Case History:
89 yo male with pain, stiffness and tightness in his cervical and upper thoracic spine
Contributed By:
Paul Sherman, DC
Case Presentation: Page 7 of 7 Due to the findings of anterior displacement of C1, it would be appropriate to refer this patient for consultation to a rheumatologist and neurosurgeon. In this particular case, the patient refused to consult with these specialists and his refusal was specifically documented in his medical record.

It should be noted, this patient was 89 years of age and his radiographic findings were all of long standing. Most likely, both of these reasons would preclude any neurosurgical stabilization of C1 to even be considered. His refusal to consult a neurosurgeon and/or rheumatologist, along with his insistance on receiving chiropractic care, was also documented in his medical records. As an alternative conservative chiropractic care was recommended. It should be noted, because of significant degenerative changes in this patient?s cervical spine from his diagnosis of DISH as well as anterior displacement of C1 from his diagnosis of RA, all chiropractic manipulation would be contraindicated for this patient?s cervical spine. Gentle techniques like soft tissue manipulation, trigger point therapy, light stretching, electromuscle stimulation, ultrasound and hydrocollator therapy could be of clinical benefit in ameliorating this patient?s pain, tightness and stiffness in his cervical and upper thoracic spine. In addition, mild non-strenuous exercises can be given this patient in order to help strengthen and stabilize his cervical and upper thoracic spine.

Reference: Yochum and Rowe, Essential of Skeletal Radiology, 2nd Edition, Williams and Wilkins 1996.

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