kristin M. Browske, MD,
and CAPT Michael D. Rosenthal, PT, DSc, ATC

a   Chiropractor,
Department of Physical and Occupational Therapy,
Naval Medical Center, San Diego, CA

b   Associate Editor,
Publications Department,
National University of Health Sciences,
Lombard, IL

Corresponding author at:
Marine Corps Air Station Miramar,
Branch Health Clinic,
PO Box 452002,
San Diego, CA 92145-2002. Tel.: + 1 858 577 9948
lim.yvan.dem@neerg.traB


Objective   The purpose of this paper is to present a case of a patient with neck pain, tinnitus, and headache in the setting of bilateral elongated styloid processes (ESP) and calcified stylohyoid ligaments (CSL), how knowledge of this anatomical variation and symptomatic presentation affected the rehabilitation management plan for this patient, and to discuss the potential relevance of ESPs and CSLs to carotid artery dissection.

Clinical features   A 29-year-old male military helicopter mechanic presented for chiropractic care for chronic pain in the right side of his neck and upper back, tinnitus, and dizziness with a past history of right side parietal headaches and tonsillitis. Conventional radiographs showed C6 and C7 spinous process fractures, degenerative disc disease at C6/7, and an elongated right styloid process with associated calcification of the left stylohyoid ligament. Volumetric computerized tomography demonstrated calcification of the stylohyoid ligaments bilaterally.

Intervention and outcome   Given the proximity of the calcified stylohyoid apparatus to the carotid arteries, spinal manipulation techniques were modified to minimize rotation of the neck. Rehabilitation also included soft tissue mobilization and stretching, corrective postural exercises, and acupuncture. An otolaryngologist felt that the symptoms were not consistent with Eagle syndrome and the tinnitus was associated with symmetric high frequency hearing loss, likely due to occupational noise exposure. Initially, the patient’s symptoms improved but plateaued by the fifth visit.

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Chiropractic Management of an 81-Year-Old ManWith Parkinson Disease Signs and Symptoms

By |February 21, 2015|Chiropractic Care, Gait Disorder, Parkinson Disease, Premenstrual Syndrome|

Chiropractic Management of an 81-Year-Old Man
With Parkinson Disease Signs and Symptoms

The Chiro.Org Blog


SOURCE:   J Chiropr Med. 2014 (Jun);   13 (2):   116–120

Joesph Bova, DC [1] and Adam Sergent, DC [2]

1   Private Practice, Latham NY.
2   Assistant Professor,
Faculty Clinician,
Palmer College of Chiropractic Florida,
Port Orange, FL


Objective   The purpose of this case report is to describe the chiropractic management of a patient with Parkinson disease.

Clinical features   An 81-year-old male with a 12-year history of Parkinson disease sought chiropractic care. He had a stooped posture and a shuffling gait. He was not able to ambulate comfortably without the guidance of his walker. The patient had a resting tremor, most notably in his right hand. Outcome measures were documented using the Parkinson’s Disease Questionaire-39 (PDQ-39) and patient subjective reports.

Intervention and outcome   The patient was treated with blue-lensed glasses, vibration stimulation therapy, spinal manipulation, and eye-movement exercises. Within the first week of treatment, there was a reduction in symptoms, improvement in ambulation, and tremor.

Conclusion   For this particular patient, the use of alternative treatment procedures appeared to help his Parkinson disease signs and symptoms.

Key indexing terms:   Parkinson disease, Tremor, Gait disorder, Chiropractic


From the FULL TEXT Article:

Introduction

Parkinson disease (PD) is a neurodegenerative brain disorder that progresses slowly in most patients. [1] When approximately 60% to 80% of the dopamine producing cells are damaged, cardinal motor symptoms such as akinesia, rigidity, and tremor begin to appear. [1] A small number of patients have a direct mutation that causes it, but genetic predisposition and environmental factors are most commonly the cause. [1] PD is a central nervous system disorder resulting from destruction of the substantia nigra, which initiates dopamine release, an inhibitory transmitter. [2–4] The lack of dopamine causes a continuous excitatory signal to be sent to the corticospinal tract of the spinal cord, causing over-excitation of the motor cortex; this over-excitation creates the typical PD symptoms. [2–4]

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Chiropractic identity, role and future: a survey of North American chiropractic students

By |February 3, 2015|Research|

Source Chiropractic and Manual Therapies

Jordan A Gliedt, Cheryl Hawk, Michelle Anderson, Kashif Ahmad, Dinah Bunn,Jerrilyn Cambron, Brian Gleberzon, John Hart, Anupama Kizhakkeveettil, Stephen M Perle, Michael Ramcharan, Stephanie Sullivan and Liang Zhang

Abstract

Background

The literature pertaining to chiropractic students’ opinions with respect to the desired future status of the chiropractic physician is limited and is an appropriate topic worthy of study. A previous pilot study was performed at a single chiropractic college. This current study is an expansion of this pilot project to collect data from chiropractic students enrolled in colleges throughout North America.

Objective

The purpose of this study is to investigate North American chiropractic students’ opinions concerning professional identity, role and future.

Methods

A 23-item cross-sectional electronic questionnaire was developed. A total of 7,455 chiropractic students from 12 North American English-speaking chiropractic colleges were invited to complete the survey. Survey items encompassed demographics, evidence-based practice, chiropractic identity and setting, and scope of practice. Data were collected and descriptive statistical analysis was performed.

Results

A total of 1,247 (16.7% response rate) questionnaires were electronically submitted. Most respondents agreed (34.8%) or strongly agreed (52.2%) that it is important for chiropractors to be educated in evidence-based practice. A majority agreed (35.6%) or strongly agreed (25.8%) the emphasis of chiropractic intervention is to eliminate vertebral subluxations/vertebral subluxation complexes. A large number of respondents (55.2%) were not in favor of expanding the scope of the chiropractic profession to include prescribing medications with appropriate advanced training. Most respondents estimated that chiropractors should be considered mainstream health care practitioners (69.1%). Several respondents (46.8%) think that chiropractic research should focus on the physiological mechanisms of chiropractic adjustments.

Conclusion

The chiropractic students in this study showed a preference for participating in mainstream health care, report an exposure to evidence-based practice, and desire to hold to traditional chiropractic theories and practices. The majority of students would like to see an emphasis on correction of vertebral subluxation, while a larger percent found it is important to learn about evidence-based practice. These two key points may seem contradictory, suggesting cognitive dissonance. Or perhaps some students want to hold on to traditional theory (e.g., subluxation-centered practice) while recognizing the need for further research to fully explore these theories. Further research on this topic is needed.