Play

Streptococcus oralis (S. oralis) is a gram-positive bacterium and component of the oral microbiota that can rarely cause opportunistic infection in the immunosuppressed. This report presents a 60-year-old man from Hong Kong with gingivitis and poorly controlled diabetes who visited his chiropractor with low back pain 2 weeks following mild COVID-19 and was diagnosed with paraspinal, psoas, and epidural abscess due to S. oralis.
CASE REPORT
The patient tested positive for COVID-19 when asymptomatic, then had a mild 10-day course of the illness, followed by low back pain 1 week later, prompting him to visit his primary care provider, who diagnosed sciatica and treated him with opioid analgesics. He presented to a chiropractor the following week, noting severe low back pain with radiation into the gluteal regions and posterior thighs, difficulty with ambulation, and mild neck pain. Considering the patient’s diabetes, widespread symptoms, and weakness, the chiropractor ordered whole-spine magnetic resonance imaging, which suggested possible multifocal spinal abscess and referred him urgently to a spine surgeon. The surgeon conducted testing consistent with bacterial infection, and referred to an infectious disease specialist, who confirmed S. oralis spinal infection via lumbar paraspinal needle biopsy and culture. The patient was first treated with oral antibiotics, then intravenous antibiotics in a hospital. Over 4 weeks, his spinal pain improved, and laboratory markers of infection normalized.
CONCLUSIONS
This case illustrates an opportunistic pyogenic spinal infection including paraspinal, psoas, and epidural abscesses caused by S. oralis in an immunocompromised patient following COVID-19 illness.
www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=36199237

Eric Chun-Pu Chu, Robert J Trager, Alan Te Chang Chen, John Sing Fai Shum (2022) A 60-Year-Old Man with Gingivitis and Poorly Controlled Diabetes Developing Low Back Pain 1 Week Following Recovery from COVID-19 Diagnosed with Spinal Abscess Due to Streptococcus oralis American Journal of Case Reports 23: e937517. September. dx.doi.org/10.12659/AJCR.937517

#BackPain, #Chiropractic, #COVID ... See MoreSee Less

Play

Patients with Arnold-Chiari Malformation I (CM-I) treated with foramen magnum decompression (FMD) can have ongoing neck pain, headaches, and other symptoms complicated by persistent syringomyelia, yet there is little research regarding treatment of these symptoms.
Case Report:
A 62-year-old woman with a history of residual syringomyelia following FMD and ventriculoperitoneal shunt for CM-I presented to a chiropractor with progressively worsening neck pain, occipital headache, upper ex- tremity numbness and weakness, and gait abnormality, with a World Health Organization Quality of Life score (WHO-QOL) of 52%. Symptoms were improved by FMD 16 years prior, then progressively worsened, and had resisted other forms of treatment, including exercises, acupuncture, and medications. Examination by the chi- ropractor revealed upper extremity neurologic deficits, including grip strength. The chiropractor ordered whole spine magnetic resonance imaging, which demonstrated a persistent cervico-thoracic syrinx and findings of cervical spondylosis, and treated the patient using a multimodal approach, with gentle cervical spine mobiliza- tion, soft tissue manipulation, and core and finger muscle rehabilitative exercises. The patient responded positively, and at the 6-month follow-up her WHO-QOL score was 80%, her grip strength and forward head posi- tion had improved, and she was now able to eat using chopsticks.
This case highlights a patient with neck pain, headaches, and persistent syringomyelia after FMD for CM-I who improved following multimodal chiropractic and rehabilitative therapies. Given the limited, low-level evidence for these interventions in patients with persistent symptoms and syringomyelia after FMD, these therapies can- not be broadly recommended, yet could be considered on a case-by-case basis.

amjcaserep.com/abstract/index/idArt/937826

Eric Chun-Pu Chu, Robert J Trager, Gabriel Siu Nam Ng, John Sing Fai Shum (2022) Neck pain and Headache Complicated by Persistent Syringomyelia After Foramen Magnum Decompression for Chiari I Malformation: Improvement with Multimodal Chiropractic Therapies American Journal of Case Reports 23: e937826. September. dx.doi.org/10.12659/AJCR.937826
Arnold-Chiari Malformation • Chiropractic • Exercise Therapy • Manipulation, Spinal • Neck Pain • Therapy, Soft Tissue ... See MoreSee Less

Play

Breast cancer is the most common cancer in women and the most common cause of spinal metastasis, and it may recur months to years after treatment.
A 41-year-old woman, recovered from breast cancer, presented to a chiropractor with acute-on-chronic 3-week history of low back pain radiating to the right leg. She had seen 2 providers previously; lumbar spondylosis had been diagnosed via radiography. Given her recent symptom progression and cancer history, the chiropractor or- dered lumbar magnetic resonance imaging, revealing L5 vertebral marrow replacement, suggestive of metas- tasis. The chiropractor referred her to an oncologist. While awaiting biopsy and oncologic treatments, the on- cologist cleared the patient to receive gentle spinal traction and soft tissue manipulation, which alleviated her back pain. The patient continued radiation and chemotherapy, with low back pain remaining improved over 18 months. A literature review identified 7 previous cases of women presenting to a chiropractor with breast cancer metastasis. Including the current case, most had spinal pain and vertebral metastasis (75%) and histo- ry of breast cancer (88%) diagnosed a mean 5±3 years prior.
This case illustrates a woman with low back pain due to recurrent metastatic breast cancer, identified by a chi- ropractor, and the utility of a multidisciplinary approach to pain relief during oncologic care. Our literature re- view suggests that although uncommon, such patients can present to chiropractors with spinal pain from ver- tebral metastasis and have a known history of breast cancer. Conservative therapies should be used cautiously and under oncologic

www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=36057783

Eric Chun-Pu Chu, Robert J Trager, Colin Ritchie Lai, John Sing Fai Shum (2022) Metastatic Recurrent Breast Cancer Identified in the Chiropractic Office: Case Report and Literature Review American Journal of Case Reports 23: e937609. dx.doi.org/10.12659/AJCR.937609 ... See MoreSee Less

Play

Postural orthostatic tachycardia syndrome (POTS) is a form of dysautonomia that’s characterised by an abnormal heart rate response to a positional change. A 50-year-old female presented with lightheadedness, palpitation, and neck pain for 3 years. Lightheadedness and palpitation occurred when shifting from a prolonged seated or lying position. Standing radiographs showed spinal misalignment with cervical kyphosis and thoracic scoliosis. Continuous static stress on these minor variants could aggravate biomechanical and autonomic disorder like POTS. After ruling out cardiovascular, neurological, or vestibular pathophysiology, a multicomponent treatment approach was adopted including the use of thermal ultrasound therapy, cervical and thoracic spinal manipulation, and intermittent motorized cervicothoracic traction to manage her neck pain complaints. Following 3 months of regular treatment, the patient reported a full resolution of neck pain, dizziness, and POTS. At 12-month follow-up, all radiographic metrics showed improvement, including improvement of cervical alignment and thoracic curvature. POTS is a prevalent, under-diagnosed dysautonomia. This study might arouse the alertness of clinicians that symptoms related to POTS may be erroneously attributed to other neuro-cardiovascular disorders.

Eric Chun Pu Chu, Andy Fu Chieh Lin (2022) Relief of postural orthostatic tachycardia syndrome with chiropractic rehabilitation Journal of Family Medicine and Primary Care 11: 7. 4006-4009 July. dx.doi.org/10.4103/jfmpc.jfmpc_2108_21

#POTS #Posturalorthostatictachycardiasyndrome ... See MoreSee Less

Play

Vertebrobasilar insufficiency (VBI) is most often caused by vertebrobasilar atherosclerosis, often presenting with dizziness and occasionally neck pain. The Chiropractic manual therapies can afford patients with VBI relief from concurrent neck pain and possibly dizziness.

Eric Chun-Pu Chu, Robert J Trager, Cliff Tao, Linda Yin-King Lee Chiropractic Management of Neck Pain Complicated by Symptomatic Vertebral Artery Stenosis and Dizziness American Journal of Case Reports 2022: 23. e937991 September. dx.doi.org/10.12659/AJCR.937991
#VBAI, #Chiropractic, #dizziness
www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=36258651 ... See MoreSee Less

Learn More

Play

Sciatica, which is pain radiating along the sciatic nerve distribution, is most often caused by degenerative con- ditions of the lower back and rarely results from lesions of the spinal cord. This case report illustrates a pa- tient with suspected lumbar radiculopathy, ultimately diagnosed with a thoracic schwannoma after visiting a chiropractor.
A 61-year-old woman presented to a chiropractor with progressively worsening lower back pain radiating to the right lower extremity and unsteady gait. Her symptoms began 10 years previously and she had been diag- nosed by an orthopedist with lumbar disc herniation causing radiculopathy via magnetic resonance imaging (MRI) and was treated with physical therapy and diclofenac. Upon examination by the chiropractor, the patient had bilateral lower-extremity neurologic deficits, hyperreflexia, and upgoing Babinski responses. The chiroprac- tor ordered thoracic MRI, but the patient preferred to initiate a trial of care, which was unsuccessful. After a delay imposed by cardiac bypass surgery, the patient returned to the chiropractor with worsened symptoms and underwent thoracic MRI, revealing an intraspinal mass at T9. The patient underwent laminectomy and tu- mor removal, with histopathology confirming a diagnosis of schwannoma. The patient gradually improved af- ter surgery with the help of rehabilitative exercises.
Clinicians should suspect a spinal cord lesion as a cause of sciatic pain when patients fail to improve with treat- ment, have a broad sensorimotor distribution unexplained by lumbar imaging findings, hyperreflexia/patho- logical reflexes, or other atypical findings (eg, negative neural tension tests). In such cases, MRI of the cervical and thoracic spine may be indicated.

Eric Chun-Pu Chu, Robert J Trager (2022) Thoracic Schwannoma as an Unusual Cause of Sciatic Pain in the Chiropractic Office: A Case Report American Journal of Case Reports 23: e938448. October. dx.doi.org/10.12659/AJCR.938448
Chiropractic, Low Back Pain, #neurilemmoma ... See MoreSee Less

Play

Whats the prevalence and types of serious pathology among adults with new low back pain presenting to chiropractors?

Eric Chun-Pu Chu, Robert J Trager (2022) Prevalence of Serious Pathology Among Adults with Low Back Pain Presenting for Chiropractic Care: A Retrospective Chart Review of Integrated Clinics in Hong Kong Medical Science Monitor 28: e938042. Sept. dx.doi.org/10.12659/MSM.938042
#Chiropractic, #Fractures, www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=36164262 ... See MoreSee Less

Learn More

Play

October is breast cancer awareness month.

This report describes a woman with a remote history of breast cancer presenting with low back pain to a chiropractic clinic with imaging findings consistent with vertebral hemangioma and vertebral metastatic lesions.

This case illustrates that when patients fail to respond to treatment for low back pain, clinical referral should be undertaken for investigations to identify possible serious underlying pathology.

amjcaserep.com/abstract/index/idArt/938034

Eric Chun-Pu Chu, Robert J Trager, Alan Te Chang Chen, John Sing Fai Shum (2022) A 68-Year-Old Woman with a Remote History of Breast Cancer Presenting with Low Back Pain to a Chiropractic Clinic in Hong Kong with Imaging Findings Consistent with a Vertebral Hemangioma and Vertebral Metastatic Lesions American Journal of Case Reports 23: e938034 September. dx.doi.org/10.12659/AJCR.938034

Chiropractic, Hemangioma, Low Back Pain, (all 4 tags) ... See MoreSee Less

Learn More

Play

bit.ly/3TyVJTY

Men with undiagnosed metastasis from prostate cancer may present to chiropractors complaining of spinal pain. Chiropractors are good in identifying the red flags warranting imaging such as older age and new or progressive symptoms and co-manage with an oncologist when suspecting prostate cancer.

Eric C Chu, Robert J Trager, Colin R Lai Benson K Leung (2022) Presumptive Prostate Cancer Presenting as Low Back Pain in the Chiropractic Office: Two Cases and Literature Review Cureus 14: 10. e30575 October. dx.doi.org/10.7759/cureus.30575 ... See MoreSee Less

Learn More

Play

Bell’s palsy, also called facial nerve palsy, occasionally co-occurs with trigeminal neuropathy, which presents as additional facial sensory symptoms and/or neck pain. Bell’s palsy has a proposed viral etiology, in particular when occurring after dental manipulation.
CASE REPORT
A 52-year-old Asian woman presented to a chiropractor with a 3-year history of constant neck pain and left-sided maxillary, eyebrow, and temporomandibular facial pain, paresis, and paresthesia, which began after using a toothpick, causing possible gum trauma. She had previously been treated with antiviral medication and prednisone, Chinese herbal medicine, and acupuncture, but her recovery plateaued at 60% after 1 year. The chiropractor ordered cervical spine magnetic resonance imaging, which demonstrated cervical spondylosis, with no evidence of myelopathy or major pathology. Treatment involved cervical and thoracic spinal manipulation, cervical traction, soft-tissue therapy, and neck exercises. The patient responded positively. At 1-month follow-up, face and neck pain and facial paresis were resolved aside from residual eyelid synkinesis. A literature review identified 12 additional cases in which chiropractic spinal manipulation with multimodal therapies was reported to improve Bell’s palsy. Including the current case, 85% of these patients also had pain in the face or neck.
CONCLUSIONS
This case illustrates improvement of Bell’s palsy and concurrent trigeminal neuropathy with multimodal chiropractic care including spinal manipulation. Limited evidence from other similar cases suggests a role of the trigeminal pathway in these positive treatment responses of Bell’s palsy with concurrent face/neck pain. These findings should be explored with research designs accounting for the natural history of Bell’s palsy.

Eric Chun-Pu Chu, Robert J Trager, Alan Te-Chang Chen (2022) Concurrent Bell’s Palsy and Facial Pain Improving with Multimodal Chiropractic Therapy: A Case Report and Literature Review American Journal of Case Reports 23: e937511. Aug. dx.doi.org/10.12659/AJCR.937511
#bellspalsy #Chiropractic Manipulation, Spinal,

www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=36117309 ... See MoreSee Less

Play

Resolution of Cervical Radiculopathic Symptoms and Restoration of Cervical Lordosis

To report the successful treatment of a 20-year- old woman with symptoms of radiculopathy in her left upper lateral extremity and reversed cervical lordosis. Her symptom resolved entirely, along with improvement in physiological cervical lordosis seen on radiography after chiropractic care.
Clinical Features: A 20-year-old female university student sought care for a complaint of non-specific, gradual onset, intermittent neck pain and numbness in the left lateral arm and forearm related to prolonged computer use for about 7 months. Pain was rated 6/10 on the NRS scale. Physical examination showed reduced cervical rotation to the left by 40° and a myofascial trigger point without a referral pattern in the musculature around her cervical region. Joint play of the cervical facet joints revealed generalized restriction of motion of the lower cervical spine, especially prominent on the left. She had a positive Spurling test on the left side of the left lateral forearm and thumb and a positive cervical distraction test. Radiographs of her neck demonstrated reversed cervical lordosis, with no obvious bony degenerative changes. The working diagnosis of cervical radiculopathy of the left C6 nerve root was given based on her presentation.
Intervention and outcome: Chiropractic spinal adjustments (mainly diversified technique), motorized flexion-distraction with extension force on the cervical spine, and therapeutic exercises were performed. The patient's numbness was completely resolved by the 5th visit. The cervical range of motion (ROM) returned, and she was pain-free by the 8th visit. Reassessment in the 9th month demonstrated restoration of the cervical #lordosis and sustained treatment outcome.
Conclusion: Our patient demonstrated improvement in the cervical lordotic angle and upper limb numbness after treatment. Chiropractic care can play a role in managing patients with one or both of these conditions. The associated recovery of the cervical lordotic angle and #radiculopathy after #chiropractic care suggest a plausible biomechanical mechanism and a potential connection between the two conditions. Further research is needed to confirm the association or causality between these findings.

King Yi Leung, BClinChiro, Eric Chun-Pu Chu, MHA DC, PhD, Kristy Yau, DC, Siu Nam Gabriel Ng, BChiro, David Bellin, DC (2022) Resolution of Cervical Radiculopathic symptoms and Restoration of Cervical Lordosis in A 20 Year Old Female: A Case Report Journal of Contemporary Chiropractic 5: 246-250 October.

journal.parker.edu/index.php/jcc/article/view/240 #脊醫 ... See MoreSee Less

Learn More