CLINICAL FEATURES: A 71-yr-old woman with a cold, painful right hand and chronic neck pain sought chiropractic evaluation. There was a left head tilt and muscular hypertonicity with fibrous bands in the opposite scalenes and sternocleidomastoid. Thermographic examination revealed a large temperature differential (12 degrees F) between the dorsum of the right and left hands, with the superficial veins on the dorsum of the cold hand collapsed. Thoracic outlet provocation tests were negative. A left-side leg-length inequality potentially indicative of putative upper cervical subluxation was also noted. A diagnosis of presumptive thoracic outlet syndrome with vasomotor vascular complications subsequent to altered cervical biomechanics was made.
INTERVENTION AND OUTCOME: Treatment was limited to chiropractic, upper cervical, vectored, linear adjustment of the atlas vertebra. Temperature differential between the hands improved significantly after individual atlas adjustment(s) and in the long term.
CONCLUSION: Scalenus anticus syndrome and upper extremity thermal asymmetry may result from altered cervical biomechanics caused by atlas vertebral subluxation complex. Furthermore, the supine leg check may be of value in determining the necessity of atlas adjustment.
Knutson GA. Thermal asymmetry of the upper extremity in scalenus anticus syndrome, leg-length inequality and response to chiropractic adjustment.J Manipulative Physiol Ther 1997 Sep;20(7):476-481
Reeves RR, Struve FA, Patrick G. Somatic dysfunction increase during caffeine withdrawal. J Am Osteopath Assoc 1997 Aug;97(8):454-456
Wax CM, Abend DS, Pearson PH. Chest pain and the role of somatic dysfunction. J Am Osteopath Assoc 1997 Jun;97(6):347-352
DESIGN: Randomized, controlled, partially blind study examining chronic neck pain patients and control subjects for differences in degree of upper cervical somatic dysfunction, standing balance and suboccipital muscle atrophy.
SETTING: Subjects were recruited from a clinical practice at Michigan State University; controls were recruited from the faculty, staff and students.
PARTICIPANTS: Seven chronic neck pain patients and seven asymptomatic control subjects.
MAIN OUTCOME MEASURES: Palpation was used to diagnose somatic dysfunction in the upper cervical spine. Balance parameters were calculated using a force platform; muscle atrophy was judged with magnetic resonance images.
RESULTS: Chronic neck pain patients had almost twice as many somatic dysfunctions as controls (p = .028). Force platform results showed a decrease in standing balance in patients compared with control subjects (p = .004). MRI showed that chronic neck pain subjects had marked atrophy of the rectus capitis posterior major and minor muscles, including fatty infiltration.
CONCLUSIONS: This study suggests that there is a relationship between chronic pain, somatic dysfunction, muscle atrophy and standing balance. We hypothesize a cycle initiated by chronic somatic dysfunction, which may result in muscle atrophy, which can be further expected to reduce proprioceptive output from atrophied muscles. The lack of proprioceptive inhibition of nociceptors at the dorsal horn of the spinal cord would result in chronic pain and a loss of standing balance.
McPartland JM, Brodeur RR, Hallgren RC. Chronic neck pain, standing balance, and suboccipital muscle atrophy--a pilot study.J Manipulative Physiol Ther 1997 Jan;20(1):24-29
DATA SOURCES: Literature on normal and abnormal cerebral circulation, including vertebrobasilar insufficiency.
DATA SYNTHESIS: Signs and symptoms produced by extrinsic compression of the vertebrobasilar system have been compared with those attributed elsewhere to the manipulable cervical lesion (cervical subluxation).
RESULTS: Extrinsic compression of the vertebrobasilar system generally does not produce signs and symptoms consistent with those attributed to the manipulable cervical lesion.
CONCLUSION: It has been hypothesized elsewhere that the manipulable cervical lesion may induce localized decreases in regional cerebral blood flow, and so signs and symptoms attributable to "cerebral hibernation." If a causal relationship does exist between the cervical subluxation and reduced regional cerebral blood flow, it is not likely to be caused by mechanical compression of the vertebral arteries.
Budgell BS, Sato A. The cervical subluxation and regional cerebral blood flow.J Manipulative Physiol Ther 1997 Feb;20(2):103-107
DATA SOURCES: A review was conducted of over 350 articles that have appeared in the scientific literature over the last 75 years. Initially, a MEDLINE search was performed; however, because of the variability of indexing terms employed by investigators within a wide variety of biomedical disciplines, most of this literature had to be located article by article.
DATA SYNTHESIS: At present, there have been no appropriately controlled studies that establish that spinal manipulation or any other form of somatic therapy represents a valid curative strategy for the treatment of any internal organ disease. Furthermore, current scientific knowledge also fails to support the existence of a plausible biological mechanism that could account for a causal segmentally or regionally related "somato-visceral disease" relationship. On the other hand, it has now been firmly established that somatic dysfunction is notorious in its ability to create overt signs and symptoms that can mimic, or simulate (rather than cause), internal organ disease.
CONCLUSIONS: The proper differential diagnosis of somatic vs. visceral dysfunction represents a challenge for both the medical and chiropractic physician. The afferent convergence mechanisms, which can create signs and symptoms that are virtually indistinguishable with respect to their somatic vs. visceral etiologies, need to be appreciated by all portal-of-entry health care providers, to insure timely referral of patients to the health specialist appropriate to their condition. Furthermore, it is not unreasonable that this somatic visceral-disease mimicry could very well account for the "cures" of presumed organ disease that have been observed over the years in response to various somatic therapies (e.g., spinal manipulation, acupuncture, Rolfing, Qi Gong, etc.) and may represent a common phenomenon that has led to "holistic" health care claims on the part of such clinical disciplines.
Nansel D, Szlazak M.omatic dysfunction and the phenomenon of visceral disease simulation: a probable explanation for the apparent effectiveness of somatic therapy in patients presumed to be suffering from true visceral disease.J Manipulative Physiol Ther 1995 Jul;18(6):379-397
Van Buskirk RL. Nociceptive reflexes and the somatic dysfunction: a model. J Am Osteopath Assoc 1990 Sep;90(9):792-794
Briggs L, Boone WR. Effects of a chiropractic adjustment on changes in pupillary diameter: a model for evaluating somatovisceral response. J Manipulative Physiol Ther 1988 Jun;11(3):181-189