Remission of Dowager's hump by manipulative correction of spinal alignment: a case report.

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.

Scoliosis Causing Cervical Dystonia in a Chiropractic Office.

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.

Spinal Metastasis Causing Dropped Head Syndrome in the Chiropractic Office: A Case Report.

Dropped head syndrome is a rare disorder involving an inability to hold the head upright. It may be caused by a variety of neuromuscular disorders and occasionally by pathological vertebral fractures. A 79-year-old man presented to a chiropractor with a two-year history of gradual-onset chin-on-chest posture and increased thoracic kyphosis, which had failed to respond to physical therapy. The chiropractor ordered whole spine computed tomography which revealed extensive mixed lytic and sclerotic changes and multiple thoracic compression fractures suggestive of metastasis. The chiropractor promptly referred the patient to an oncologist, who performed a biopsy confirming prostate adenocarcinoma. The patient's health deteriorated, and he expired three weeks later. This case highlights that chiropractors should be aware that patients may present to their office with symptoms related to undiagnosed cancer, such as spinal deformity and dropped head syndrome. Chiropractors should order advanced imaging when patients have red flag signs or symptoms (e.g., older age, progressive symptoms despite care) and refer to an oncologist when clinical features or testing are suggestive of metastasis.