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Changes in Pressure Pain Thresholds Over C5-C6 Zygapophyseal Joint After a Cervicothoracic Junction Manipulation in Healthy Subjects
César Fernández-de-las-Peñas, PT, PhD, Cristina Alonso-Blanco, PT, Joshua A. Cleland, PT, PhD, Cleofás Rodríguez-Blanco, PT, DO, Francisco Alburquerque-Sendí, PT, DO
Objective: This study examines if C7-T1 manipulation results in changes in pressure pain thresholds (PPT) over bilateral C5-C6 zygapophyseal joints in asymptomatic subjects.
Methods: Thirty subjects, 13 men and 17 women, without a current history of neck, shoulder or upper extremity pain participated. Participants were randomly divided into three groups: an experimental dominant group, consisting of subjects who received the manipulative thrust directed at the right side of the C7-T1 joint; an experimental nondominant group, consisting of subjects who received the thrust on the left side of the C7-T1 joint; and a placebo group, members of which received a sham-manual procedure. The outcome measure was the PPT on both right and left C5-C5 zygapophyseal joints, assessed at preintervention and 5 minutes postintervention by an assessor blinded to the treatment allocation of the subject. A three-way repeated measures analysis of covariance was used to evaluate changes in PPT.
Results: The analysis of covariance revealed time × group (F = 32.3; P < .001), time × side (F = 4.9; P < .05), time × sex (F = 7.93; P < .01), and time × group × sex (F = 7.606; P < .001) interactions. Post hoc analyses found that (a) both experimental groups showed greater improvements in PPT than the placebo group (P < .05), without significant differences between them (P > .6); (b) the right side had greater increases in PPT in both experimental groups (P < .05), but not within the placebo group (P > .8); and (c) men experienced greater increases in PPT levels than women, particularly in the experimental nondominant group (P < .01). Within-group effect sizes were large for both experimental groups (d > 1), but small for the placebo condition (d < 0.2).
Conclusions: These results suggest a C7-T1 manipulation induced changes in PPT in both right and left C5-C6 zygapophyseal joints in healthy subjects.
Muscular Tenderness in the Anterior Chest Wall in Patients With Stable Angina Pectoris is Associated With Normal Myocardial Perfusion
Preman Kumarathurai, MD, Mohammed Kashaf Farooq, MD, Henrik Wulff Christensen, MD, DC, PhD, Werner Vach, PhD, Poul F. Høilund-Carlsen, MD, DMSc
Objective: This study examines the relationship between the existence of chest wall tenderness evoked by palpation and the absence of ischemic heart disease defined by myocardial perfusion imaging in patients with known or suspected stable angina pectoris.
Methods: Two hundred seventy-five patients were recruited. Myocardial perfusion imaging was performed on 273 of the subjects. Chest pain was classified according to type by criteria given by the Danish Society of Cardiology and severity by the Canadian Cardiovascular Society. The pectoralis major and pectoralis minor were palpated for tenderness using a standardized procedure.
Results: The association between tenderness and myocardial perfusion imaging (normal vs. abnormal) produced an odds ratio (OR) of 2.24 (confidence interval, 1.26-3.99; P = .009). The OR was the same magnitude and significance when stratified by sex, age, type of pain or class. When adjusting simultaneously for sex, age, type of pain and class, the association between tenderness and myocardial perfusion imaging (normal vs. abnormal) was still present (OR = 2.57; confidence interval, 1.342-4.902; P = .004).
Conclusion: Presence of tenderness in the anterior chest wall is associated with a higher prevalence of normal myocardial perfusion imaging in patients with known or suspected angina pectoris, and this association cannot be explained by a common association to age, sex or pain.
Reliability of Isometric Muscle Endurance Tests in Subjects With Postural Neck Pain
Stephen J. Edmondston, PhD, Magnus E. Wallumrød, MManipTher, Fiachra MacLéid, MManipTher, Lars S. Kvamme, MManipTher, Sandra Joebges, MManipTher, Glen C. Brabham, BSc
Objective: The purpose of this study was to determine the reliability of three isometric muscle endurance tests in subjects with postural neck pain.
Methods: Twenty-one subjects with chronic postural neck pain performed three submaximal muscle tests twice on the first occasion and once at the second session three days later. The tests examined isometric neck flexion, neck extension, and scapular muscle endurance.
Results: Reliability was excellent for the neck flexor test (intraclass correlation coefficient [ICC] = 0 93), moderate for the scapular test (ICC = 0.67) and good for the neck extensor test (ICC = 0 88). The standard error of measure for the tests was 6.4, 10.9 and 25.9 seconds, respectively. The minimum change required to represent real change in muscle endurance was 17.8 seconds for the neck flexor test, 30.1 seconds for the scapular test and 71.3 seconds for the neck extensor test.
Conclusion: This study showed the reliability of three cervical spine and shoulder girdle submaximal muscle endurance tests in patients with postural neck pain.
Foraminal Stenosis With Radiculopathy From a Cervical Disc Herniation in a 33-Year-Old Man Treated With Flexion-Distraction Decompression Manipulation
Sharina Gudavalli, DC, Ralph A. Kruse, DC
Objective: The purpose of this report was to describe the use of Cox flexion-distraction decompression manipulation on a patient with radiculopathy from a C6/C7 disc herniation.
Clinical Features: A 33-year-old man complained of severe neck pain and spasms, pain radiating down his left arm and upper back, and associated numbness in his fingers. Cervical spine plain-film radiographs showed mild C6/C7 osseous degenerative changes. Cervical magnetic resonance imaging revealed a moderate-sized left posterolateral disc herniation at C6/C7 causing severe foraminal stenosis.
Intervention and Outcome: Treatment consisted of Cox flexion-distraction decompression manipulation and adjunctive physiotherapy modalities. The patient was treated a total of 15 times over a period of 10 weeks. Subjective findings using a pain scale and objective examination findings supported a good clinical outcome. At two-year follow-up, subjective and objective findings remained stable.
Conclusion: This study reports Cox flexion-distraction decompression manipulation and physiotherapy modalities showed good subjective and objective clinical outcomes for this patient.
Glenoid Hypoplasia: A Report of Two Patients
Christopher J. Lynch, BS, John A.M. Taylor, DC, Dale J. Buchberger, MS, PT, DC
Objective: This article discusses the imaging findings, clinical findings and conservative chiropractic management of two patients with glenoid hypoplasia.
Clinical Features: Conventional radiographs of both patients revealed a hypoplastic glenoid bilaterally. Notch-like defects along with signs of degenerative disease were evident within the lower portion of the glenoid rims bilaterally in one patient and in the left glenoid rim of the other patient. Magnetic resonance imaging revealed a degenerative cyst or cortical defect in one patient along the anterior humeral head. The second patient showed a small, slightly lobulated cystic region just posterior to the glenoid rim, consistent with the appearance of a synovial or ganglion cyst. Computed tomography with three-dimensional reconstruction in one patient confirmed the presence of large posterior and superior osteophytes arising from the significantly hypoplastic glenoid. These images also revealed a slight posterior subluxation of the humeral head, widening of the anterior glenohumeral joint space and retroversion of the glenoid.
Intervention and Outcome: Treatment consisted of manual joint manipulation, soft-tissue therapies and therapeutic exercise for both patients. Both patients experienced improvements in symptoms, function and physical examination findings.
Conclusions: Glenoid hypoplasia is a developmental anomaly of the scapular neck that is predominantly bilateral and symmetric. Cross-sectional imaging studies should be considered in patients with symptoms that fail to improve over time. Conservative chiropractic care may be effective in managing symptoms in patients with glenoid hypoplasia.
Treatment of Paroxysmal Supraventricular Tachycardia Using Instrument-Assisted Manipulation of the Fourth Rib: A Six-Year Case Study
Mary Rose Julian, MSEd, DC
Objective: The purpose of this case report was to describe the observation of the manipulation of the fourth rib followed by the reproducible, rapid return of heart rate to normal in a patient with paroxysmal supraventricular tachycardia.
Clinical Features: A male patient had paroxysmal supraventricular tachycardia. He was evaluated using standard methods of palpation. He was followed over a six-year period.
Intervention and Outcome: The patient was treated during episodes of supraventricular tachycardia (SVT) with instrument-assisted manipulation of the fourth rib without treatment of any other segments. Tachycardia was eliminated after rib manipulation within less than two minutes. Over a six-year period, effective control of episodes of SVT was consistently achieved associated with manipulation of the fourth rib.
Conclusions: This case study is suggestive of a relationship between SVT and misalignment of the fourth rib. Controlled studies are necessary to validate this observation.
