Case Study #1: Neck/Arm pain- long term consequences

Our first case study shows us a number of interesting things about an interesting patient. It also points out that plain film X-Rays still have a place in the everyday practice and can reveal postural issues that may have been fomenting for years only to have "pain" appear years later. Let's see how this patient's history and findings came together:

HISTORY AND PRESENTING COMPLAINTS: 
Haley (39 yo female) presented seeking treatment for acute upper mid back pain, right arm radiculopathy and neck pain. She told us that although she has had discomfort in the back for a fairly long time, it was very recently that the pain in her back and arm became so profound that she “felt like her arm was coming off.” She told us further that she had sought two massages and began taking Ibuprophin. As a result of that, she continued, her pain seemed to calm down. Haley presented to us due to continual pain in the areas described. She stated that the worst of it is in her upper middle thoracic region, medial scapular area. She described the pain as being heretofore stabbing in nature but more of a noticeably achy sensation now as well as constant. She stated that stress issues as well as sitting at a desk all day aggravate as does sleeping. Haley added that movement relieved the pain somewhat. She further described the right arm pain along a specific C7 locus to the elbow. That is to say, a pure triceps pattern. She described this pain as achy/sore now, constant, where again, stress and sitting all day aggravate and movement offers some relief.  Haley further told us that the neck pain is right sided and more of a casual ache and least bothersome of her three big pain issues. It is also constant with the same aggravating and relieving factors.

RADIOGRAPH DISCUSSION:
Due to the patient’s presenting complaints and objective findings, a clinical decision was made to perform AP/Lat/APOM views of the C-spine. Of note:

C-spine: The AP view reveals most prominently, a gentle dextro scoliosis reaching from the upper thoracics to the cephalad portion of the C spine. See documenting digital photos of the region in this view as well as the lateral view. The unco-vertebral joints were clear and well maintained. The lateral view is the other view that revealed much about Ms. H’s situation: noted was a frank kyphosis of the entire region. As well, her entire C spine is tilted slightly forward. Disc and body heights appear proportional and are well maintained. Finally, we have the APOM shot. Ms. H’s C1-2 segmental interface is intact and perfectly normal in relative body spacing. Due to the possible involvement of the thoracic spine in her scoliosis, we may opt to shoot an additional AP Thoracic X-Ray in the near future.

No evidence of fx, dislocation or neoplastic activity to the extent visualized on these films. *800 speed Rare Earth systems were used with full lead collimation and the inclusion of the thick lead gonadal shield to absorb lower limb/abdomen scatter. Ms. H was also given a lead apron for another layer of protection. Technique was good in this set. All views were weight bearing.

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  Ms. H’s lateral Cervical shot. Note the frank kyphosis (curve reversal, as opposed to a normal “lordosis”). Disc spacing is good and there is a minimum of any other indication of early DJD.

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DIAGNOSIS:
Based on the patient's subjective comments, the case history, the DDX analysis and the physical exam, it was opined that the patient suffers from a chronic Cervico -Thoracic scoliosis that has finally begun to cause cognizant pain to this patient. Thus, a variant of the pathomechanical syndrome, the scoliosis is a long term issue. Noted also, pathomechanics in the entire spine with appreciable muscle spasm and cervicogenic radiculopathy. This to a reasonable degree of medical certainty.

Analysis: The patient enjoyed her first two treatments and felt markedly better. She was admonished to use the ortho pillow regularly and sleep on her back henceforth. Patient involvement with care is crucial to ongoing success in treatment, especially in a "wholistic" approach to care in which a patient's lifestyle, postural and sleeping habits and exericise are taken into consideration.

Judicial used of X-Rays are indicated in many cases. When findings like we have here come up, they make for a compelling "Report of Findings" when explaining a diagnosis to a patient.

Remember, pain is NOT a reliable criteria with which to judge one's health. The deformation in this woman's spine took years to happen, yet she only felt serious pain more recently. Get checked by your chiropractor when there is the slightest suspicion of back/leg/arm pain and any of the other common issues we regularly treat such as headaches.

Yours in Good Health, Dr. Haberstroh