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Presenting Complaint:
Neck pain and occasional headaches. The neck pain was intermittent and aching in
nature. This began over the last 10-15 years. Since this time, he had adjustments
every week at least twice a week by a chiropractor in Tasmania. Now in Sydney, he
wants to have an adjustment which involves a position of rotation and then a strong
twist into further rotation and traction. The patient was insistent that the adjustment
be performed.
Physical Examination
Palpation: Hypermobility throughout the cervical spine. There was marked
hypertonicity throughout the cervical spine and shoulders bilaterally. There was
normal neurology, orthopaedic tests and physical examination findings.
1) What is the likely diagnosis? Give reasons for your answer.
Hypermobility
a condition of generalized ligamentous laxity affecting both spinal and
peripheral joints.
Early Spinal Instability:
a functional condition in which excessive, abnormal segmental motion
and positive instability tests with no neurological deficits. Deformation
under load exceeds the capacity for the tissues to recover. There may
be early signs of incipient disc degeneration that occurs before classic
disc involvement.
2) Does this sort of adjustment described have dangers? Please explain the
mechanisms involved.
Deformation under load exceeds the capacity for the tissues to recover. There
may be early signs of incipient disc degeneration that occurs before classic disc
involvement. Symptomatic instability may be induced by a single severe
combined compression and torsion force. It is usually brought about by repeated
torsional injury and gradual loss of nuclear integrity. Adjustments at end range
may increase torsional strain of the 3 joint complex and would be not be advised
unless necessary.
Week 5 CASE STUDY 5 CHIR13009
Presenting Complaint:
Alison presents to you with recurrent headaches. She has suffered from various
types of headaches since adolescence. She admits that stress appears to bring the
headaches on, and that they are sometimes accompanied by feelings of dizziness
and nausea.
Previous investigations over the years never revealed any pathology, and she was
regularly reassured by her medical practitioner that ‘they were nothing to worry
about’.
Any trauma, location and intensity of HA, any triggers, questions around
eating,what kinds of foods, any red flag questions, signs and symptoms
of flu, medications ,drugs, eyeglasses.
2. Using ONLY the information in the above case history, give 3 likely differential
diagnoses for;
Her headaches-
GERD or ulcer. Back pain after eating is likely caused by referred pain. Pay
attention to other symptoms that may help your doctor diagnose your
condition. These most commonly occur in the stomach or oesophagus.
This open sore will often be irritated by spicy food, sugary foods, alcohol
or stress, and will also cause stomach pain that is often described as a
gnawing or burning pain.
If your back pain is caused by GERD or ulcers, you may need to make lifestyle
adjustments. Those can include changes to your diet, reducing your weight,
exercise, or medications.
Posture
Slouching, bending over your food or bringing your mouth to the fork rather
than the other way around can all contribute to digestive issues and back pain.
If you eat at a desk or on the couch with your body hunched over, this will also
cause problems.
Explain your answer in each case.
3. What do you need to examine?
Physical Examination.
Alison is tall and slightly overweight and walks with slightly hunched shoulders.
Vitals: Pulse rate/min = 62, Respiratory rate/min =10, Blood pressure/mm Hg =
150/95,
Height (cm) = 175, Weight (kg) = 85, BMI 27.7, Temperature (degrees) = 36.1
Her neck ROM is limited to left rotation by about 35% with minimal pain. Cervical
extension is uncomfortable at the extreme of range limited by 50%. Orthopaedic,
UMN and LMN tests are negative.
Interscapular region: tightness of rhomboids and trapezius.
Abdomen: Soft, non-tender, no masses.
4. Using ONLY the information above do you think Alison is suffering from:
1 Cervicogenic headaches
2 Classic migraine
3 Cluster headaches
4 Common Migraine
5 Subdural hematoma
(6 Not likely or more likely)
Posture
Possibly because of slouching as in the exam Alison has rounded shoulders
but this may also be due to her having osteoporosis at this age either way
bending over your food or bringing your mouth to the fork rather than the other
way around can all contribute to digestive issues and back pain. If you eat at a
desk or on the couch with your body hunched over, this will also cause
problems.
6. Do you think it was necessary to take vital signs? Are the vital signs
normal/abnormal?
An ulcer. These most commonly occur in the stomach or oesophagus. This open sore
will often be irritated by spicy food, sugary foods, alcohol or stress, and will also cause
stomach pain that is often described as a gnawing or burning pain.
Pancreatitis. This is when the pancreas, an organ that sits just behind the
stomach, becomes inflamed. This causes stomach pain that can extend into the
back and left shoulder blade. You may also experience nausea and indigestion.
This condition can be acute or chronic and requires urgent medical attention.
General Questions
1. Give the 2 categories for headaches and give examples for each.
Wine, cheese, alcohol, bright lights, noise levels, smoking, cured meats,
chocolate, oranges and the list goes on
Types of Headaches
Write an illness script for each headache including those demonstrated in the
diagram below.
Week 5 CASE STUDY 5 CHIR13009
https://www.youtube.com/watch?v=3mF1hvIAcoo