Distance Management of Spinal Disorders During the COVID-19 Pandemic and Beyond: Evidence-Based Patient and Clinician Guides From the Global Spine Care Initiative.

BACKGROUND: The COVID-19 pandemic has greatly limited patients' access to care for spine-related symptoms and disorders. However, physical distancing between clinicians and patients with spine-related symptoms is not solely limited to restrictions imposed by pandemic-related lockdowns. In most low- and middle-income countries, as well as many underserved marginalized communities in high-income countries, there is little to no access to clinicians trained in evidence-based care for people experiencing spinal pain. OBJECTIVE: The aim of this study is to describe the development and present the components of evidence-based patient and clinician guides for the management of spinal disorders where in-person care is not available. METHODS: Ultimately, two sets of guides were developed (one for patients and one for clinicians) by extracting information from the published Global Spine Care Initiative (GSCI) papers. An international, interprofessional team of 29 participants from 10 countries on 4 continents participated. The team included practitioners in family medicine, neurology, physiatry, rheumatology, psychology, chiropractic, physical therapy, and yoga, as well as epidemiologists, research methodologists, and laypeople. The participants were invited to review, edit, and comment on the guides in an open iterative consensus process. RESULTS: The Patient Guide is a simple 2-step process. The first step describes the nature of the symptoms or concerns. The second step provides information that a patient can use when considering self-care, determining whether to contact a clinician, or considering seeking emergency care. The Clinician Guide is a 5-step process: (1) Obtain and document patient demographics, location of primary clinical symptoms, and psychosocial information. (2) Review the symptoms noted in the patient guide. (3) Determine the GSCI classification of the patient's spine-related complaints. (4) Ask additional questions to determine the GSCI subclassification of the symptom pattern. (5) Consider appropriate treatment interventions. CONCLUSIONS: The Patient and Clinician Guides are designed to be sufficiently clear to be useful to all patients and clinicians, irrespective of their location, education, professional qualifications, and experience. However, they are comprehensive enough to provide guidance on the management of all spine-related symptoms or disorders, including triage for serious and specific diseases. They are consistent with widely accepted evidence-based clinical practice guidelines. They also allow for adequate documentation and medical record keeping. These guides should be of value during periods of government-mandated physical or social distancing due to infectious diseases, such as during the COVID-19 pandemic. They should also be of value in underserved communities in high-, middle-, and low-income countries where there is a dearth of accessible trained spine care clinicians. These guides have the potential to reduce the overutilization of unnecessary and expensive interventions while empowering patients to self-manage uncomplicated spinal pain with the assistance of their clinician, either through direct in-person consultation or via telehealth communication.

Clinical management of an adult with erythema infectiosum: a retrospective case report.

OBJECTIVE: To review the epidemiology, etiology, diagnosis and typical management of erythema infectiosum and to illustrate the clinical management of an adult with erythema infectiosum. CLINICAL FEATURES: A 38-year-old male complaining of severe global pain, swelling, weakness and stiffness in his shoulders, elbows, knees, and fingers of seven weeks duration. INTERVENTION AND OUTCOME: The patient was treated with a combination of 1) pharmacological treatment of naprosyn, prednisone, methotrexate, hydroquinone and sulfasalazine, 2) conservative treatment consisting of spinal manipulation, peripheral joint mobilization, acupuncture and low-tech Qi Gong and Tai Chi exercises, and 3) an active physiotherapy program consisting of strengthening exercises, and stationary bike. The patient reported marked improvement in pain, mobility, strength, and function with the addition of conservative physical treatment. SUMMARY: Erythema infectiosum is associated with a wide spectrum of clinical manifestations, where arthropathy is the most common clinical manifestation in adults. Erythema infectiosum should be suspected as a potential differential diagnosis when a patient presents with red or purplish skin rashes, especially when accompanied by fever and joint pain. Conservative management could be considered as an adjunctive therapy option for this condition. However, further validation and research is warranted.

OBJECTIF: Examiner l'épidémiologie, l'étiologie, le diagnostic et la gestiontypique de l'érythème infectieux, et illustrer la gestion clinique d'un adulte présentant un érythème infectieux. CARACTÉRISTIQUES CLINIQUES: Un homme âgé de 38 ans, se plaignant d'une douleur intense, de tuméfaction, d'une faiblesse et d'une raideur intense dans les épaules, les coudes, les genoux et les doigts depuis sept semaines. INTERVENTION ET RÉSULTATS: Le patient a été traité avec l'association suivante: 1) traitement pharmacologique aux naprosyne, prednisone, méthotrexate, hydroquinone et sulfasalazine, 2) traitement conservateur consistant en une manipulation vertébrale, une mobilisation articulaire périphérique, en de l'acupuncture et des exercices de Qi Gong et Tai Chi à faible technologie, et 3) un programme de physiothérapie active comprenant la pratique d'exercices de renforcement et de vélo stationnaire. Avec l'ajout d'un traitement physique conservateur, le patient a rapporté une nette amélioration de la douleur, de sa mobilité, de sa force et de sa condition. RÉSUMÉ: L'érythème infectieux s'accompagne d'un large éventail de manifestations cliniques, l'arthropathie étant la plus courante chez l'adulte. L'érythème infectieux doit être considéré comme un diagnostic différentiel potentiel lorsqu'un patient présente des éruptions cutanées rouges ou violacées, surtout s'il est accompagné de fièvre et de douleurs articulaires. Un traitement conservateur pourrait être envisagé comme une option thérapeutique complémentaire pour cette affection. Toutefois, une validation et des recherches poussées s'imposent.

Atypical presentation of axillary web syndrome (AWS) in a male squash player: a case report.

Axillary Web Syndrome (AWS), also known as lymphatic cording, refers to a condition in which a rope-like soft-tissue density develops in the axilla. It usually appears in the 5 to 8 week period following breast cancer surgery and can lead to shoulder pain and restricted motion. We present a case of AWS in a male squash player with no history of breast cancer or surgery following a period of intense exercise. This case highlights the rare presentation of AWS in a male patient and raises awareness for the health care practitioner who may not suspect this condition in this population.

Le syndrome des cordelettes axillaires (AWS), également connu sous le nom de thromboses lymphatiques, se réfère à une condition dans laquelle des tissus mous denses comme une corde se forment dans la région de l'aisselle. Ceci apparaît généralement dans 5 à 8 semaines après une chirurgie du cancer du sein et peut entraîner des douleurs à l'épaule et limiter les mouvements. Nous présentons un cas d'AWS chez un joueur masculin de squash, sans antécédents de cancer du sein ou de chirurgie du sein, après une période intense d'exercice. Ce cas met en évidence la rare présentation de l'AWS chez un patient masculin et sert à sensibiliser le professionnel de la santé qui ne pourrait pas soupçonner cette condition chez cette population.

History of the Royal College of Chiropractic Sports Sciences (Canada): the early years.

In 1978 the Canadian Chiropractic Association recognized the need to establish an organization that would prepare chiropractors to treat athletic injuries and promote these services to sports organizations. Dr. Adrian Grice approached three chiropractors to establish such an organization. The Canadian Chiropractic Sports Academy (CCSA) was established in 1978. This was the start of the chiropractic sports movement which has seen chiropractors playing prominent roles as team doctors to professional and amateur teams and athletes and in the delivery of care at major national and international competitions. This paper will show the work done by the original founders of the CCSA which has helped to pave the way to the present level of acceptance of chiropractic sports injury management and performance enhancement and as the progenitor of the Royal College of Chiropractic Sports Sciences Canada.

En 1978, l'Association chiropratique canadienne a reconnu la nécessité de créer une organisation qui préparerait les chiropraticiens à traiter les blessures sportives et proposerait ces services à des organisations sportives. Le Dr Adrian Grice a approché trois chiropraticiens pour établir une telle organisation. Le Canadian Chiropractic Sports Academy (CCSA) a été créé en 1978. Ce fut le début du mouvement sportif en chiropratique qui a vu les rôles importants joués par les chiropraticiens en tant que médecins d'équipe auprès d'équipes et d'athlètes professionnels et amateurs, et dans la prestation de soins pendant les principaux événements sportifs nationaux et internationaux. Cet article présente le travail effectué par les fondateurs initiaux du CCSA qui a contribué à ouvrir la voie au niveau actuel d'acceptation de la gestion des blessures sportives en chiropratique et l'amélioration des performances et, comme le prédécesseur du Collège royal des sciences du sport chiropratique (Canada).

Chronic recurrent multifocal osteomyelitis in a 13 year old female athlete: a case report.

Chronic recurrent mutlifocal osteomyelitis (CRMO) is an extremely rare skeletal disorder in the younger population. It presents with multifocal bony lesions that often mimic more sinister diagnoses such as infection or neoplasm. The cause of this condition remains unknown and there is limited evidence on effective treatments. In this case, a 13-year-old female athlete presented to a sports chiropractic clinic with non-traumatic onset of right ankle pain. After failed conservative management, radiographs and MRI were obtained exhibiting a bony lesion of the distal tibia resembling osteomyelitis. The patient was non-responsive to antibiotics, which lead to the diagnosis of CRMO. CRMO should be considered as a differential diagnosis for chronic bone pain with affinity for the long bones of the lower extremity in children and adolescents. The role of the primary clinician in cases of CRMO is primarily that of recognition and referral for further diagnostic investigations.

L'ostéomyélite multifocale chronique récurrente (OMCR) est une maladie du squelette extrêmement rare qui touche les jeunes. Elle présente des lésions osseuses multifocales qui imitent souvent des diagnostics plus sinistres tels qu'une infection ou une tumeur. La cause de cette maladie reste inconnue et il y a peu de preuves sur les traitements efficaces. Dans ce cas, une athlète de 13 ans s'est présentée à une clinique chiropratique sportive avec l'apparition non traumatique de douleurs à la cheville droite. Après l'échec des traitements conservateurs, les radiographies et l'IRM ont montré une lésion osseuse du tibia distal ressemblant à une ostéomyélite. Comme les antibiotiques n'agissaient pas sur la patiente, on en conclut qu'elle souffrait d'une OMCR. L'OMCR doit être considérée comme un diagnostic différentiel des douleurs osseuses chroniques, surtout des os longs des membres inférieurs chez les enfants et les adolescents. Le rôle du médecin traitant en cas d'OMCR est de la reconnaître surtout et de renvoyer le patient pour des tests diagnostics avancés.