更新資訊

11/18/2023

香港脊醫 2023 11月刊

11/01/2023

回應《2023施政報告》

 
親愛的醫務衞生局局長/衞生署署長,
我謹代表香港執業脊醫協會(CDAHK),回應您在《行政長官2023年施政報告》中關於醫療衞生政策的部分。我們深信脊醫專業在香港醫療衛生政策中佔有重要地位,並對以下幾個相關議題作出回應:
首先,關於醫療創新科技的問題,香港執業脊醫協會正在努力推動脊骨神經醫學在中國的發展。我們很榮幸今年能夠獲得世界脊骨神經醫學聯會的最高榮譽,這使我們更為堅定地致力於為病人提供「好藥港用、研發惠民」的服務。我們將繼續努力輔助香港成為國際康復脊椎藥械的權威機構,並積極參與康復藥械的評審和註冊。
其次,在跨境醫療協作方面,我們意識到在大灣區的發展和人口流動增加的情況下,跨境醫療協作的重要性日益凸顯。我們將積極參與並推動脊醫在這方面的角色。
此外,我們也將強化人才培訓和交流。我們計劃加強與內地及大灣區以外地區的脊醫醫療人才培訓和交流,以提升我們的專業水平並為香港的脊醫業界帶來新的視野。
最後,我們認識到需要增加醫護人手供應。我們認為脊醫可以在緩解公營機構的供需不均問題上發揮重要作用。因此,我們將繼續推動修訂《脊醫註冊條例》並積極訓練本地脊醫。我們希望能有更多脊醫加入醫管局和衞生署,以解決公營醫院人手短缺的問題。
我們會持續努力,確保脊醫專業在香港的醫療體系中得到充分的認識和應用,並致力於提供最優質的脊醫服務給香港市民。
感謝您的關注和支持。
香港執業脊醫協會主席
朱君璞脊醫
 
10/31/2023

脊醫為緩解公營醫療供需不均問題

《脊醫為緩解公營醫療供需不均問題》
香港執業脊醫協會(CDAHK)近日關注到公營醫療服務長期供不應求的問題,有些專科診症的輪候時間甚至以年計算。我們認為脊骨神經科醫生(脊醫)可以為這個問題提供有效的解決方案。
根據最新數據,從去年10月到今年9月,骨科和耳鼻喉科的穩定新症輪候時間繼續上升,達到了100周以上。其中港島西、九龍中、九龍西及新界東的骨科輪候時間更是直線上升。
為了解決這個問題,香港執業脊醫協會呼籲政府和公眾更多地認識並利用脊骨神經科醫生的服務。脊醫是醫療系統中的重要組成部分,他們專門處理關於神經系統,肌肉系統和骨骼系統的問題,並且有能力進行脊柱檢查,診斷和治療。他們的能力和服務可以緩解專科門診的壓力,並且減輕患者的等待時間。
我們認為,脊醫的服務可以成為解決問題的一部分。如果能將脊醫更好地整合到醫療系統中,可以大大緩解專科門診的壓力,並且讓更多的患者可以及時獲得必要的醫療服務。

 

09/27/2023

香港脊醫 2023 9月刊

08/07/2023

【脊醫研究】將脊醫療法納入“健康中國2030”

06/22/2023

【脊醫研究】了解香港脊醫對實驗室檢測和放射成像的利用、挑戰和態度:一項橫斷面調查

Abstract

Objective

This cross-sectional survey aimed to investigate the utilization, challenges, and attitudes of chiropractors in Hong Kong towards laboratory testing and radiological imaging.

Method

An online survey was conducted between May 1, 2023, and June 1, 2023. The target population for the survey was registered chiropractors in Hong Kong, which has a total of 325 practitioners. A total of 151 chiropractors participated in the survey, resulting in a response rate of 46.5%. The respondents provided information on their demographics, years of experience, practice settings, awareness of their right to request diagnostic tests, utilization of laboratory testing and imaging, and attitudes towards evidence-based practice. The survey data were analyzed using descriptive statistics.

Result

The survey findings revealed that a significant proportion of chiropractors in Hong Kong utilized laboratory testing and radiological imaging in their practice. Most respondents reported using laboratory testing to diagnose medical conditions and monitor existing conditions. Imaging is commonly used for diagnosing medical conditions and monitoring disease progression. However, a notable proportion of chiropractors reported facing rejection of their tests and imaging requests, which limited their ability to provide optimal care to their patients. The identified challenges included high rejection rates for specific imaging requests, leading to patient frustration, increased costs, and delayed diagnosis. Nevertheless, chiropractors in Hong Kong showed a strong belief in evidence-based practice and demonstrated a willingness to search for literature and incorporate it into their daily practice.

By addressing this issue, our aim was to gain valuable insights into the status of laboratory testing and radiological imaging among chiropractors in Hong Kong. The findings of this study underscore the necessity for collaborative efforts among chiropractors, healthcare professionals, healthcare facilities, policymakers, and insurance companies to effectively address the challenges identified and improve patient care outcomes. Specifically, enhancing access to diagnostic tests and working towards reducing rejection rates will play a pivotal role in supporting chiropractors’ role as primary healthcare providers in Hong Kong.

06/16/2023

【脊醫研究】通過手法矯正脊柱排列緩解太后駝背:病例報告

Abstract

Dowager’s hump is described as excessive kyphotic curvature in the thoracic spine with a Cobb angle of more than 40 degrees. This case report presents a 61 years old female office clerk who experienced headaches and neck pain for 3 years that extended into her right shoulder and upper chest. She consulted her primary care physician two months before seeing the chiropractor when the neck pain worsened. A diagnosis of cervicalgia related to osteoarthritis was made based on cervical and thoracic X-ray findings. The patient received non-steroid anti-inflammatory drugs (celecoxib and etoricoxib) and stretching exercises at home. At the onset of chiropractic care, radiographs showed loss of cervical lordosis, narrowing at the C4-5, C5-C6, and C6-7 intervertebral disc space with marginal osteophytes. Based on these findings, a working diagnosis of cervicogenic headache was established. After treatment for 9 months, the patient showed improvement in symptoms and function from cervical curve radiographic change and dextro-convexity of the thoracic spine. Avoiding forward head flexion and maintaining correct posture in daily activities will be key mechanisms to prevent the reoccurrence of Dowager’s hump. The improvement of symptoms following chiropractic therapy has been shown to correlate with radiographic markers of spinal realignment.

Keywords: cervicalgia, cervicothoracic junction, chiropractic therapy, Dowager’s hump, forward head posture, myofascial trigger points, postural hyperkyphosis, thoracic spine
05/31/2023

【脊醫研究】骶脊索瘤在脊醫診所表現為背痛:病例報告

Abstract

Cases of lumbar and gluteal pain are commonly encountered in chiropractic clinics, with a broad differential diagnosis primarily centered on musculoskeletal conditions. This report presents the second documented case of sacral chordoma diagnosed at a chiropractic clinic and emphasizes the importance of considering alternative diagnoses and interdisciplinary collaboration in patient care. A 42-year-old man presented to a chiropractic clinic with complaints of lumbar and gluteal pain. The initial conservative management based on a presumptive musculoskeletal diagnosis was ineffective. Suspicion of an alternative etiology prompted a referral for imaging, which revealed a sacral chordoma. An interdisciplinary collaboration involving orthopedic surgeons, oncologists, radiologists, and other healthcare professionals was initiated to optimize the treatment outcomes of this rare and aggressive tumor. This case report underscores the importance of maintaining a high index of suspicion in cases of musculoskeletal presentations in chiropractic clinics and the critical role of advanced imaging in establishing a definitive diagnosis. Interdisciplinary collaboration is essential for managing complex conditions such as sacral chordomas, ensuring the delivery of the highest quality of care, and optimizing patient outcomes. Chiropractors play a crucial role in identifying, referring, and contributing to the management of patients with complex presentations as part of a comprehensive multidisciplinary treatment plan.

05/31/2023

【脊醫研究】骶脊索瘤在脊醫診所表現為背痛:病例報告

Abstract

Cases of lumbar and gluteal pain are commonly encountered in chiropractic clinics, with a broad differential diagnosis primarily centered on musculoskeletal conditions. This report presents the second documented case of sacral chordoma diagnosed at a chiropractic clinic and emphasizes the importance of considering alternative diagnoses and interdisciplinary collaboration in patient care. A 42-year-old man presented to a chiropractic clinic with complaints of lumbar and gluteal pain. The initial conservative management based on a presumptive musculoskeletal diagnosis was ineffective. Suspicion of an alternative etiology prompted a referral for imaging, which revealed a sacral chordoma. An interdisciplinary collaboration involving orthopedic surgeons, oncologists, radiologists, and other healthcare professionals was initiated to optimize the treatment outcomes of this rare and aggressive tumor. This case report underscores the importance of maintaining a high index of suspicion in cases of musculoskeletal presentations in chiropractic clinics and the critical role of advanced imaging in establishing a definitive diagnosis. Interdisciplinary collaboration is essential for managing complex conditions such as sacral chordomas, ensuring the delivery of the highest quality of care, and optimizing patient outcomes. Chiropractors play a crucial role in identifying, referring, and contributing to the management of patients with complex presentations as part of a comprehensive multidisciplinary treatment plan.

05/16/2023

【脊醫研究】脊椎治療後與生物力學功能障礙相關的頸源性吞嚥困難的緩解

05/12/2023

【脊醫研究】冠狀病毒病大流行期間,八旬老人未確診的骨質疏鬆性椎體骨折

bstract

Osteoporotic vertebral fractures are frequently misdiagnosed or under-recognized in the older population, leading to disease progression and reduced quality of life. This case of an 87-year-old woman with acute back pain highlights the importance of early diagnosis and management of fragility fractures. During the coronavirus disease (COVID-19) pandemic, patients with a history of well-managed osteoporosis experienced worsening symptoms of vertebral collapse due to activity limitations and prolonged immobilization. The initial diagnosis of spinal stenosis delayed appropriate treatment for four months. Serial magnetic resonance imaging revealed compression fractures at L1 and L3, and a dual-energy x-ray absorptiometry scan showed osteoporosis with a T-score of −3.2. Pharmacological therapy, including bisphosphonates, was initiated. A comprehensive rehabilitation program with a multidisciplinary approach, with bracing, and lifestyle changes helped stabilize the spine, reduce pain, and maximized function. Her condition improved with close monitoring and guidance during home exercises. This case exemplifies the necessity of a precise and timely diagnosis of osteoporotic vertebral fractures to initiate management and mitigate disease progression.

Keywords: octogenarian, pathological fracture, pandemic, chiropractor, chiropractic, diagnosis, covid-19, elderly, vertebral fractures, osteoporosis
04/30/2023

【脊醫研究】表現為孤立性頸伸肌病的脊髓灰質炎後綜合徵:病例報告

Abstract

04/28/2023

【脊醫研究】小兒文字頸綜合症

Abstract

Text neck syndrome is a growing concern in the pediatric population due to the increased use of mobile devices and screens, potentially leading to long-lasting musculoskeletal issues. This case report presents a six-year-old boy with a one-month history of cephalgia and cervicalgia, who initially received insufficient care. After nine months of chiropractic intervention, the patient reported significant improvements in pain relief, neck mobility, and neurological symptoms, supported by radiographic findings. This report emphasizes the importance of early recognition and intervention in pediatric patients, as well as the role of ergonomics, exercise, and proper smartphone usage habits in preventing text neck and maintaining spinal health.

Keywords: cervicogenic dyspnea, cervicogenic vertigo, cervicogenic dizziness, chiropractor, chiropractic, cervicogenic headache, text neck
04/21/2023

【脊醫研究】繼發於頸神經根病的頸源性心絞痛和呼吸困難

Abstract

Cervicogenic angina and dyspnea are conditions characterized by chest discomfort and breathing difficulties that resemble angina pectoris and dyspnea of cardiac origin. However, this condition is caused by cervical spine pathology, cervical spondylosis, and radiculopathy. This case study reports a 66-year-old man who presented with cervicogenic angina and dyspnea due to cervical radiculopathy to a chiropractic clinic. The patient underwent a comprehensive diagnostic evaluation, including taking the patient’s history, a physical examination, and radiological investigations, which demonstrated cervical spine involvement consistent with a cervicogenic origin of the pain. The patient’s angina-like symptoms and dyspnea improved significantly after chiropractic manipulation of the spine, soft tissue mobilization, and other manual therapies. Accurate diagnosis is essential to minimize unnecessary cardiac interventions and ensure proper therapy for underlying cervical spine problems. This case demonstrates the necessity of conservative management, such as chiropractic care, for patients presenting with cervicogenic angina and dyspnea, particularly when a diagnostic assessment reveals cervical spinal involvement.

Keywords: angina pectoris, cervical radiculopathy, cervicogenic dyspnea, cervicogenic angina, chiropractic
04/18/2023

【脊醫研究】高水平馬拉松運動員第五節指骨撕脫性骨折

03/12/2023

【脊醫研究】類風濕關節炎患者腰痛和脊柱側彎的保守治療:八年隨訪

Abstract

Scoliosis in patients with rheumatoid arthritis (RA) can cause significant pain and disability. RA has been extensively studied in relation to the cervical spine, yet the pathology of the thoracic and lumbar spine in RA patients has been largely overlooked. A 66-year-old woman, with longstanding RA and severe scoliosis, presented to the chiropractic clinic with a five-month history of exacerbated low back pain radiating to the right lower limb. The patient was treated with a combination of full-spine mechanical spinal distraction, spinal manipulative therapy, mechanical distraction of the cervical spine, and soft tissue treatment (scraping therapy). Thereafter, the patient recovered from the pain and radiculopathy and showed improvements in the radiological parameters, walking gait, and postural balance. Radiography was performed at the 12-month, four-year, and eight-year follow-up appointments and revealed improvements in symptoms, posture, and scoliosis. Although the treatment for RA-related scoliosis is similar to that for other types of scoliosis, due to the nature of RA, treatment should be tailored to individual patients. This case report highlights the importance of considering chiropractic therapy for the management of lumbar scoliosis in patients with RA, as a comprehensive treatment plan resulted in improved spinal balance, mobility, gait, posture, and quality of life.

03/10/2023

【脊醫研究】肺癌伴椎體轉移在脊醫表現為腰痛:病例報告

03/01/2023

香港脊醫 2023 3月刊 

 

02/12/2023

【脊醫研究】通過多模式脊醫治療改善寰樞椎後路融合手術後慢性頸部疼痛:病例報告

Abstract

There is a lack of research regarding the effectiveness and safety of manual therapies, including spinal manipulative therapy (SMT), for patients with previous cervical spine surgery. A 66-year-old, otherwise healthy, woman who underwent C1/2 posterior surgical fusion for rotatory instability during adolescence presented to a chiropractor with a six-month history of progressive worsening of chronic neck pain and headaches despite acetaminophen, tramadol, and physical therapy. Upon examination, the chiropractor noted postural changes, limited cervical range of motion, and muscle hypertonicity. Computed tomography revealed a successful C1/2 fusion, and degenerative findings at C0/1, C2/3, C3/4, and C5/6, without cord compression. As the patient had no neurologic deficits or myelopathy and tolerated spinal mobilization well, the chiropractor applied cervical SMT, along with soft tissue manipulation, ultrasound therapy, mechanical traction, and thoracic SMT. The patient’s pain was reduced to a mild level and the range of motion improved over three weeks of treatment. Benefits were maintained over a three-month follow-up as treatments were spaced apart. Despite the apparent success in the current case, evidence for manual therapies and SMT in patients with cervical spine surgery remains limited, and these therapies should be used with caution on an individual patient basis. Further research is needed to examine the safety of manual therapies and SMT in patients following cervical spine surgery and determine predictors of treatment response.

02/10/2023

【脊醫研究】脊醫:脊柱側凸導致頸椎肌張力障礙

Abstract

Cervical dystonia is a movement disorder characterized by continuous and involuntary muscular contractions that result in aberrant head and neck motions or postures. A recent study indicates that persons with a history of scoliosis may be at a higher risk of acquiring cervical dystonia later in life. Although muscular tension and contraction abnormalities are linked in both illnesses, the pathophysiological pathways linking these two ailments are not entirely understood. A 13-year-old boy previously diagnosed with adolescent idiopathic scoliosis developed symptoms of cervical dystonia, including moderate neck pain, left-sided migraines, and tingling in the neck and shoulders. During the course of three months, the patient attended 16 chiropractic therapy sessions. He reported slow but considerable improvements in his symptoms, such as the recovery of normal cervical range of motion, decreases in neck discomfort and accompanying headaches as well as paresthesia, and enhancements in sleep quality, daily functioning, and learning capacities. The patient’s clinical and radiographic improvements show that chiropractic spinal manipulation may assist in reducing pain and improving spine alignment and mobility in these circumstances. To further investigate the efficacy and safety of chiropractic therapy for the treatment of cervical dystonia, particularly in the setting of associated scoliosis, more study with bigger patient populations is required.

 
02/03/2023

【脊醫研究】前列腺癌在脊醫表現為髖部疼痛:病例報告和文獻綜述

Abstract

Prostate cancer is one of the most common cancers found in males, and it tends to metastasize to bony parts such as the hip, spine, and pelvis, resulting in pain and/or radicular pain, which can present similarly to musculoskeletal complaints. The lack of routine screening and musculoskeletal symptoms present challenges in the diagnosis of prostate cancer.

We report the case of a 62-year-old male with no history of cancer and no previous prostate cancer screening who visited a chiropractor for the care of worsening left hip pain after a marathon. The patient visited other healthcare providers and was suggested to have degenerative conditions; he received nonsteroidal anti-inflammatory medication, physiotherapy, and acupuncture. Given the patient’s limited improvement by other providers and neurological symptoms, the chiropractor requested lumbar spine radiography, which revealed suspected bone metastasis, and ordered a hip MRI accordingly. MRI findings suggested prostate cancer, and the chiropractor referred the patient to an oncologist, who performed additional imaging and testing to make a presumptive prostate cancer diagnosis. A literature search found nine cases of undiagnosed prostate cancer presenting to a chiropractor for care. All patients included in this case were older males with no previous prostate screening or bone metastasis.

The study is focused on the need for a comprehensive evaluation of patients with hip pain during a chiropractic visit due to the chances of prostate cancer. There are higher chances of ignoring cancer symptoms during a hip examination. Comprehensive evaluation and advanced imaging could help chiropractors detect patients with prostate cancer.

01/29/2023

【脊醫研究】使用推力頸椎手法療法治療複雜性頸部疼痛:亞太脊醫的橫斷面調查

Abstract

Background

Chiropractors often use manual thrust cervical spinal manipulative therapy (thrust-cSMT) to treat musculoskeletal neck conditions. We hypothesized <50% of surveyed Asia-Pacific chiropractors would report using thrust-cSMT given potential contraindications, and secondarily explored predictors of thrust-cSMT use.

Materials and methods

We designed, validated, achieved sufficient reliability, and disseminated a survey to explore thrust-cSMT use. The survey queried chiropractors’ characteristics (e.g., years in practice, education level, time with patients, importance of subluxation), and use of thrust-cSMT for uncomplicated neck pain and vignettes describing vertebral artery disorders, Arnold-Chiari malformation, and anterior cervical discectomy and fusion (ACDF). We performed logistic regression for each vignette with thrust-cSMT as the dependent variable and chiropractor characteristics as covariates.

Results

There were 241 respondents, having 12.8±10.9 years in practice, representing >15 countries. Less than 50% of chiropractors reported the use of thrust-cSMT for each vignette, including vertebral artery insufficiency (14%) and stenosis (17%), Arnold-Chiari type I (18%) and type II (5%), C5/6 ACDF (39%) and C3-6 ACDF (27%). Regressions identified significant predictors of increased or decreased use of thrust-cSMT including time spent with new patients, focus on subluxation, degree, group practice environment, use of thrust-cSMT on a healthy patient, and hours reading scientific literature (P<.05 for each).

Conclusions

This study was the first to chiropractors’ use of thrust-cSMT for complicated neck pain and found that most Asia-Pacific chiropractors reported avoiding this treatment in the presence of a potential treatment contraindication. The use of thrust-cSMT in complicated neck pain may be related to practice characteristics. However, further research is needed to identify specific reasons why chiropractors use or avoid thrust-cSMT.

12/29/2022

【脊醫研究】脊醫患 COVID-19 疾病後出現自發性頸椎硬膜外血腫:病例報告

Abstract

Cervical epidural hematoma (CEH) is a rare and potentially fatal condition in which blood accumulates in the epidural space of the cervical spine.

A 64-year-old man presented to a chiropractor with a two-week history of sudden-onset neck pain, shoulder pain, occipital headache, and numbness in the shoulders and upper extremities. He had recovered from a mild course of coronavirus disease 2019 (COVID-19) illness one month prior. The patient’s primary care provider had previously prescribed a nonsteroidal anti-inflammatory drug for his neck pain. However, his symptoms worsened, and he visited the emergency department where he had unremarkable cervical spine radiographs and was discharged with a diagnosis of neck strain. The chiropractor ordered cervical spine magnetic resonance imaging (MRI), revealing a ventral CEH extending from C2 to C5. The chiropractor referred the patient to a nearby hospital for urgent management. The patient was admitted and observed, progressively improved, and did not require surgery. After 10 weeks in the hospital the patient was asymptomatic, a follow-up MRI revealed resolution of the CEH, and the patient was discharged.

While the current case highlights a temporal relationship between COVID-19 and CEH, further research is needed to determine if COVID-19 is a risk factor for this condition. Clinicians who encounter patients with spinal disorders must be able to recognize the clinical features of CEH and refer these patients for emergency care and/or neurosurgical evaluation.

12/01/2022

【脊醫研究】脊柱和顱內硬膜下血腫同時發生是脊醫治療室中近乎致命的腰痛的原因:病例報告

Abstract

In older individuals, minor trauma may cause potentially fatal intracranial subdural hematoma (SDH). Rarely, these patients present with only low back and radicular pain as gravity redistributes the SDH to the lumbar spine.

A 69-year-old male presented to a chiropractor with a 10-day history of acute on chronic low back pain, which radiated into his lower extremities bilaterally, involving weakness and difficulty walking, and a ground-level fall onto his elbows 16 days prior. He had visited his primary care provider, orthopedist, and traditional Chinese medicine practitioner, received oral analgesics and three ketorolac injections, and had lumbar radiographs, followed by acupuncture, cupping, and spinal manipulation without lasting relief. Considering the patient’s concerning presentation, the chiropractor ordered lumbar magnetic resonance imaging (MRI) on the first visit, revealing findings suggestive of late subacute lumbar SDH, and recommended urgent brain MRI and neurosurgical referral. The patient went to an orthopedic surgeon at a nearby hospital, becoming disoriented upon presentation, prompting admission. Brain MRI confirmed bilateral chronic intracranial SDH, prompting emergency hematoma evacuation via burr hole craniostomy. The patient’s gait rapidly improved, and the pain subsided over the following two weeks.

This case highlights an older male identified as having spinal SDH by a chiropractor, leading to referral and surgery for concurrent life-threatening intracranial SDH. Clinicians should be aware that spinal SDH may stem from asymptomatic intracranial SDH and should be suspicious of SDH in older individuals after a fall, signs of which warrant emergency referral for MRI and surgical evaluation.

11/24/2022

【脊醫研究】松果體切除術後的頸部疼痛和頭痛:多模式脊醫療法的改善


Abstract
Patient: Male, 45-year-old

Final Diagnosis: Cervical facet syndrome • radiation induced fibrosis

Symptoms: Headache • neck pain and stiffness

Medication: —

Clinical Procedure: Neck stretches • soft tissue manipulation • spinal manipulation • therapeutic ultrasound

Specialty: Chiropractic • Rehabilitation

Objective:
Rare disease

Background:
Pineal gland tumors are rare central nervous system tumors, and while neck pain and headaches may be common among those who have had these tumors removed, there is little research regarding management of these symptoms.

Case Report:
A 45-year-old man with a history of pineal germinoma treated with pinealectomy, chemotherapy, radiation therapy, and ventriculoperitoneal shunt placement at age 21 presented with chronic neck pain and headaches, which initially improved following his surgery and concurrent therapies, yet progressively worsened over the following years. He required thyroid and testosterone medication because of radiation-induced hypopituitarism, yet was employed, and until recently, active with playing tennis. He had previously seen his primary care provider, orthopedist, and neurologist, and had been cleared of severe pathology via brain magnetic resonance imaging and was referred to the chiropractor. On examination, the patient had severely limited passive cervical spine range of motion, yet hat no neurologic deficits, and radiographs showed mild cervical spondylosis and cervicothoracic scoliosis. His history and presentation were suggestive of radiation-induced fibrosis. The patient’s neck pain, headaches, and quality of life improved with multimodal treatments including spinal and soft-tissue manipulation, stretches, and yoga.

Conclusions:
This case illustrates long-term sequelae of a pineal gland tumor and its treatment, including neck pain and headache, and improvement with multimodal chiropractic therapies. Despite the success in this case, these results are not broadly generalizable. Further research is needed to understand the natural history of symptoms and effectiveness of multimodal therapies among patients who have had pineal tumor surgery.

Keywords: Chiropractic, Manipulation, Spinal, Neck Pain, Pineal Gland, Radiotherapy

11/21/2022

【脊醫研究】腰椎神經鞘瘤是脊醫室神經根病的罕見原因:病例報告

Abstract

Patient: Male, 45-year-old

Final Diagnosis: Cervical facet syndrome • radiation induced fibrosis

Symptoms: Headache • neck pain and stiffness

Medication: —

Clinical Procedure: Neck stretches • soft tissue manipulation • spinal manipulation • therapeutic ultrasound

Specialty: Chiropractic • Rehabilitation

Objective:
Rare disease

Background:
Pineal gland tumors are rare central nervous system tumors, and while neck pain and headaches may be common among those who have had these tumors removed, there is little research regarding management of these symptoms.

Case Report:
A 45-year-old man with a history of pineal germinoma treated with pinealectomy, chemotherapy, radiation therapy, and ventriculoperitoneal shunt placement at age 21 presented with chronic neck pain and headaches, which initially improved following his surgery and concurrent therapies, yet progressively worsened over the following years. He required thyroid and testosterone medication because of radiation-induced hypopituitarism, yet was employed, and until recently, active with playing tennis. He had previously seen his primary care provider, orthopedist, and neurologist, and had been cleared of severe pathology via brain magnetic resonance imaging and was referred to the chiropractor. On examination, the patient had severely limited passive cervical spine range of motion, yet hat no neurologic deficits, and radiographs showed mild cervical spondylosis and cervicothoracic scoliosis. His history and presentation were suggestive of radiation-induced fibrosis. The patient’s neck pain, headaches, and quality of life improved with multimodal treatments including spinal and soft-tissue manipulation, stretches, and yoga.

Conclusions:
This case illustrates long-term sequelae of a pineal gland tumor and its treatment, including neck pain and headache, and improvement with multimodal chiropractic therapies. Despite the success in this case, these results are not broadly generalizable. Further research is needed to understand the natural history of symptoms and effectiveness of multimodal therapies among patients who have had pineal tumor surgery.

Keywords: Chiropractic, Manipulation, Spinal, Neck Pain, Pineal Gland, Radiotherapy

11/18/2022

【脊醫研究】頸神經根病是心絞痛的一個隱藏原因:頸源性心絞痛

Abstract

Patients presenting with chest pain to the emergency department constitute a diagnostic challenge as 77% of the patients’ symptoms are not cardiac. Diagnostic uncertainty is a pervasive issue in primary care. A 56-year-old man presented with non-traumatic chest pain and chronic neck pain for 2 years, as well as numbness in his right third and fourth fingers for 6 months. It was not associated with palpitation, orthopnea or pedal edema. Except for hyperglycemia, no abnormal findings were found in diagnostic tests. At that time, he was being treated for type 2 diabetes using glucose-lowering drugs in order to lower his blood glucose and lessen his risk of heart disease. The cause of his chest pain remained unknown. Following a second opinion from an orthopedist, the patient was diagnosed with cervical radiculopathy and was treated with analgesics and physical therapy. Because the treatments had only provided temporary pain relief for the previous 6 months, he sought chiropractic care for pain relief. The patient’s vital signs were stable and within normal limits during the assessment. A restricted neck movement, a positive Spurling test, and hypoesthesia in the right C7 dermatome were seen. Cervical radiographs revealed degenerative spondylosis with right C5/C6 neuroforaminal stenoses and bilateral C6/C7 neuroforaminal stenoses. A provisional diagnosis of cervical spondylotic radiculopathy associated with cervicogenic angina (CA) was made. Chiropractic procedures, including cervical manipulation, instrumented soft tissue mobilization, and motorized intermittent neck traction, were performed two to three times per week. After 3 months, the patient reported that the chest pain, neck pain, and radicular symptoms had completely resolved. Repeated radiographs taken during the 11th month follow-up revealed a comparable improvement in the increased spacing of the restricted neuroforamina, which could signify a beneficial alteration related to cervical function retrieval. CA is an angina-like chest pain caused by cervical spine disorders. This study adds to our understanding of the biomechanical impact of cervical radiculopathy on chest pain, which has largely been overlooked during diagnostic workups. Once cervical radiculopathy has been identified, CA symptoms can be eased by alleviating the noxious input stemming from the pinched nerve roots.

11/16/2022

【脊醫研究】頸椎病是纖維肌痛的一個隱藏因素:病例報告

Abstract

The present case study describes the long-term symptomatic remission in a patient with fibromyalgia (FM) after multimodal spinal manipulation. A 44-year-old woman presented with a chronic headache, severe neck pain, shoulder pain, and back pain lasting for 2 years after experiencing domestic violence. She had sleep disorders, fatigue, and depressive mood. Her primary care physician diagnosed her with FM and comorbid depression. Despite treatment with non-steroidal anti-inflammatory drugs, muscle relaxants, anti-depressants, anti-epileptics, acupuncture, and aqua-therapy, she experienced no appreciable relief from her symptoms. The patient then sought a chiropractic evaluation and potential treatment for her symptoms. At presentation, widespread tenderness was palpable over the neck, shoulder, back, anterior chest, abdominal wall, and buttock. Radiographs showed loss of cervical lordosis, widespread degenerative spondylosis, and osteitis pubis. Surface electromyography (sEMG) revealed neck and thoracic paraspinal muscular spasms. The patient was diagnosed with FM based on the American College of Rheumatology diagnostic criteria and the associated comorbidities. Multimodal chiropractic approaches, which consisted of spinal manipulation, massage, and intermittent motorized cervical traction, were used twice weekly to relieve soft-tissues and intervertebral joints and stretch core musculatures. The patient’s physical and mental complaints were mostly resolved near the end of 9 months of treatment. Her symptom alleviation was associated with corresponding change in normalized sEMG signal and cervical spine realignment at the 16th- and 26th-month follow-ups. Widespread pain in FM can lead to confused thinking and a lack of awareness of cervical spondylosis. In this example, it is assumed that the noxious cervical inputs triggered an ongoing FM process. Chiropractic treatment blocked noxious inputs coming from pain sources, corrected pain thresholds, and lowered excitability, thereby eradicating FM symptoms.

11/15/2022

【脊醫研究】胸部神經鞘瘤是脊醫診所坐骨神經痛的異常原因:病例報告

Abstract

Patient: Female, 61-year-old

Final Diagnosis: Schwannoma

Symptoms: Low back pain with radiation • unsteady gait

Medication: —

Clinical Procedure: Laminectomy • thoracic magnetic resonance imaging

Specialty: Chiropractic • Neurosurgery

10/20/2022

【脊醫研究】脊醫治療室中表現為腰痛的疑似前列腺癌:兩個病例和文獻綜述

Abstract

Prostate cancer is a common type of cancer in men and may metastasize to the spine and pelvis, causing back and/or radicular pain that appears to be musculoskeletal. This presents a diagnostic challenge and can be complicated by a lack of routine screening for prostate cancer.

In two similar cases, elderly males (ages 78 and 82) with no known history of cancer and no previous prostate-specific antigen screening presented to a chiropractor with chronic, worsening radiating low back pain. In each case, a previous provider obtained radiographs and ascribed symptoms to a non-cancerous etiology (i.e., lumbar spondylosis, osteoporotic compression fracture), treated with nonsteroidal anti-inflammatory medications and physiotherapy. Given each patient’s progressive worsening and neurologic deficits, the chiropractor ordered lumbar magnetic resonance imaging, revealing potential spinal metastasis. The chiropractor referred each patient to an oncologist who performed additional testing, making a presumptive diagnosis of prostate cancer. A literature review identified seven cases of previously undiagnosed prostate cancer presenting to a chiropractor. Including the current cases, patients were often older, presenting with thoracolumbar pain caused by spine or pelvic metastasis.

The current cases and literature review illustrate that men with undiagnosed metastasis from prostate cancer may present to chiropractors complaining of spinal pain. Chiropractors should be aware of red flags warranting imaging such as older age and new or progressive symptoms and should refer patients to an oncologist when suspecting prostate cancer.

02/21/2022

【脊醫研究】頸椎相鄰節段病理

脊醫研究: 頸椎相鄰節段病理
作者: Eric Chun-Pu Chu, Linda Wong
发表日期: 2022/2
期刊: Journal of Family Medicine and Primary Care
卷号: 2
期号: 11
页码范围: 787-789

简介:

Adjacent segment pathology (ASP) refers to degenerative changes at segments immediately contiguous to previous spinal fusion. Its pathophysiology is hypothesized as being possibly due to altered biomechanical stresses on adjacent levels following spinal fusion or due to patient propensity to develop progressive degenerative change. This case report describes a 61-year-old female who presented with neck pain and cervical radiculopathy attributed to an anterior cervical discectomy and spinal fusion performed for degenerative disc disease 30 years earlier. ASP was seen on magnetic resonance imaging (MRI) and radiograph. Treatment consisted of cervical manipulation, soft-tissue mobilization, flexion-distraction decompression, and therapeutic ultrasound to release restriction and restore muscle strength. Following 34 sessions of chiropractic intervention, her symptoms were resolved. Patients with ASP will have ongoing shared care between general practitioners and secondary or tertiary care pain units. This report aims to build a shared understanding from the wider vision of ASP and help primary practitioners to manage ASP effectively.

Key words: Adjacent segment pathology; chiropractic manipulation; degenerative change; spinal fusion

Introduction: Adjacent segment pathology (ASP) refers to degenerative changes observed at functional spinal units adjacent to the site of previous fusion procedure.[1] All spinal surgeries altering motion across a joint can contribute to additional stress and mechanical loads on the segments immediately above and below the surgery site and accelerate subsequent degeneration. These conditions can compress nerves in the spine, causing pain and additional conditions like radiculopathy and myelopathy. ASP can be complicated by age-related changes, anatomical disruption, surgical technique, malalignment of the spine, and preexisting comorbidities (e.g., degenerative spondylosis, osteoporosis, diabetes mellitus, and smoking).[23]

The accelerated degeneration of the adjacent segments could be a multisegmental problem and can be challenging to manage. This article will enhance readers understanding of ASP and help primary practitioners to manage ASP effectively. This case report has been prepared after obtaining written informed consent from the patient to have the case details and accompanying images published. Owing to the nature of the retrospective chart review, IRB approval is not required.

Case Report: A 61-year-old female presented with severe neck pain that radiated into the right shoulder and upper arm for 2 months duration. The patient described experiencing the same symptoms 30 years earlier and was treated successfully with C5-C6 and C6-C7 anterior cervical discectomy and fusion. Following surgical intervention, the patient experienced approximately 20 years of symptomatic improvement, but the patient observed progressive deterioration of her condition over the past 10 years and had been followed by her orthopedic surgeon. Two months prior to presentation, the patient experienced rapid deterioration of her neck pain, which was associated with numbness, radiating pain, and weakness of the right arm. She had attempted 20 sessions of physical therapy with minimal relief.

Discussion:

ASP is recognized by clinicians as a debilitating condition characterized by axial pain and radiculopathy after spinal fusion. The progression of ASP can result from compressive loading on the adjacent segments and the compromised nutrient diffusion in the intervertebral discs after segment fusion.[4] Biomechanical and clinical data have demonstrated that motion preservation technologies minimize stresses placed on adjacent functional segments.[2] The latest data suggested that positive effects after artificial disc replacement are found in terms of a reduced incidence of ASP and reoperation as compared with anterior cervical discectomy and interbody fusion procedures.[25]

The radiographic changes of the adjacent segments include osteophyte formation, disc degeneration, foraminal narrowing, spinal stenosis, spinal instability, and scoliosis.[6] As in all degenerative conditions, the goals of ASP treatment are to alleviate pain, strengthen paravertebral musculature, improve range of motion, limit progressive changes, and avoid unnecessary surgery. Apart from physical suffering, persistent pain has clear emotional and behavioral consequences that have an impact on the outcome of treatment. With proper instruction and support, psychological approaches can improve pain management outcomes.

General practitioners have a key role to play in securing better outcomes for their patients. Patients can have both nociceptive and neuropathic pain and will have ongoing shared care between general practitioners and secondary or tertiary care pain units. It is inappropriate to place total reliance on further surgery. Multidisciplinary care allows patients to receive coordinated support and comprehensive care. Nonsurgical treatments such as medications, physiotherapy, manipulative therapy, psychotherapy, and nerve stimulation/modulation techniques can be helpful in most spine symptoms. Minimally invasive surgery is reserved for ASP patients with gradual emergence of neurological deficits.[7] However, there are no comparative studies on the efficacy of conservative treatment versus surgical treatment.[8] The current study aims to share an understanding of tasks between primary and secondary care for alleviating musculoskeletal pains like ASP.

Conclusion: Presented is a case of symptomatic ASP after anterior cervical discectomy and spinal fusion. Appropriate conditioning and proper retrieval of biomechanical elasticity can allow the spine to function properly. Conservative treatments should always be contemplated as an alternative method for ASP patients before resorting to surgery.

Key Message:
  1. Adjacent segment pathology (ASP) refers to degenerative changes at segments immediately contiguous to previous spinal fusion.
  2. Symptomatic ASP is a disappointing long-term outcome for patients after spinal fusion.
  3. Patients with ASP will have ongoing shared care between general practitioners and secondary or tertiary care pain units.
  4. Nonsurgical measures should be used for the initial treatment of ASP.
Reference:

1. Donnally CJ 3rd, Patel PD, Canseco JA, Divi SN, Goz V, Sherman MB, et al Current incidence of adjacent segment pathology following lumbar fusion versus motion-preserving procedures:A systematic review and meta-analysis of recent projections Spine J 2020 20 1554–65

2. Parish JM, Coric D Cervical arthroplasty:Long-term outcomes of FDA IDE trials Global Spine J 2020 10 2 Suppl S61–4
3. Oh HS, Seo HY The relationship between adjacent segment pathology and facet joint violation by pedicle screw after posterior lumbar instrumentation surgery J Clin Med 2021 10 2911
4. Wang X, Meng Y, Liu H, Chen H, Wang B, Hong Y Association of cervical sagittal alignment with adjacent segment degeneration and heterotopic ossification following cervical disc replacement with Prestige-LP disc J Orthop Surg (Hong Kong) 2020 28 2309499020968295

5. Findlay C, Ayis S, Demetriades AK Total disc replacement versus anterior cervical discectomy and fusion:A systematic review with meta-analysis of data from a total of 3160 patients across 14 randomized controlled trials with both short- and medium- to long-term outcomes Bone Joint J 2018 100-B 991–1001

6. Nunley PD, Kerr EJ 3rd, Cavanaugh DA, Utter PA, Campbell PG, Wadhwa R, et al Adjacent segment pathology after treatment with cervical disc arthroplasty or anterior cervical discectomy and fusion, part 1:Radiographic results at 7-year follow-up Int J Spine Surg 2020 14 269–77

7. Kapetanakis S, Gkantsinikoudis N, Gkasdaris G, Charitoudis G Treatment of adjacent segment disease with percutaneous transforaminal endoscopic discectomy:Early experience and results J Orthop Surg (Hong Kong) 2020 28 2309499020960560

8. Fourney DR, Skelly AC, DeVine JG Treatment of cervical adjacent segment pathology:A systematic review Spine (Phila Pa 1976) 2012 37 22 Suppl S113–22
9. Chu EC. Preventing the progression of text neck in a young man: A case report. Radiol Case Rep. 2022 Mar;17(3):978-982. doi: 10.1016/j.radcr.2021.12.053. eCollection 2022 Mar. PubMed PMID: 35106108; PubMed Central PMCID: PMC8784282.
10. Chu EC. Remission of Headache and Neck Pain Following Chiropractic Manipulative Treatment in a Patient with Neurofibromatosis. Chiropractic Journal of Australia. 2022 February; 49(1):8-18. doi: https://www.cjaonline.com.au/index.php/cja/article/view/284.
11. Chu EC, Yau K, Ho V, Yun S. The scalable approach to the Chiropractic patient journey. Asia Pacific Chiropractic Journal. 2022 February; 2(5):2-8. doi: http://apcj.net/papers-issue-2-5/#ChuPatientJourney.
12. Chu E. Smart Rehabilitation Clinic. Journal of Contemporary Chiropractic. 2022; 5(1):7-12. doi: https://journal.parker.edu/index.php/jcc/article/view/182.
13. Chu EC, Wong A. Change in Pelvic Incidence Associated With Sacroiliac Joint Dysfunction: A Case Report. Journal of Medical Cases. 2022 January; 13(1):31-35.
14. Chu EC. Improvement of quality of life by conservative management of thoracic scoliosis at 172°: a case report. Journal of Medicine and Life. 2022 January; 15(1):144-148. doi: 10.25122/jml-2021-0332.
15. Chu EC, Leung K, Ng LL, Lam A. Vascular Thoracic Outlet Syndrome: A Case Report. J Contemp Chiropr. 2021 December; 4(1):142–145. doi: https://journal.parker.edu/index.php/jcc/article/view/176.
16. Chu EC, Wong AY. Cervicogenic Dizziness in an 11-Year-Old Girl: A Case Report. Adolesc Health Med Ther. 2021;12:111-116. doi: 10.2147/AHMT.S341069. eCollection 2021. PubMed PMID: 34866956; PubMed Central PMCID: PMC8636150.
17. Chu EC, Zoubi FA, Yang J. Cervicogenic Dizziness Associated With Craniocervical Instability: A Case Report. J Med Cases. 2021 Nov;12(11):451-454. doi: 10.14740/jmc3792. Epub 2021 Nov 5. PubMed PMID: 34804305; PubMed Central PMCID: PMC8577610.
18. Leung K, Chu EC. Hong Kong Chiropractic Survey: Analysis of Data. Asia-Pac Chiropr J. 2021 November; 2(3). doi: https://www.apcj.net/papers-issue-2-3/#LeungChuHongKong.
02/14/2022

【脊醫研究】脊醫緩解治神經纖維瘤的頭痛頸部疼痛

Authors: Benjamin Kah Chun Cheong Eric Chun Pu Chu, Valerie Kok Yan Chu, Alan Te-Chang Chen
Publication date: 2022/2
Journal: Chiropractic Journal of Australia
Volume: 49
Issue: 1
Pages: 8-18
ABSTRACT
Objective: To describe the case of a 21-year-old male with a 10-year history of neurofibromatosis type 1 (NF1) who complained of nuchal pain (2 on a 0-10 point numeric pain rating scale, NRS) and right frontal headache (8 on NRS) for six months.

Clinical features: The painful symptoms were associated with a great impact on the sleep and routine tasks during the month preceding the first presentation to the practitioner. The patient scored an 84% on the Neck Disability Index (NDI). Spinal palpation revealed restricted range of motion at C2/3, C4/5, C5/6, T1/2, T3/4 and T7/8 vertebral segments. Radiographic evaluation of the cervical spine revealed reduced cervical lordosis with Cobb angle 3°.

Intervention and outcomes: Chiropractic treatment aimed to reduce pain, muscle hypertonicity and restore spinal mobility. Treatment consisted of thermal ultrasound therapy, cervical manipulation with a high-velocity, low-amplitude force, and skin to skin contact manual adjustment. As the result of 12-month treatment, the patient experienced a resolution of neck pain and headache. He reported a reduced headache score from 8 to 0 on a scale of 10. His NDI reduced from 84 % to 8%, and cervical lordosis was restored from 3° to 20° as measured by the Cobb angle between the inferior endplate of C2 to the inferior endplate of C7.

Conclusion: This case report details the long-term recovery of a patient with NF1 from severe headaches and neck pain following chiropractic treatment. It provides evidence and highlights the value of chiropractic intervention in improving neuromuscular functions and resolving cervicogenic headache in a patient with NF1, especially when the problems cannot be effectively solved by pharmacological or other conservative means. Chiropractic manipulative therapy may be a viable option as conservative management of musculoskeletal dysfunction resulting from NF1.

02/12/2022

【脊醫研究】防止年輕人頸變形

作者: Eric Chun Pu Chu
发表日期: 2022/3
期刊: Radiology Case Reports
卷号: 17
期号: 3
页码范围: 978-982
出版商: University of Washington
简介: Text neck describes an overuse injury of the cervical spine resulting from the repetitive stress of prolonged forward head flexion while looking down on a mobile screen. This case report describes a 24-year-old young man who presented with a 12-month history of head and neck pain and paresthesia of the right upper limb. The patient worked as a YouTuber and has been editing and posting videos on the website for three years. One year prior to referral for chiropractic assessment, the patient first visited his family physician for similar complaints. Based on cervical radiographs, the diagnosis of cervical spondylosis was given. Previous management included pain medication and muscle relaxants. Interventions included repeated physical therapy, cervical traction, and acupuncture, with some temporary relief during the subsequent year. However, severe flare-up of the symptoms occurred, which was brought about …
 
Keywords: Cervical radiculopathy; Cervical spondylosis; Chiropractic manipulation; Surface electromyology; Text neck.
 
Introduction: Text neck refers to the degeneration of the cervical spine resulting from the repetitive stress of prolonged forward head flexion while looking down at mobile screens. If left insufficiently treated, the text neck can worsen over time, causing a multitude of physical health problems such as cervical curvature alteration, neck and shoulder muscle strain, impaired neck muscle perception, posterior ligamentous injury, and entrapment neuropathies. Disorders associated with flexed head posture include cervicogenic headaches, cervicogenic dizziness, and cervical radiculopathy. Most of these conditions manifest with clusters of painful symptoms and spine dysfunctions.

This case highlights the progression of text neck, which was insufficiently treated in a young man. The patient subsequently underwent nine months of chiropractic intervention. He reported resolution of pain and neurological symptoms in the neck and shoulder and regained neck mobility, which were supported by the improvement of radiographic and electromyological findings. Surgery is usually not indicated for mechanical causes of neck pain, unless there are progressive neurologic deficits or intractable pain and disability that is unresponsive to conservative treatments [2]. Avoiding prolonged texting along with maintaining a correct position are keys in preventing or addressing text neck [7].

Case Report

A 24-year-old male YouTuber presented with head and neck pain and paresthesia of the right upper limb for 12 months. He denied any injury event. During the past three years, the patient regularly edited blogging and videos on the YouTube website. He relied heavily, at least 16 hours a day, on a smartphone for both job resources and personal tasks. He would check his screen every 10 minutes. One year prior to this diagnosis, the patient experienced similar symptoms and visited his family physician. Cervical radiographs (Fig. 1) exhibited reduced cervical lordosis, axial rotation of the C5 vertebra, and degenerative proliferation of facets (white arrows) and uncovertebral joints (yellow arrows), suggestive of cervical spondylosis. Previous management included pain medication and muscle relaxants. Interventions included repeated physical therapy, cervical traction, and acupuncture, with some temporary relief. However, 12 months later, the patient repeatedly experienced severe flare-ups of the symptoms. This time, the patient could keep his head up for only a minute and was unable to move his neck without pain. These new difficulties forced him to seek chiropractic attention.

Discussion

Mobile texting and gaming is a growing lifestyle and health concern, with the constant growth in mobile/smartphone usage and adoption. Researches [9,10] revealed that the distinct cervical flexion seen in heavy smartphone users is causing a new overuse condition known as “text neck.” The fulcrum for flexion in the cervical spine in adults is at the C5/C6 level [2]. A neck flexion of 0° to 15° is akin to having the head squarely over the shoulders, wherein the stress on the cervical muscles is acceptably low [9]. A static and flexed neck posture can cause continuous strain of the posterior cervical musculature (the cervical erector spinae and suboccipital muscles, levator scapulae, and semispinalis and trapezius muscles), producing tension headaches, neck and shoulder pain, temporomandibular joint pain, and decreased cervical and upper thoracic ranges of motion [11]. Sustained flexed stress can also slacken posterior ligamentous structures, resulting in instability between vertebral segments, degenerative spondylosis, and vertebral body sliding [2,11]. In the long term, text neck can lead to plastic changes within the nervous system, causing sensorimotor integration deficiencies and further dysfunction [11].

When the neck is in flexion position, the paraspinal muscles act as antagonistic muscles to maintain compliance of the posture, which results in increased myoelectric activity [12]. Surface electromyography (sEMG) is a reliable technique to evaluate muscle activity. Applying two handheld recording electrodes on both sides of the spine 4 cm apart, static sEMG will record and process the level of muscle guarding quantitatively. The signal amplitude of sEMG is positively related to the amount of force produced by the muscles. The levels of muscle tension are displayed with the length and color of the bars in the schematic representation. The sum of all muscle activity readings (in microvolts) for both sides at all levels of the spine is referred to as the electrophysiological (EP) stress score (Fig. 3). In the present study, sEMG was used to assess the myoelectric activity of the paraspinal muscles in the patient with text neck syndrome before and after treatment. It was found that the signal amplitude and EP stress score were significantly different before and after the 9-month chiropractic therapy and were significantly correlated with symptom relief and cervical curvature correction, suggesting that sEMG could be used to objectively assess muscle functional change.

A long-lasting neck flexion due to excessive texting on a smartphone was assumed to be hazardous to cervical structures. Researchers have observed that 10 minutes of static flexion can lead to changes in mechanical and neuromuscular behavior of the cervical spine, potentially leading to decreased strength of cervical spine structures [13]. Surgery is usually not indicated for mechanical causes of neck pain, unless there are progressive neurologic deficits or intractable pain and disability that is unresponsive to conservative treatments [2]. Manual therapy has been shown to have a clinical benefit in correcting reversed cervical curvature [4,6,14]. Treatments for text neck syndrome should target neck problems and be tailored for individual patients based on their treatment responses. Regarding the current case, extension traction therapy is designed to target the anterior longitudinal ligament that attaches to the front of each vertebra. The viscoelastic properties of ligament fibers allow them to accommodate sustained loads. It is presumed that the restoration of natural cervical lordosis following extension traction therapy is mostly due to ligamentous creep (stretching) [15]. Text neck is an altogether preventable overuse degeneration that must be brought into high awareness for smartphone users [11].

Conclusion: In conclusion, the current study reported a progression of text neck, which has been insufficiently treated. Sustained flexion of the neck will cause cervical spine distortion. The improvement of neurologic symptoms has been shown to correlate with radiographic and electromyological alterations responding to the correction of cervical misalignment.

References:
  1. David D, Giannini C, Chiarelli F, Mohn A. Text neck syndrome in children and adolescents. Int J Environ Res Public Health. 2021;18(4):1565. doi: 10.3390/ijerph18041565. – DOI – PMC – PubMed
  2. Chu ECP, Wong AYL. Cervicogenic dizziness in an 11-year-old girl: A case report. Adolesc Health Med Ther. 2021;(12):111–116. doi: 10.2147/AHMT.S341069. – DOI – PMC – PubMed
  3. Chu ECP, Chu VKY, Lin AFC. Cervicogenic headache alleviating by spinal adjustment in combination with extension-compression traction. Arch. Clin Med Case Rep. 2019;3(5):269–273. doi: 10.26502/acmcr.96550090. – DOI
  4. Chu ECP, Chin WL, Bhaumik A. Cervicogenic dizziness. Oxf Med Case Rep. 2019;2019(11):476–478. doi: 10.1093/omcr/omz115. – DOI – PMC – PubMed
  5. Chu ECP, Lim T, Mak KC. Cervical radiculopathy alleviating by manipulative correction of cervical hypolordosis. J Med Cases. 2018;9(5):139–141. doi: 10.14740/jmc3051w. – DOI
  6. Chu ECP. Alleviating cervical radiculopathy by manipulative correction of reversed cervical lordosis: 4 years follow-up. J Fam Med Prim Care. 2021;10(11):4303–4306. doi: 10.4103/jfmpc.jfmpc_648_21. – DOI
  7. Neupane S, Ali U, Mathew A. Text neck syndrome-systematic review. Imperial J Interdiscipl Res. 2017;3(7):141–148.
  8. Safikhani S, Gries KS, Trudeau JJ, Reasner D, Rüdell K, Coons SJ, et al. Response scale selection in adult pain measures: results from a literature review. J Patient Rep Outcomes. 2017;2:40. doi: 10.1186/s41687-018-0053-6. – DOI – PMC – PubMed
  9. Namwongsa S, Puntumetakul R, Neubert MS, Boucaut R. Effect of neck flexion angles on neck muscle activity among smartphone users with and without neck pain. Ergonomics. 2019;62(12):1524–1533. doi: 10.1080/00140139.2019.1661525. – DOI – PubMed
  10. Ahmed S, Akter R, Pokhrel N, Samuel AJ. Prevalence of text neck syndrome and SMS thumb among smartphone users in college-going students: a cross-sectional survey study. J Public Health (Berl) 2021;29(2):411–416. doi: 10.1007/s10389-019-01139-4. – DOI
  11. Fiebert I, Kistner F, Gissendanner C, DaSilva C. Text neck: an adverse postural phenomenon. Work. 2021;69(4):1261–1270. doi: 10.3233/WOR-213547. – DOI – PubMed
  12. Qiao J, Zhang SL, Zhang J, Feng D. A study on the paraspinal muscle surface electromyography in acute nonspecific lower back pain. Med (Baltim) 2019;98(34):e16904. doi: 10.1097/MD.0000000000016904. – DOI – PMC – PubMed
  13. Mousavi-Khatir R, Talebian S, Toosizadeh N, Olyaei GR, Maroufi N. The effect of static neck flexion on mechanical and neuromuscular behaviors of the cervical spine. J Biomech. 2018;72:152–158. doi: 10.1016/j.jbiomech.2018.03.004. – DOI – PubMed
  14. Chu ECP, Lo FS, Bhaumik A. Plausible impact of forward head posture on upper cervical spine stability. J Fam Med Prim Care. 2020;9(5):2517–2520. doi: 10.4103/jfmpc.jfmpc_95_20. – DOI – PMC – PubMed
  15. Fortner MO, Oakley PA, Harrison DE. Cervical extension traction as part of a multimodal rehabilitation program relieves whiplash-associated disorders in a patient having failed previous chiropractic treatment: a CBP ® case report. J Phys Ther Sci. 2018;30(2):266–270. doi: 10.1589/jpts.30.266. – DOI – PMC – PubMed
02/11/2022

【脊醫研究】智能康復診所

Authors: Shun Zhe Piong Eric Chun-Pu Chu, Steve Ming Hei Yun, Kristy Hoi Ying Hau
Publication date: 2022/2
Journal: Journal of Contemporary Chiropractic
Volume: 5
Issue: 1
Pages: 7-12
Publisher: Parker University
 
Objective: With the advancement of information technology, the concept of smart rehabilitation clinics has gradually become a reality. As the concept of smart rehabilitation clinics has not been previously introduced in the literature, we list the essential factors that promote smart clinic transformation and the current state of smart clinics in various critical fields in this review.

Discussion: Smart clinics employ a new generation of information technologies, such as technological enablement, digitalization, automation, artificial intelligence, telemedicine, virtual reality, and robotic rehabilitation equipment, to completely revolutionize the existing medical system, making it more efficient, easy, and personalized.

Conclusion: This paper reviews the characteristics of smart clinics and evaluate the prospects for smart clinic owners.

02/02/2022

【脊醫研究】與骶髂關節功能障礙相關的骨盆發病率變化

Change in Pelvic Incidence Associated With Sacroiliac Joint Dysfunction: A Case Report
Authors: Arnold Wong, Eric Chun Pu Chu
Publication date: 2022/1
Journal: Journal of Medical Cases
Volume: 13
Issue: 1
Pages: 31-35
Description: The sacroiliac joint (SIJ) is designed primarily for stability with minute motions. SIJ dysfunction refers to improper movement of the SIJs. Diagnosis and evaluation of SIJ dysfunction are difficult, with use of physical maneuvers and image-guided anesthetic injection. This case report describes a 47-year-old female who experienced right buttock pain and painful limp for approximately 2 months. Standing radiographs revealed inflammatory sclerosis surrounding the right SIJ. Physical examination found tenderness over the right SIJ and positive results in provocation (the distraction, compression, and thigh thrust) tests, compatible with right SIJ dysfunction. Her pain was resolved and gait performance was retrieved following 6-month program of combined thoracolumbar manipulation and rehabilitation exercises. Unexpectedly, change in pelvic incidence (PI) angles was noticed on follow-up radiograph. PI remains more or less fixed throughout adult life since the mobility of the SIJs is considered negligible. The current presentation is designed to explore the significance of PI change. The PI disparity unfolds the possibility of recognizing SIJ dysfunction based on consecutive radiographs.
02/01/2022

【脊醫研究】脊醫患者旅程

Authors: Kristy Hoi Ying Yau Eric Chun Pu Chu, Vicky Wei Kye Ho, Piong Shun Zhe
Publication date: 2022/1
Journal:Asia-Pacific Chiropractic Journal
Volume:2
Issue: 5
Pages: 2-8
Publisher: Asia-Pacific Chiropractic Journal
12/16/2021

【脊醫研究】胸廓出口綜合徵

血管胸廓出口綜合徵:病例報告

Eric Chu
King Yi Leung
Lucina Lo Wah Ng
Ada Yuk Yin Lam

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胸廓出口綜合徵,保守治療

目的:探討一例血管性胸廓出口綜合徵患者的脊醫治療。

臨床特徵: 一名 30 歲男性報告右手突然出現間歇性麻木、緊繃和無力。表現為右上肢皮膚片狀剝落,右肩紫紺;以及冰冷蒼白的右手。運動被確定為激發運動。骨科檢查顯示艾倫測試呈陽性,而 Adson 測試結果有所改變。他的右肘/腕屈肌和伸肌的運動強度為 4/5,右側第 5 掌骨的屈肌和外展肌明顯弱於左側。他之前曾被神經科醫生診斷出患有胸動脈出口綜合徵,並給他開了肌肉鬆弛劑、物理治療運動、按摩治療和針灸治療。

干預和結果:治療方案包括脊柱推拿療法、熱超聲檢查、器械輔助軟組織鬆動和伸展加壓牽引。他的症狀完全消失了,他反復進行的胸廓出口綜合徵和頸椎前凸的骨科檢查都正常。

結論:一名 30 歲男性血管胸廓出口綜合徵通過脊醫治療。

參考

1. Jones MR, Prabhakar A, Viswanath O, et al. Thoracic outlet syndrome: a comprehensive review of pathophysiology, diagnosis, and treatment. Pain Ther 2019;8(1):5-18
2. Sanders RJ, Hammond SL, Rao NM. Diagnosis of thoracic outlet syndrome. J Vascular Surg 2007;46(3):601-604
3. Huang JH, Zager EL. Thoracic outlet syndrome. Neurosurg2004;55(4):897-903
4. Lo CC, Bukry SA, Alsuleman S, Simon JV. Systematic review: The effectiveness of physical treatments on thoracic outlet syndrome in reducing clinical symptoms. Hong Kong Physiother J 2011;29(2):53-63
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9. Murphy DR, Hurwitz EL, Gregory A, Clary R. A nonsurgical approach to the management of patients with cervical radiculopathy: a prospective observational cohort study. J Manipulative Physiol Ther 2006;29(4):279-287
10. Chu EC, Chan AK, Lin AF. Pitting oedema in a polio survivor with lumbar radiculopathy complicated disc herniation. J Family Med Prim Care.2019;8(5):1765-1768
11. Kim J, Sung DJ, Lee J. Therapeutic effectiveness of instrument-assisted soft tissue mobilization for soft tissue injury: mechanisms and practical application. J Exerc Rehabil 2017;13(1):12-22
12. Chu EC, Lim T, Mak K. Cervical Radiculopathy alleviating by manipulative correction of cervical hypolordosis. J Med Cases 2018;9(5):139-141
13. Berry RH, Oakley P, Harrison DE. Alleviation of radiculopathy by structural rehabilitation of the cervical spine by correcting a lateral head translation posture (-TXH) using Berry translation as a part of CBP Methods. A case report. Chiropr J Australia 2017;45(1):63-72
14. Hooper TL, Denton J, McGalliard MK, Brismée J, Sizer PS Jr. Thoracic outlet syndrome: a controversial clinical condition. Part 1: anatomy, and clinical examination/diagnosis. J Man Manip Ther 2010;18(2):74-83
15. Sanders RJ, Pearce WH. The treatment of thoracic outlet syndrome: A comparison of different operations. J Vasc Surg 1989;1 0(6):626-634
16. Jones MR, Prabhakar A, Viswanath O, et al. Thoracic outlet syndrome: a comprehensive review of pathophysiology, diagnosis, and treatment. Pain Ther 2019;8(1):5-18

11/01/2021

【脊醫研究】脊醫香港脊醫調查:數據分析

Review
   

Hong Kong Chiropractic Survey: Analysis of Data.

Abstract

Abstract: Objective -To summarize the key findings of the 2021 Survey of the Hong Kong Chiropractic Profession given to Hong Kong chiropractors and compare them to the practice patterns seen in similar local and international studies.

Method: A 52-question survey was conducted online, and access was provided via an email, Facebook, or WhatsApp invitation. The survey was sent to all registered chiropractors in Hong Kong and those on the database at the Chiropractic Doctors Association of Hong Kong, Hong Kong Chiropractic Association, and China Hong Kong Macau Chiropractic Association. The questions were divided into sections into the following areas: information about the typical chiropractic practitioner, chiropractic practice management, chiropractor beliefs, and chiropractor clinical management.

Summary: 80 chiropractors responded to the survey. The results indicate that the typical chiropractor in Hong Kong has a monthly income of $150,000-$300,000 HKD (19,230-38,460USD/month) and is an employee or sole practitioner with a thriving practice. Findings also suggest that the majority of chiropractors in Hong Kong have a vertebral subluxation focus and use a range of techniques in their practice.

Indexing Terms: chiropractic; Hong Kong; survey; practitioner income; practitioner beliefs.

Cite: Leung K, Chu ECP. 2021 Hong Kong Chiropractic Survey: Analysis of Data. Asia-Pac Chiropr J. 2021;2.3. URL apcj.net/papers-issue-2-3/#LeungChuHongKong

09/27/2021

【脊醫研究】脊醫與亞洲醫療的未來

08/10/2021

【脊醫研究】 探索刮痧療法:古代療法的當代觀點

05/21/2021

【脊醫研究】上交叉綜合徵矯正後胃食管反流病的解決-案例研究和簡要回顧

04/30/2021

【脊醫研究】腰椎間盤突出引起的慢性睾丸痛:病例報告和簡要回顧

Review
   
 May-Jun 2021;15(3):15579883211018431.
  doi: 10.1177/15579883211018431.

腰椎間盤突出引起的慢性睾丸痛:病例報告和簡要回顧

Affiliations 
Free PMC article

Abstract

Chronic orchialgia can be the result of pathological processes of the scrotal contents or stem from non-intrascrotal structures. Successful pain management depends on identifying the source of localized or referred pain. This is a case report of a 39-year-old male sports coach who presented with low back pain, right orchialgia, and sciatica refractory to conservative management. Magnetic resonance (MR) imaging revealed disc protrusion at L3/L4 and L4/L5 levels. Positive outcomes in relieving back and testicular pain were obtained after a total of 30 chiropractic sessions over a 9-week period. The evidence of the subjective improvement was corroborated by regression of the herniated discs documented on the repeat MR imaging. While chronic orchialgia is not an uncommon problem for men of all ages, it has seldom been described in association with lumbar discogenic disease. The current study provided preliminary support for a link between orchialgia and lumbar disc herniation. Chiropractic manipulation had provided a mechanistic alleviation of noxious lumbar stimuli, leading to symptomatic and functional improvements.

Keywords: chiropractic; discogenic disease; lumbar disc herniation; orchialgia; testicle.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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04/23/2021

【脊醫研究】胸腰椎間盤突出症是夜間遺尿症的隱藏原因

研究中一名30歲的男性,有4年的慢性背痛病史,他抱怨最近在一周前打籃球時扭傷,背痛發現劇烈的疼痛一直扯到下背部和臀部的地方。到醫院的時候,磁共振成像顯示有明顯的椎間盤突出水壓迫T12 / L1脊髓。在經過兩星期的脊醫治療後,他的搖肺部活動能力明顯增加。很意外的,患者長年的晚上尿床習慣也突然消失。
遺尿症又叫尿床,是指在不適當的時間或是不適當的地點,產生的正常排尿情況。遺尿症有別於一般的尿失禁,因為遺尿症是一個完整的排尿過程,只不過在這個排尿過程當中,病人並未意識到他有排尿的感覺。椎間盤突出症是遺尿症的一個經常被忽視的原因。研究發現胸腰椎間盤突出症是引起的脊髓壓迫的罕見結果。
在沒有嚴重的脊髓病的情況下,醫生團隊主張用非手術治療和定期監測治療椎間盤突出的症狀。手術治療通常是在保守治療的過程中得不到療效,才會使用侵入性的方法且走椎間盤的壓迫。脊骨神經治療主要是包括脊椎矯正、肌肉刺激、或者是機械人脊椎牽引。經過二個星期的脊醫治療後,神經痛得到了舒緩,椎間盤突出也縮回和消退。

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04/15/2021

【脊醫研究】脊醫醫治顱頸不穩定

Case Reports
   
 2021 Apr 25;5:12.
  doi: 10.21037/acr-20-131. eCollection 2021.

脊醫醫治顱頸不穩定

Affiliations 
Free PMC article

Abstract

Rheumatoid arthritis (RA) is an autoimmune disease that affects the synovial tissue which lines joints and tendons. The craniocervical junction is made up exclusively of synovial joints and ligaments and especially vulnerable to the inflammatory process of RA. The chronic inflammation of RA leads to loss of ligamentous restriction and erosion of the bony structures and results in craniocervical instability (CCI). This is a case report of an 80-year-old woman who had been diagnosed with seropositive RA two decades ago presented with head dropping and losing balance while walking for several months. Radiographic images of the cervical spine showed RA-related features of instability in the form of atlantoaxial instability, cranial settling and subaxial subluxation. Since physical therapy and acupuncture previously failed to provide a substantial, long-lasting outcome, the patient sought chiropractic care for her condition. The chiropractic regimen consisted of upper thoracic spine mobilization/adjustment, electrical muscle stimulation of the cervical extensors, home exercises and neck bracing. She regained substantial neck muscle strength, gaze angle and walking balance following a 4-month chiropractic treatment, although cervical kyphosis persisted. The current study aims to provide basic knowledge of CCI associated with RA and ability to modify a treatment program to accommodate the needs of patients with coexisting red flags.

Keywords: Cervical spine; chiropractic; craniocervical instability (CCI); head dropping; rheumatoid arthritis (RA).

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/acr-20-131). The authors have no conflicts of interest to declare.

12/02/2020

【脊醫研究】孤立的頸伸肌病

孤立的頸伸肌病: 頭跌落綜合症

 
紐約醫療朱君璞脊醫, 理工大學康復治療科學系黃宇樂助理教授, 紐約醫療林福杰脊醫
First Published December 2, 2020 Case Report
 
 

 

 

頭跌落綜合徵(DHS)表現為無法將頭部保持直立姿勢,與各種各樣的肌病和神經系統疾病有關,孤立的頸伸肌病(INEM)是導致DHS的許多潛在原因之一。這是一例72歲男子患有退行性頸椎病和DHS長達2年的病例報告,他以前在藥物治療,頸托和運動康復方面未能取得積極的成果,但他能夠恢復健康。人們認為,INEM是由慢性損傷和頸肌超負荷引起的孤立性肌病性變化引起的,頸椎病被認為是繼發於頸椎伸肌神經支配的DHS的原因。儘管與退行性脊柱病相關的INEM不能在醫學上治療,但在考慮手術干預之前可以採用脊醫治療。

08/22/2020

【脊醫研究】脊醫矯正脊柱疾病可緩解睾丸疼痛

 

 

 

Degenerative disease of the lumbar spine is often ignored as a potential cause of testicular pain because the exact link between the two remains uncertain. This article reports the case of a 60-year-old man with a 3-year history of low back pain and unexplained right testicular pain for 2 years. Painful symptoms were negatively affecting his social, physical, and sexual functions. After failure to achieve pain relief through multiple types of therapy, the patient sought chiropractic treatment for his condition. Lumbar spine magnetic resonance imaging (MRI) revealed disc protrusion at the L1/L2, L3/L4, and L4/L5 segments causing thecal sac indentations. Due to the absence of direct testicular causes, the medical impression was chronic testicular pain (CTP) complicating lumbar disc disease. The patient experienced regular improvement in his low back and testicular pain with complete resolution of both after 8 weeks of chiropractic treatment. This article describes an overlook of the etiology of this patient’s testicular pain and a successful option in treating the patient. CTP has multifactorial etiology. An excellent treatment outcome depends heavily on recognizing the origin of the pain.

07/03/2020

【脊醫研究】非手術治療后腰椎間盤突出症的消退

Regression of Lumbar Disc Herniation Following Non-surgical Treatment

Eric Chun-Pu Chu, Divya Midhun Chakkaravarthy, Fa-Sain Lo, Amiya Bhaumik.

    

Abstract
Symptomatic disc herniation is the most common disc pathology and can result in substantial disability and poor quality of life. Here, we present a male patient who was diagnosed as having lumbar disc herniation at L3/L4 and L4/L5 levels with nerve root entrapment. The patient sought chiropractic treatment for severe back pain which lead to trouble walking. After 7 months of a medical/chiropractic intervention, complete pain relief and recovery of muscle weakness were achieved. At 11-month follow-up, the regression of the herniated discs was documented on MR imaging. This case presentation aims to raise a reappraisal of our knowledge of intervertebral disc herniation in regard to the natural history, the components of herniated material and possible mechanisms behind hernia regression, which holds the key to treating this problem. Through the translation of research evidence into practice, current guidelines recalibrate instructions on the diagnosis and treatment of symptomatic disc herniation.

Key words: Chiropractic, herniated disc regression, lumbar disc herniation, non-surgical treatment

 

 

07/03/2020 

香港脊醫 2020 6月刊

香港脊醫 Hong Kong Chiropractors June 2020

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07/01/2020

【脊醫研究】10歲男孩的寰樞椎旋轉半脫位

06/30/2020

【脊醫研究】腰椎薦椎化可能是脊柱側彎矯正的潛在因素

腰椎薦椎化可能是脊柱側彎矯正的潛在因素

Abstract: Lumbosacral transitional vertebrae (LSTVs) are the most common congenital anomaly of the lumbosacral spine that presents either as L5 sacralisation or S1 lumbarisation. Although most of the LSTVs are of minor clinical importance, these anomalies may contribute to disruptions in biomechanics and alterations in spinal and paraspinal structures. Here, we present two cases of adolescent idiopathic scoliosis to illustrate some overlooked effects of a unilateral LSTV on spinal deformity. Cure correction was not attained in both cases. While a unilateral LSTV was on a different side of their lumbosacral spine, it is incidentally noticed that the direction of the curve was convex on the contralateral side of the LSTV. Most likely, unilateral LSTVs on certain occasions could cause the growing spine to curve and rotate. The aim of this report is to demonstrate an overlooked association between minor anomalies and the growing spines, which may be important to tailor an appropriate treatment plan. Indexing Terms: Adolescent idiopathic scoliosis; congenital anomaly; lumbosacral transitional vertebra, Chiropractic adjustment, Vertebral adjustment Cite: Chu ECP, Huang KHK, Shum JSF. Lumbosacral transitional vertebra as a potential contributing factor to scoliosis: a report of two cases. Asia-Pac Chiropr J. 2020;1:007 DOI https://doi.org/10.46323/2021007
 
06/05/2020

【脊醫研究】頸椎1/2節錯位案例

04/01/2020

設立脊醫遠程醫療指引

設立脊醫遠程醫療指引 

To: 食物及衞生局局長

 

香港添馬添美道2號政府總部東翼18樓

CC: 香港灣仔皇后大道東182號

香港脊醫管理局及委員會辦公室

 

陳肇始教授: 

設立脊醫遠程醫療指引 

新病毒擴大,遠程醫療將會變成未來趨勢。患者如果可以通過電話或視像會議與脊醫聯繫,進行各種遠端看診,以避免民眾到診所引發的人際傳染風險,也大幅提高對患者的醫療服務。

香港醫務委員會在二零一九年十二月已公布了遠程醫療指引, 本會現就建議香港脊醫管理局可立即設立制度和相關指引, 積極引進及推動遠程醫學,以加強脊醫學教育、診斷及治療工作的效率。

遠程醫療應用範圍廣泛,可透過資訊科技分析病歷、視像診症、診症分流,甚至遠距離護理、遙距教育等,病人足不出戶,便可接受脊醫評估,減省輪候時間,亦能妤緩醫療人手及服務不足以應付需求的壓力。

香港脊醫遠程醫療指引也可以做到以下的功能:

(一) 脊醫可以使用遠程醫學設備,討論及會診,節省卻轉運病人的時間,減少交叉感染,令病人和家人得到及時的治療和關懷。

(二)脊醫可和醫院系統接軌,在不同的地點會診門診的病人。

(三)脊醫科生可以在教學上觀察病人,學習臨床醫學。

(四)可加入國際專家會診。

本會促請閣下積極設立及推動遠程醫學,讓更多註冊脊醫履行醫務責任。 

專此奉達,敬候赐覆。

 


朱君璞脊醫 (香港執業脊醫協會主席)

二零二零年三月二十六日 

01/30/2020

香港脊醫 2020 2月刊

香港脊醫 Hong Kong Chiropractors Feb 2020

  設立脊醫遠程醫療指引
04/01/2020

設立脊醫遠程醫療指引

設立脊醫遠程醫療指引 To: 食物及衞生局局長   香港添馬添美道2號政府總部東翼18樓 CC: 香港灣仔皇后大道東182號 香港脊醫管理局及委員會辦公室   陳肇始教授: 設立脊醫遠程醫療指引 新病毒擴大,遠程醫療將會變成未來趨勢。患者如果可以通過電話或視像會議與脊醫聯繫,進行各種遠端看診,以避免民眾到診所引發的人際傳染風險,也大幅提高對患者的醫療服務。 香港醫務委員會在二零一九年十二月已公布了遠程醫療指引, 本會現就建議香港脊醫管理局可立即設立制度和相關指引, 積極引進及推動遠程醫學,以加強脊醫學教育、診斷及治療工作的效率。 遠程醫療應用範圍廣泛,可透過資訊科技分析病歷、視像診症、診症分流,甚至遠距離護理、遙距教育等,病人足不出戶,便可接受脊醫評估,減省輪候時間,亦能妤緩醫療人手及服務不足以應付需求的壓力。 香港脊醫遠程醫療指引也可以做到以下的功能: (一) 脊醫可以使用遠程醫學設備,討論及會診,節省卻轉運病人的時間,減少交叉感染,令病人和家人得到及時的治療和關懷。 (二)脊醫可和醫院系統接軌,在不同的地點會診門診的病人。 (三)脊醫科生可以在教學上觀察病人,學習臨床醫學。 (四)可加入國際專家會診。 本會促請閣下積極設立及推動遠程醫學,讓更多註冊脊醫履行醫務責任。 專此奉達,敬候赐覆。   朱君璞脊醫 (香港執業脊醫協會主席) 二零二零年三月二十六日
12/31/2019

持續專業發展記錄

CDAHK Record on Continuing Professional Development (CPD) Activities

(for the period from   1-1-2019  to   31-12-2019 )

PDF

 

 

 

12/10/2019

【脊醫研究】頸椎病患者吞嚥困難的異常原因

 

 

頸椎病患者吞嚥困難的異常原因

朱君璞脊醫 ; 岑承輝放射線專科醫生 ; 林福傑脊醫
2019
Clinical medicine insights. Case reports, Vol.12, p.1179547619882707

各種與年齡有關的問題,包括唾液分泌紊亂,口腔運動協調不良,神經肌肉無力,神經退行性疾​​病,中風和結構改變,都可能導致吞嚥障礙。考慮到吞嚥困難的原因因患者而異,因此需要針對患者俱體情況量身定制的個性化治療計劃。在這裡,我們介紹一例老年婦女,患有上頸僵硬和吞嚥困難,尋求整脊治療。影像學檢查提示頸椎病伴垂直寰樞關節半脫位。在進行了20次脊椎按摩治療後,患者完全擺脫了頸部問題和吞嚥困難。有規律的吞嚥動作由腦幹的中央模式生成電路控制。在這種情況下,由於C1 / 2不穩定,腦幹可能已被軸的齒狀突壓緊。頸源性吞嚥困難是吞嚥困難的頸原因。吞嚥困難時的頸不適大多被低估了。高度的臨床懷疑對於及時干預至關重要。

11/09/2019

【脊醫研究】頸椎性暈眩

頸椎性暈眩

朱君璞脊醫 ; 陳惠玲脊醫 ; Bhaumik, Amiya
2019 11月
牛津醫學案例, Vol.2019(11), pp.476-478

 

 
Cervical muscles have numerous connections with vestibular, visual and higher centres, and their interactions can produce effective proprioceptive input. Dysfunction of the cervical proprioception because of various neck problems can alter orientation in space and cause a sensation of disequilibrium. Cervicogenic dizziness (CGD) is a clinical syndrome characterized by the presence of dizziness and associated neck pain in patients with cervical pathology. Here, we report a 24-year-old female, who was diagnosed with CGD based on the correlating episodes of neck pain and dizziness. Both symptoms improved with targeted chiropractic adjustment and ultrasound therapy. CGD is a seemingly simple complaint for patients, but tends to be a controversial diagnosis because there are no specific tests to confirm its causality. For CGD to be considered, an appropriate management for the neck pain should not be denied any patient.
Cervical muscles have numerous connections with vestibular, visual and higher centres, and their interactions can produce effective proprioceptive input. Dysfunction of the cervical proprioception because of various neck problems can alter orientation in space and cause a sensation of disequilibrium. Cervicogenic dizziness (CGD) is a clinical syndrome characterized by the presence of dizziness and associated neck pain in patients with cervical pathology. Here, we report a 24-year-old female, who was diagnosed with CGD based on the correlating episodes of neck pain and dizziness. Both symptoms improved with targeted chiropractic adjustment and ultrasound therapy. CGD is a seemingly simple complaint for patients, but tends to be a controversial diagnosis because there are no specific tests to confirm its causality. For CGD to be considered, an appropriate management for the neck pain should not be denied any patient.
11/01/2019

香港脊醫 2019 11月刊 

11/01/2019

【脊醫研究】 脊骨矯正後頑固性皮肌炎的緩解

 

脊骨矯正後頑固性皮肌炎的緩解

朱君璞脊醫 ; Lo, Fa-Sain ; Bhaumik, Amiya
家庭醫學期刊, 2019, Vol.8(11), p.3742-3744
Dermatomyositis (DM) is an idiopathic inflammatory myopathy characterized by progressive muscle weakness and pathognomonic skin eruptions. Systemic corticosteroid with or without an immunosuppressive agent is the current treatment of choice in most cases. Cutaneous disease in DM is often refractory…
09/09/2019

【脊醫研究】後小兒麻痺症候群

脊骨神經醫學系如何幫助後小兒麻痺症候群? 香港執業脊醫協會林嘉慧和朱君璞的病例研究探討了後小兒麻痺症候群的治療方案 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6690913/
09/01/2019

香港脊醫 2019 9月刊

08/17/2019

香港執業脊醫協會「2019 施政報告」建議書 

07/01/2019

香港脊醫 2019 7月刊

06/16/2019

【脊醫研究】 在患有腰椎神經根病的脊髓灰質炎倖存者中出現水腫並發椎間盤突出症

. 2019 May; 8(5): 1765–1768.
 
PMCID: PMC6559111
PMID: 31198752

Pitting oedema in a polio survivor with lumbar radiculopathy complicated disc herniation

Abstract

We report a 58-year-old male with sequelae of polio who presented with low back and left buttock pain, and pitting oedema of both legs for four months. The patient had a history of poliomyelitis at the age of 1 year which resulted in bilateral lower leg weakness, particularly on the left side. Magnetic resonance imaging showed cervical spinal stenosis secondary to posterior osteophyte formation, left paracentral disc extrusion at L2/L3 and L3/L4 levels with compression of the traversing L4 nerve root. The findings confirmed a diagnosis of lumbar radiculopathy caused by a herniated disc. The patient subsequently underwent a chiropractic treatment. The painful symptoms and pitting oedema in this case resolved with spinal adjustment in addition to scraping therapy to strengthen bilateral low back and the gluteal muscles. This case provides circumstantial evidence of a scarcely mentioned association between pitting oedema and lumbar radiculopathy caused by disc herniation. The pathophysiological mechanism is elusive, but might involve a complexity of cytokine-mediated inflammation and interconnection between somatic and autonomic nervous systems.

Keywords: Chiropractic, disc herniation, lumbar radiculopathy, pitting oedema, poliomyelitis
05/01/2019 

香港脊醫 2019 5月刊

04/12/2019

【脊醫研究】頸椎矯正後緩解重肌無力症

頸椎矯正後緩解重肌無力症.

朱君璞脊醫 ; 大衛貝林脊醫
2019
AME case reports, Vol.3, p.9
03/14/2019

【脊醫研究】兒童良性急性肌炎的罕見表現

 

兒童良性急性肌炎的罕見表現

朱君璞脊醫 ; 葉紹亮醫生
Clinical Case Reports, March 2019, Vol.7(3), pp.461-464
Benign acute childhood myositis is a self‐limiting muscle disorder characterized by calf pain with an isolated finding of elevated serum creatine kinase, being preceded by an influenza‐like illness. The classic clinical and laboratory features may allow for a correct diagnosis. This report describes some accompanying symptoms which are not usually perceived. An incorrect diagnosis could lead to unnecessary treatments. Benign acute childhood myositis is a self‐limiting muscle disorder characterized by calf pain with an isolated finding of elevated serum creatine kinase, being preceded by an influenza‐like illness. The classic clinical and laboratory features may allow for a correct diagnosis. This report describes some accompanying symptoms which are not usually perceived. An incorrect diagnosis could lead to unnecessary treatments.
02/19/2019

【脊醫病例】脊醫治療後近視性視網膜劈裂的自發消退

朱君璞脊醫在AME病例雜誌發表脊醫治療後近視性視網膜劈裂的自發消退

11/30/2018

【脊醫研究】脊醫治療後可長期緩解緊張型頭痛和重度抑鬱

Title
Long-term relief from tension-type headache and major depression following chiropractic treatment
Summary
We report the case of a 44-year-old school teacher who experienced long-term relief from tension-type headache (TTH) and major depression following chiropractic treatment. It is well recognized that psychiatric comorbidity and suicide risk are commonly found in patients with painful physical symptoms such as chronic headache, backache, or joint pain. Recent studies indicated that autonomic dysfunction plays a role in the pathogenesis of TTHs and depressive disorders. The autonomic nervous system is mainly controlled by reflex centers located in the spinal cord, brain stem, and hypothalamus. This report highlights the rewarding outcomes from spinal adjustment in certain neuropsychiatric disorders. Long-term results of chiropractic adjustment in this particular case were very favorable. Further studies with larger groups are warranted to better clarify the role of chiropractic.
Language
English
Is Part Of
Journal of family medicine and primary care, 2018, Vol.7(3), pp.629-631
Identifier
ISSN: 2249-4863
PMID: 30112321 Version:1
DOI: 10.4103/jfmpc.jfmpc_68_18
07/11/2018 

香港脊醫 2018 7月刊

 

03/12/2018 

香港脊醫 2018 3月刊

12/08/2017

CDAHK e-newsletter Dec 2017 

12/01/2017 

世界衛生組織脊骨神經醫學指南

07/21/2017 

CDAHK E-Newsletter Jul

03/13/2017

Feb 2017 e-newsletter 

09/26/2016

Sept 2016 e-newsletter

06/03/2016

e-Newsletter_May

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02/29/2016

[CDAHK] AGM reports 

12/19/2015

e-Newsletter 

11/19/2015

信件 

11/16/2015

信件

11/11/2015 

Autism and Neurotoxin detoxing/ Chronic Pain and detoxing

10/07/2015 

Current Concepts of Rehabilitation of Anterior Cruciate Ligament (ACL) Injury

04/10/2015

Great News!

Great News! The F4CP’s ad appears today on page D3 of the Wall Street Journal. Be sure to pick up a copy and share this news with your peers!

01/24/2015

Jan 2015 E-Newsletter

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01/14/2015 

June 2014 E-Newsletter

07/05/2013

政府統計處主題性住戶統計調查 第 53 號報告書

11/13/2012

脊醫課程訓練

zh_HK