今日資訊

Osteochondromas are benign bone tumors that occur only rarely in the scapula. We report a case of an eight-year-old boy with dorsal scapular osteochondroma that initially presented as middle back pain, scoliosis, and a winged scapula. Unlike in most reported cases, the patient did not report severe pain. The chiropractor reviewed his previous radiograph and ordered a computed tomography scan, which revealed a bony mass on the dorsal aspect of the left scapula consistent with an osteochondroma. Given the patient’s age and lack of symptoms, a conservative chiropractic treatment plan, focusing on posture, flexibility, and close monitoring, was adopted. Scapular mobilization, spinal adjustment, and a tailored exercise program provided symptomatic relief from scoliosis and improved mobility. Follow-up evaluations revealed further enlargement of the osteochondroma without accompanying symptoms. This study highlights the importance of considering a broad range of differential diagnoses in pediatric patients with atypical or unclear presentations. This study also demonstrates the potential benefits of conservative chiropractic management in patients with osteochondroma-induced musculoskeletal issues.

We report the case of a 52-year-old Asian man presenting with severe lower back pain and bilateral radiculopathy due to acute L3/L4 disc extrusion, causing severe spinal canal stenosis and bilateral L4 nerve root compression. Following a ten-week conservative management plan consisting of high-velocity, low-amplitude spinal manipulation, adjunctive therapies, and home exercise, the patient experienced significant pain relief, functional improvement, and near resolution of deficits. A six-month follow-up MRI revealed the resolution of the L3/L4 disc extrusion, and the patient remained asymptomatic at nine months. This case highlights the potential for spontaneous resorption of a lumbar disc herniation and symptomatic improvement with conservative management, including chiropractic treatment. A favorable natural course of a disc herniation should be considered when deciding between early surgical intervention and conservative management, warranting further prospective studies to evaluate the effectiveness of chiropractic treatment and the role of spontaneous regression in symptomatic lumbar disc herniation.

Objective

This cross-sectional survey aimed to investigate the utilization, challenges, and attitudes of chiropractors in Hong Kong towards laboratory testing and radiological imaging.

Method

An online survey was conducted between May 1, 2023, and June 1, 2023. The target population for the survey was registered chiropractors in Hong Kong, which has a total of 325 practitioners. A total of 151 chiropractors participated in the survey, resulting in a response rate of 46.5%. The respondents provided information on their demographics, years of experience, practice settings, awareness of their right to request diagnostic tests, utilization of laboratory testing and imaging, and attitudes towards evidence-based practice. The survey data were analyzed using descriptive statistics.

Result

The survey findings revealed that a significant proportion of chiropractors in Hong Kong utilized laboratory testing and radiological imaging in their practice. Most respondents reported using laboratory testing to diagnose medical conditions and monitor existing conditions. Imaging is commonly used for diagnosing medical conditions and monitoring disease progression. However, a notable proportion of chiropractors reported facing rejection of their tests and imaging requests, which limited their ability to provide optimal care to their patients. The identified challenges included high rejection rates for specific imaging requests, leading to patient frustration, increased costs, and delayed diagnosis. Nevertheless, chiropractors in Hong Kong showed a strong belief in evidence-based practice and demonstrated a willingness to search for literature and incorporate it into their daily practice.

By addressing this issue, our aim was to gain valuable insights into the status of laboratory testing and radiological imaging among chiropractors in Hong Kong. The findings of this study underscore the necessity for collaborative efforts among chiropractors, healthcare professionals, healthcare facilities, policymakers, and insurance companies to effectively address the challenges identified and improve patient care outcomes. Specifically, enhancing access to diagnostic tests and working towards reducing rejection rates will play a pivotal role in supporting chiropractors’ role as primary healthcare providers in Hong Kong.

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.

Syringomyelia is a neurological condition characterized by the presence of fluid-filled cavities within the spinal cord, resulting in progressive neurological deficits. Secondary holocord syringomyelia, a rare manifestation in the entire spinal cord, is associated with spinal hemangioblastomas. We report the case of a 29-year-old female who presented with neck and bilateral upper limb pain and numbness. She was diagnosed with secondary holocord syringomyelia associated with a spinal hemangioblastoma and underwent conservative management. Magnetic resonance imaging plays a critical role in diagnosing neurological conditions. The management of spinal hemangioblastomas and syringomyelia can be challenging and requires a multidisciplinary approach to patient care. In this report, we discuss the clinical presentation, diagnosis, and management of a patient with secondary holocord syringomyelia associated with spinal hemangioblastoma.

Cases of lumbar and gluteal pain are commonly encountered in chiropractic clinics, with a broad differential diagnosis primarily centered on musculoskeletal conditions. This report presents the second documented case of sacral chordoma diagnosed at a chiropractic clinic and emphasizes the importance of considering alternative diagnoses and interdisciplinary collaboration in patient care. A 42-year-old man presented to a chiropractic clinic with complaints of lumbar and gluteal pain. The initial conservative management based on a presumptive musculoskeletal diagnosis was ineffective. Suspicion of an alternative etiology prompted a referral for imaging, which revealed a sacral chordoma. An interdisciplinary collaboration involving orthopedic surgeons, oncologists, radiologists, and other healthcare professionals was initiated to optimize the treatment outcomes of this rare and aggressive tumor. This case report underscores the importance of maintaining a high index of suspicion in cases of musculoskeletal presentations in chiropractic clinics and the critical role of advanced imaging in establishing a definitive diagnosis. Interdisciplinary collaboration is essential for managing complex conditions such as sacral chordomas, ensuring the delivery of the highest quality of care, and optimizing patient outcomes. Chiropractors play a crucial role in identifying, referring, and contributing to the management of patients with complex presentations as part of a comprehensive multidisciplinary treatment plan.