A Patient With Pancoast Tumor Presenting With Cervical Radiculopathy: A Case Report.

Objective: The purpose of this report was to describe a patient with a Pancoast tumor who presented for chiropractic care with neck and arm pain. Clinical Features: A 52-year-old male patient with right-sided cervicothoracic pain and numbness in the right upper extremity presented to a chiropractic office for care. The patient reported an occupational history of repetitive lifting motions and overuse injuries. The patient denied history of smoking at the time of presentation. Intervention and Outcome: Radiographic imaging revealed tracheal deviation. A chest computed tomography image demonstrated a large lesion in the apex of the right lung, suggestive of bronchogenic carcinoma. The patient was referred to an oncology clinic, where he admitted to having a 20-year history of smoking. The diagnosis of adenocarcinoma was made via biopsy, and the oncologist's evaluation confirmed the cancer to be stage IIIC. The patient received palliative care treatments, as the advanced state of his condition determined that he was not a candidate for surgical intervention. Conclusion: Chiropractors and other first-contact health care providers must keep in mind unusual presentations masquerading as common conditions. This case demonstrates the importance of including apical lung tumors in the differential diagnosis of unilateral arm and neck pain and neurologic deficits of the upper extremity. This case demonstrates the importance of thorough follow-up on images ordered, including the ordering clinicians viewing the images themselves.

Conservative management of neck and thoracic pain in an adult with neurofibromatosis-1.

OBJECTIVE: To describe the case of a 21-year-old female with previously diagnosed neurofibromatosis type 1 (NF1) with neck, scapular, lumbar, and temporomandibular discomfort along with headaches. CLINICAL FEATURES: The patient had chronic tightness and pain in the cervicothoracic region as well as pain in the lumbar spine at the site of prior neurofibroma removal. Radiographs demonstrated multilevel osseous changes. In addition to NF-1, she was diagnosed with cervical myalgia, tension-type headaches, and chronic temporomandibular joint disorder. INTERVENTION AND OUTCOMES: Treatment consisted of a course of manual therapy including cervical flexiondistraction, myofascial release, patient education on workplace ergonomics, and an at-home active care plan. The patient experienced a reduction in pain and headache frequency. SUMMARY: Manual therapy in the form of cervical flexion-distraction with myofascial release and education on workplace ergonomics were effective in reducing neck and thoracic pain as well as reducing headache frequency in a 21-year-old with NF-1.

OBJECTIF: Présenter le cas d'une jeune femme de 21 ans atteinte de neurofibromatose de type 1 (NF1) et ressentant une gêne au cou, aux épaules, à la région lombaire, à l'articulation temporomandibulaire et souffrant de maux de tête. CARACTÉRISTIQUES CLINIQUES: La patiente se plaignait de raideurs chroniques et de douleurs à la région cervicothoracique et à la colonne lombaire au point d'ablation d'un neurofibrome. Les clichés radiographiques montraient des altérations osseuses à plusieurs étages. En plus d'être atteinte de NF1, la patiente avait des myalgies cervicales, des céphalées de tension et un trouble chronique de l'articulation temporomandibulaire. INTERVENTION ET RÉSULTATS: On a opté pour une thérapie manuelle consistant en une décompression discale en flexion-distraction, un relâchement myofascial, l'information sur l'ergonomie du poste de travail et un plan de soins actifs à domicile. Les douleurs et la fréquence des maux de tête de la patiente ont diminué. RÉSUMÉ: La thérapie manuelle sous forme de décompression en flexion-distraction, le relâchement mysofascial et l'information sur les postes de travail ergonomiques ont permis de réduire les douleurs cervicales et thoraciques et la fréquence des maux de tête chez une jeune femme de 21 ans atteinte de NF1.

Post-infectious ankylosis of the cervical spine in an army veteran: a case report.

Background: Vertebral osteomyelitis is a rare, life-threatening condition. Successful management is dependent on prompt diagnosis and management with intravenous antibiotic therapy or surgery in addition to antibiotics. Reoccurrence is minimal after 1 year. However, very little is reported in the conservative spine literature regarding the long-term follow-up and the changes to the spine following management of the spinal infection. We report the dramatic radiologic findings of the long-term sequela of a cervical spine infection following a gunshot wound from 1969. Most impressive to the spine specialist is this patient's ability to return to work despite significant alterations to spinal biomechanics. Case presentation: A 69 year-old caucasian male presented to the chiropractic clinic at a Veterans Affairs Medical Center with complaint of chronic left shoulder pain secondary to an associated full thickness tear of the left infraspinatus. An associated regional assessment of the cervical spine ensued. Radiological imaging on file revealed ankylosis C2/C3 to C7/T1. The patient reported a history of multiple fragment wounds in 1969 to the left anterior neck and shoulder 45 years earlier. Osteomyelitis of the cervical spine resulted from the wounds. Conclusion: Potential sequela of osteomyelitis is ankylosis of affected joints. In this particular case, imaging provides evidence of regional ankylosis of the cervical spine. Considering the patient did not complain of cervical pain or related symptoms apart from lack of cervical range of motion, and his Neck Disability Index score was 2 out of 50 (4%), no intervention was provided to the cervical spine. The patient reported he self-managed well, worked full-time as a postal worker after he was discharged due to the injury to his neck, and planned to retire in less than one month at age 70. The patient demonstrates successful return to work with pending retirement at age 70 following spondylodiscitis and subsequent ankylosis of the cervical region.