Subluxation associated with temperature difference

OBJECTIVE: To describe a case of a vasomotor, vascular form of thoracic outlet syndrome that causes upper extremity thermal asymmetry, and to discuss a single subject case study (N-of-1) comparing the correlation of a subjective test for putative atlas vertebral subluxation complex (supine leg-length inequality) with a single blinded objective measurement [temperature differential (delta degree T)] on the dorsum of the hands.

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

Somatic Dysfunctions Increased By Viscerosomatic Reflexes

The authors studied the effects of caffeine withdrawal on 14 subjects at baseline and during a 4-day period of abstinence from caffeine. They studied the results from quantitative electroencephalograms performed on these subjects and gauged any changes that may have been evoked during this withdrawal period. The participants were also evaluated for the occurrence of somatic dysfunctions. Examinations for the presence of somatic dysfunctions were performed on the participants before caffeine cessation and on Days 1, 2 and 4 of abstinence. Results showed that the number of somatic dysfunctions increased significantly during the process of caffeine withdrawal.

Reeves RR, Struve FA, Patrick G. Somatic dysfunction increase during caffeine withdrawal. J Am Osteopath Assoc 1997 Aug;97(8):454-456

Spinal Manipulation Is Effective At Reducing Mechanical Chest Pain

The symptom of chest pain may be a result or manifestation of somatic dysfunction of the musculoskeletal system. Chest pain is a common chief complaint among patients in a family practice office or in the emergency room. Various intrathoracic and extrathoracic factors may be responsible. The authors describe their experience with one patient in whom osteopathic manipulative treatment was used along with accepted medical tests and therapy to diagnose and treat this patient. If chest pain is effectively diagnosed and promptly treated, OMT can provide the most thorough, cost-effective, and satisfying care available.

Wax CM, Abend DS, Pearson PH. Chest pain and the role of somatic dysfunction. J Am Osteopath Assoc 1997 Jun;97(6):347-352

VSC Results In Suboccipital Muscle Atrophy

OBJECTIVE: To study the relationship between chronic neck pain, standing balance and suboccipital muscle atrophy. We hypothesize that patients with chronic neck pain have more somatic dysfunction in the cervical spine than control subjects without neck pain. We also hypothesize that patients with chronic neck pain and somatic dysfunction exhibit more atrophy of suboccipital muscles. Lastly, because suboccipital muscles have a high density of proprioceptors, we hypothesize that chronic pain patients exhibit a loss in standing balance.

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

Mechanical Cervical Compression Not Likely To Decrease Cerebral Circulation

OBJECTIVE: This article specifically addresses the question of whether the manipulable cervical lesion is likely to cause extrinsic compression of the vertebral arteries sufficient to cause such symptoms of reduced regional cerebral blood flow as might be relieved by spinal manipulation.

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

VSC Mimicking Visceral Conditions

BACKGROUND AND OBJECTIVES: Several theories have been put forth in attempts to explain the possible mechanisms by which patients presumed to be suffering from any of a variety of internal organ diseases are occasionally found to respond quickly and dramatically to therapies delivered to purely somatic structures (e.g., spinal manipulation). The purpose of this review is to examine the scientific bases upon which these sorts of clinical phenomenaight be interpreted.

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

Nociceptive Reflexes And Somatic Dysfunction

A model of somatic dysfunction is developed in which restriction in mobility and autonomic, visceral, and immunologic changes are produced by pain-related sensory neurons and their reflexes. Nociceptors are known to produce muscular guarding reactions, as well as autonomic activation, when musculoskeletal or visceral tissue is stressed or damaged. This guarding causes abnormal musculoskeletal position and range of motion. Local inflammatory responses and autonomic reflexes further reinforce nociceptor activity, maintaining restriction. Nociceptive autonomic reflexes also evoke changes in visceral and immunologic function. Finally, maintenance of muscles, joints, and related tissues in an abnormal guarding position causes changes in the connective tissues, solidifying the abnormal position. Stretching these tissues into a normal range of motion will restimulate the nociceptor, reflexly reinforcing the somatic dysfunction. This model has evolved from Korr's neurologic model but emphasizes the nociceptor and its reflexes as a source of the connective tissue, circulatory, visceral, and immunologic changes seen in the somatic dysfunction.

Van Buskirk RL. Nociceptive reflexes and the somatic dysfunction: a model. J Am Osteopath Assoc 1990 Sep;90(9):792-794

Pupillary Diameter Affected By Somatovisceral Reflex

The relationship between a cervical chiropractic adjustment, in subluxated vs. unsubluxated subjects, and autonomic response monitored as change in pupillary diameter was evaluated in 15 subjects. The results indicate that: a) a successful adjustment elicits either a parasympathetic or sympathetic response; b) the vertebral level at which the adjustment is administered has undetectable specificity for the parasympathetic or sympathetic input to the pupil; c) unsubluxated subjects generally exhibit no change in pupillary diameter following a sham adjustment and d) subluxated subjects exhibit variable preadjustment pupillary diameters, with significant pupillary diameter changes in response to an adjustment. These data suggest that autonomic input to the pupil may be influenced by subluxation, as well as the magnitude and direction of force exerted during the chiropractic adjustment. An anatomical pathway through which the observed responses may occur is proposed.

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