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The patient described an inability to find a comfortable position for his neck, and rated his pain at 7/10 on the VAS that was constant. Slight pain relief was achieved by taking two Tylenol 3s and pressing his occiput against the edge of the bed. There was an immediate reaction including sweating and dizziness, lasting five minutes. The pain began early that morning when the patient sat up in bed from a supine position, turned to step out and heard what he described as a “crunch-like” sound. He came to the clinic wearing a soft cervical collar. The second is to remind clinicians to rely on all of their assessment tools, including radiographic imaging, if orthopaedic tests are of limited value.Ī 61-year-old retired male presented to a chiropractic clinic in the mid-morning, complaining of dull, achy cervicothoracic discomfort in the left upper scapular area.
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The first is to highlight the need to be vigilant in recognizing and responding to subtle signs and symptoms of disease processes. The objective of this case report is two-fold. If there is any indication for further work-up, such as blood work or advanced imaging, inter-professional collaboration with other health care professionals is crucial. For chiropractors, radiological plain film imaging is used to assess bone health and to screen for underlying pathology. When the physical exam does not confirm the suspected diagnosis, further investigation is required. Specific historical considerations should include the patient’s history, the report of the present complaint, and additional work-up such as imaging and blood work. A physical exam that follows an adequate history is usually confirmatory rather than exploratory. The history accounts for 82% of the diagnosis, with the physical exam used to help verify the anticipated diagnosis. It is well documented that in chronic conditions patient self-reporting is accurate, as care is a habitual part of their daily lives. (4) poor success with comparable treatments. (3) a poor response to conservative care including a lack of pain relief with prescribed bed rest, or (2) pain that is worsened at night or not relieved by any position, (1) pain that is worse during rest versus activity, The presence of serious pathology includes, but is not limited to: This includes the mechanism of injury, temporal onset, aggravating and relieving factors, and psychosocial influences. In order to elicit an appropriate diagnosis, chiropractors rely heavily on the history the patient provides.
#BURST FRACTURE MANUAL#
KEYWORDS: burst fracture chiropractic red flagsĬhiropractors are manual therapists trained in the diagnosis and treatment of musculoskeletal conditions.
![burst fracture burst fracture](https://ars.els-cdn.com/content/image/1-s2.0-S0001457513002224-gr1.jpg)
This identified a pathological burst fracture in the C4 vertebrae. Pain with traction and the sudden onset of symptoms prompted further investigation with plain film imaging of the cervical spine. SUMMARY: The patient's initial physical examination was largely unremarkable, with an absence of clinical red flags.
![burst fracture burst fracture](https://www.researchgate.net/profile/Alain-Akiki/publication/233806902/figure/fig2/AS:213780094033924@1427980554588/CT-Scan-confirming-the-burst-fracture-of-T12.png)
No medical intervention was performed on the fracture. INTERVENTION & OUTCOMES: The patient was sent by ambulance to the hospital where he was diagnosed with multiple myeloma. After a physical exam that was relatively unremarkable, imaging identified a burst fracture in the cervical spine. OBJECTIVE: To report on a case of a pathological burst fracture in the cervical spine where typical core red flag tests failed to identify a significant lesion, and to remind chiropractors to be vigilant in the recognition of subtle signs and symptoms of disease processes.ĬLINICAL FEATURES: A 61-year-old man presented to a chiropractic clinic with neck pain that began earlier that morning. Jocelyn Cox, DC, Chris DeGraauw, DC FRCCSS(C), andĭepartment of Graduate Education and Research Program, Send all comments or additions to: Can Chiropr Assoc. Pathological Burst Fracture in the Cervical Spine PATHOLOGICAL BURST FRACTURE IN THE CERVICAL SPINE WITH NEGATIVE RED FLAGS: A CASE REPORT