tag:typepad.com,2003:weblog-1250480 %ISSUE_DATE%T09:25:32-07:00 Explainers and tips on the use of vital diagnostic tools. TypePad tag:mpamedia.com,2008:post-56337 2013-02-01T12:00:32-07:00 2013-02-01T12:00:07-07:00

Retropharyngeal calcific tendinitis, also termed calcific tendinitis of the longus colli muscle, is often unrecognized or misdiagnosed because of its relatively rare occurrence. It was initially described in 1964 by Hartley. Ring, et al., determined the disorder was due to calcium hydroxyapatite deposition in the longus colli muscle.

By Deborah Pate, DC, DACBR Retropharyngeal calcific tendinitis, also termed calcific tendinitis of the longus colli muscle, is often unrecognized or misdiagnosed because of its relatively rare occurrence. It was initially described in 1964 by Hartley. Ring, et al., determined the disorder was due to calcium hydroxyapatite deposition in the longus colli muscle. tag:mpamedia.com,2008:post-56300 2013-01-01T12:00:32-07:00 2013-01-01T12:00:07-07:00

The first metatarsophalangeal joint includes four bones. The most readily apparent portion of the joint is the articulation between the concave-shaped base of the proximal phalanx and the convex, rounded head of the first metatarsal. The plantar surface includes the two sesamoid bones (fibular or lateral and tibial or medial) and the joint capsule. The joint capsule is reinforced on its plantar aspect by both a fibrocartilagenous plate and the plantar accessory ligament. The flexor hallucis longus and flexor hallucis brevis attach on the plantar aspect, along with the abductor hallucis muscle and the adductor hallucis muscle. The hallux MTP sesamoids are embedded in the tendons of flexor hallucis brevis.

By Deborah Pate, DC, DACBR The first metatarsophalangeal joint includes four bones. The most readily apparent portion of the joint is the articulation between the concave-shaped base of the proximal phalanx and the convex, rounded head of the first metatarsal. The plantar surface includes the two sesamoid bones (fibular or lateral and tibial or medial) and the joint capsule. The joint capsule is reinforced on its plantar aspect by both a fibrocartilagenous plate and the plantar accessory ligament. The flexor hallucis longus and flexor hallucis brevis attach on the plantar aspect, along with the abductor hallucis muscle and the adductor hallucis muscle. The hallux MTP sesamoids are embedded in the tendons of flexor hallucis brevis. tag:mpamedia.com,2008:post-56216 2012-11-18T12:00:32-07:00 2012-11-18T12:00:07-07:00

The use of computed tomography (CT) is increasing exponentially. Providers and patients are not well-informed about the relative latent cancer risks associated with repetitive exposure to ionizing radiation. Conservative estimates indicate that more than 60 million CT examinations are performed annually in the U.S.

By Deborah Pate, DC, DACBR The use of computed tomography (CT) is increasing exponentially. Providers and patients are not well-informed about the relative latent cancer risks associated with repetitive exposure to ionizing radiation. Conservative estimates indicate that more than 60 million CT examinations are performed annually in the U.S. tag:mpamedia.com,2008:post-56132 2012-09-23T12:00:32-07:00 2012-09-23T12:00:07-07:00

The lateral thoracic view can be challenging because to visualize the cervicothoracic junction often requires an additional view. In fact, I find that this cervicothoracic junction is perhaps the most difficult area to demonstrate on plain films. The choice we are given is the swimmer's view, which is one of those projections that just seems to require a bit of luck. We all have our own technical tricks that we swear by, but my experience is that sometimes we get lucky and the patient has more flexibility than we expect; other times, it doesn't really matter what you do to position the patient – it just isn't going work out right.

By Deborah Pate, DC, DACBR The lateral thoracic view can be challenging because to visualize the cervicothoracic junction often requires an additional view. In fact, I find that this cervicothoracic junction is perhaps the most difficult area to demonstrate on plain films. The choice we are given is the swimmer's view, which is one of those projections that just seems to require a bit of luck. We all have our own technical tricks that we swear by, but my experience is that sometimes we get lucky and the patient has more flexibility than we expect; other times, it doesn't really matter what you do to position the patient – it just isn't going work out right. tag:mpamedia.com,2008:post-56031 2012-07-29T12:00:32-07:00 2012-07-29T12:00:07-07:00

When I first studied radiology in chiropractic college, a mnemonic for reading skeletal radiographs was offered to assist students in establishing an orderly method for reading film. The mnemonic ABC'S represents Alignment, Bone, Cartilage and Soft tissues. I found the mnemonic very useful; I used it in college and during my first few years of practice. It definitely helped me remember to look at each of these diagnostic factors methodically.

By K. Jeffrey Miller, DC, DABCO When I first studied radiology in chiropractic college, a mnemonic for reading skeletal radiographs was offered to assist students in establishing an orderly method for reading film. The mnemonic ABC'S represents Alignment, Bone, Cartilage and Soft tissues. I found the mnemonic very useful; I used it in college and during my first few years of practice. It definitely helped me remember to look at each of these diagnostic factors methodically. tag:mpamedia.com,2008:post-55988 2012-07-15T12:00:32-07:00 2012-07-15T12:00:07-07:00

A trampoline fracture is a transverse fracture of the proximal tibial metaphysis occurring in children while jumping on a trampoline (or inflatable castle). This fracture was first described by Richard Boyer, et al., in 1986. The fracture occurs when a second, usually heavier individual causes the jumping surface to recoil upward as the unsuspecting victim is descending. The combined excessive load is thought to produce the characteristic fracture, which is most often seen in children 2 to 5 years of age. This fracture has also been observed when a child is jumping on a bunk-bed mattress and another child pushes up on the mattress from the bunk below.

By Deborah Pate, DC, DACBR A trampoline fracture is a transverse fracture of the proximal tibial metaphysis occurring in children while jumping on a trampoline (or inflatable castle). This fracture was first described by Richard Boyer, et al., in 1986. The fracture occurs when a second, usually heavier individual causes the jumping surface to recoil upward as the unsuspecting victim is descending. The combined excessive load is thought to produce the characteristic fracture, which is most often seen in children 2 to 5 years of age. This fracture has also been observed when a child is jumping on a bunk-bed mattress and another child pushes up on the mattress from the bunk below. tag:mpamedia.com,2008:post-55930 2012-06-03T12:00:32-07:00 2012-06-03T12:00:07-07:00

Posterior ankle impingement syndrome, PAIS, is a term used to describe a musculoskeletal disorder created from the repeated abutment of the posterior process of the talus or os trigonum between the tibia and calcaneus during plantarflexion of the ankle. The repetitive plantarflexion of the foot causes compression and entrapment of soft tissues, bony processes or unfused ossicles between the posterior-tibial plafond and the superior surface of the calcaneus; similar to nuts in a nutcracker. As a result, bone contusions and local synovitis develop in the tibiotalar and subtalar joints.

By Deborah Pate, DC, DACBR Posterior ankle impingement syndrome, PAIS, is a term used to describe a musculoskeletal disorder created from the repeated abutment of the posterior process of the talus or os trigonum between the tibia and calcaneus during plantarflexion of the ankle. The repetitive plantarflexion of the foot causes compression and entrapment of soft tissues, bony processes or unfused ossicles between the posterior-tibial plafond and the superior surface of the calcaneus; similar to nuts in a nutcracker. As a result, bone contusions and local synovitis develop in the tibiotalar and subtalar joints. tag:mpamedia.com,2008:post-55839 2012-04-09T12:00:32-07:00 2012-04-09T12:00:07-07:00

Plain-film imaging of the sacrum and coccyx are often difficult because of obstructing factors such as the bowel, bladder, clothing artifact, and patients who are difficult to penetrate due to obesity. An import goal when selectively imaging the sacrum and coccyx is reducing the amount of radiation dose. Properly preparing the patient can make all the difference. A clean colon and an empty bladder will reduce the possibility of fluid and fecal material obstructing the view.

By Deborah Pate, DC, DACBR Plain-film imaging of the sacrum and coccyx are often difficult because of obstructing factors such as the bowel, bladder, clothing artifact, and patients who are difficult to penetrate due to obesity. An import goal when selectively imaging the sacrum and coccyx is reducing the amount of radiation dose. Properly preparing the patient can make all the difference. A clean colon and an empty bladder will reduce the possibility of fluid and fecal material obstructing the view. tag:mpamedia.com,2008:post-55751 2012-02-12T12:00:32-07:00 2012-02-12T12:00:07-07:00

There are several normal anatomical differences between the adult and the pediatric cervical spine. This is a brief review of the main radiographic features that one should be aware of in order to avoid confusing normal differences with pathologic findings.

By Deborah Pate, DC, DACBR There are several normal anatomical differences between the adult and the pediatric cervical spine. This is a brief review of the main radiographic features that one should be aware of in order to avoid confusing normal differences with pathologic findings. tag:mpamedia.com,2008:post-55706 2012-01-15T12:00:32-07:00 2012-01-15T12:00:07-07:00

Routine radiographic examination of the wrist is not difficult, but does require some attention to positioning. Keep in mind that to evaluate a joint on X-ray, one must be able to visualize the joint in two planes at 90 degrees to one other. The routine series for a wrist includes PA and lateral views. For further evaluation, oblique projection may also be necessary if trauma or arthritis is evident.

By Deborah Pate, DC, DACBR Routine radiographic examination of the wrist is not difficult, but does require some attention to positioning. Keep in mind that to evaluate a joint on X-ray, one must be able to visualize the joint in two planes at 90 degrees to one other. The routine series for a wrist includes PA and lateral views. For further evaluation, oblique projection may also be necessary if trauma or arthritis is evident. tag:mpamedia.com,2008:post-55689 2012-01-01T12:00:32-07:00 2012-01-01T12:00:07-07:00

How often does a patient come in with an MRI showing a herniated or extruded disc who has been told they need surgery? Examination may show minimal weakness or even diminished reflexes. The problem is that often, the patient did not receive a functional examination to determine other possible causations or treatments that might help repair the area without surgery.

By Warren Hammer, MS, DC, DABCO How often does a patient come in with an MRI showing a herniated or extruded disc who has been told they need surgery? Examination may show minimal weakness or even diminished reflexes. The problem is that often, the patient did not receive a functional examination to determine other possible causations or treatments that might help repair the area without surgery. tag:mpamedia.com,2008:post-55554 2011-09-23T12:00:32-07:00 2011-09-23T12:00:07-07:00

Primary osteoarthritis of the hip appears to have a structural basis. It was hypothesized that acetabular retroversion could be associated with osteoarthritis of the hip by Murray and Stulberg in the mid '60s and early '70s. They were the first to describe this association between abnormal hip anatomy and its possible role in the development of osteoarthritis (OA).

By Deborah Pate, DC, DACBR Primary osteoarthritis of the hip appears to have a structural basis. It was hypothesized that acetabular retroversion could be associated with osteoarthritis of the hip by Murray and Stulberg in the mid '60s and early '70s. They were the first to describe this association between abnormal hip anatomy and its possible role in the development of osteoarthritis (OA). tag:mpamedia.com,2008:post-55454 2011-07-29T12:00:32-07:00 2011-07-29T12:00:07-07:00

Osteoarthritis of the hip affects more than 4 million people in the U.S., and over 200,000 primary elective total hip replacements (THR) are performed per year. The number of revisions due to failure or just wearing out is estimated at 37,000, but there is no national total joint registry in the U.S. Therefore, there are no reliable estimates of the annual and cumulative rates and determinants of THR failure in the smaller hospitals that perform the vast majority of THR. (The lack of data on U.S. procedure volume and outcomes is not the topic for this article; it is just interesting to note that we rely on data from large referral-based hospitals and the national total joint registries developed in Scandinavian countries to monitor failure of THR for determining outcomes.)

By Deborah Pate, DC, DACBR Osteoarthritis of the hip affects more than 4 million people in the U.S., and over 200,000 primary elective total hip replacements (THR) are performed per year. The number of revisions due to failure or just wearing out is estimated at 37,000, but there is no national total joint registry in the U.S. Therefore, there are no reliable estimates of the annual and cumulative rates and determinants of THR failure in the smaller hospitals that perform the vast majority of THR. (The lack of data on U.S. procedure volume and outcomes is not the topic for this article; it is just interesting to note that we rely on data from large referral-based hospitals and the national total joint registries developed in Scandinavian countries to monitor failure of THR for determining outcomes.) tag:mpamedia.com,2008:post-55369 2011-06-03T12:00:32-07:00 2011-06-03T12:00:07-07:00

The elbow fracture is one of the most common fractures in children. Assessing the elbow for fracture can be difficult because of the changing anatomy of the growing skeleton and the subtlety of some of these fractures. It's important to be aware of the radiographic signs of fracture in the elbow, along with knowing the appearance and fusion of the ossification centers in the pediatric patient, to avoid confusing an ossification center with a fracture fragment. Of course, alignment and radiographic positioning are also extremely important in making a diagnostic assessment.

By Deborah Pate, DC, DACBR The elbow fracture is one of the most common fractures in children. Assessing the elbow for fracture can be difficult because of the changing anatomy of the growing skeleton and the subtlety of some of these fractures. It's important to be aware of the radiographic signs of fracture in the elbow, along with knowing the appearance and fusion of the ossification centers in the pediatric patient, to avoid confusing an ossification center with a fracture fragment. Of course, alignment and radiographic positioning are also extremely important in making a diagnostic assessment. tag:mpamedia.com,2008:post-55331 2011-05-20T12:00:32-07:00 2011-05-20T12:00:07-07:00

RF Co., Ltd., expresses our heartfelt sympathy to the victims and their families who were affected by the March 11 earthquake and resulting tsunami in the northeastern Japan area, and sends prayers for the earliest possible restoration, as well as everyone's safety and health. RF Co., Ltd., and all of our affiliates are committed to supporting disaster relief efforts. We are seeking donations from the chiropractic community in this regard and would greatly appreciate any and all support. You can give by calling 800-905-1554.

Submitted By RF Co., Ltd. RF Co., Ltd., expresses our heartfelt sympathy to the victims and their families who were affected by the March 11 earthquake and resulting tsunami in the northeastern Japan area, and sends prayers for the earliest possible restoration, as well as everyone's safety and health. RF Co., Ltd., and all of our affiliates are committed to supporting disaster relief efforts. We are seeking donations from the chiropractic community in this regard and would greatly appreciate any and all support. You can give by calling 800-905-1554. tag:mpamedia.com,2008:post-55153 2011-02-12T12:00:32-07:00 2011-02-12T12:00:07-07:00

New President of the New Zealand College of Chiropractic; Honorary ACBR Diplomate Awarded to Dr. Doug Lawson.

By Editorial Staff New President of the New Zealand College of Chiropractic; Honorary ACBR Diplomate Awarded to Dr. Doug Lawson. tag:mpamedia.com,2008:post-55082 2011-01-01T12:00:32-07:00 2011-01-01T12:00:07-07:00

Many women would say it's worth it for the one woman and that they are willing to tolerate the risk of undergoing biopsy and/or treatment to save the life of another. But do we have all the facts? Simply put, no. We have been debating the relative merits of screening mammography for over a decade despite the wealth of data that suggests the test is a close call in terms of the benefits (which are modest) and the harm, which is rarely discussed. All women hear is that mammography saves lives, period.

By Deborah Pate, DC, DACBR Many women would say it's worth it for the one woman and that they are willing to tolerate the risk of undergoing biopsy and/or treatment to save the life of another. But do we have all the facts? Simply put, no. We have been debating the relative merits of screening mammography for over a decade despite the wealth of data that suggests the test is a close call in terms of the benefits (which are modest) and the harm, which is rarely discussed. All women hear is that mammography saves lives, period. tag:mpamedia.com,2008:post-54792 2010-07-29T12:00:32-07:00 2010-07-29T12:00:07-07:00

Radiation exposure from medical imaging has become a concern with the dramatic increase in scanning (particularly CT scanning) over the past several decades. In 1980, 3 million CT scans were performed in the U.S.; this has increased to more than 62 million CT scans per year, 4 million of which are performed on children. It is estimated that one-third of these scans may not be medically necessary. For example, some emergency departments have drastically increased the use of CT scans for the examination of patients with abdominal pain or headaches.

By Deborah Pate, DC, DACBR Radiation exposure from medical imaging has become a concern with the dramatic increase in scanning (particularly CT scanning) over the past several decades. In 1980, 3 million CT scans were performed in the U.S.; this has increased to more than 62 million CT scans per year, 4 million of which are performed on children. It is estimated that one-third of these scans may not be medically necessary. For example, some emergency departments have drastically increased the use of CT scans for the examination of patients with abdominal pain or headaches. tag:mpamedia.com,2008:post-54712 2010-06-17T12:00:32-07:00 2010-06-17T12:00:07-07:00

Patients often ask for specialized imaging to determine the extent or cause of neck and low back pain. Some patients come in touting MRIs with proof of disc bulges and/or herniations. Others have back pain and want to be imaged right away. Unfortunately, images alone do not provide the entire picture, of course, because several factors contribute to back pain. For example, state of mind, social background, other health conditions, family history, inflammation, and muscular instability may play a causative role. Moreover, some people have structural defects on MRI that are non-problematic; in other words, some structural abnormalities may not cause pain or dysfunction.

By Marco Lopez, DC, CCEP Patients often ask for specialized imaging to determine the extent or cause of neck and low back pain. Some patients come in touting MRIs with proof of disc bulges and/or herniations. Others have back pain and want to be imaged right away. Unfortunately, images alone do not provide the entire picture, of course, because several factors contribute to back pain. For example, state of mind, social background, other health conditions, family history, inflammation, and muscular instability may play a causative role. Moreover, some people have structural defects on MRI that are non-problematic; in other words, some structural abnormalities may not cause pain or dysfunction. tag:mpamedia.com,2008:post-54286 2009-10-21T12:00:32-07:00 2009-10-21T12:00:07-07:00

At a luncheon held during Life Chiropractic College West's annual Homecoming Festival, 123Chiropractors.com presented Life West President Dr. Gerard Clum with a donation of $15,000 that will fund a new state-of-the-art digital radiology laboratory. The donation came as a result of the number of Life West doctors who registered their practices through 123Chiropractors.com, which promised to donate one month's service fee of $30 for every registered Life West doctor. To date, 500 doctors from Life West have participated in the program.

At a luncheon held during Life Chiropractic College West's annual Homecoming Festival, 123Chiropractors.com presented Life West President Dr. Gerard Clum with a donation of $15,000 that will fund a new state-of-the-art digital radiology laboratory. The donation came as a result of the number of Life West doctors who registered their practices through 123Chiropractors.com, which promised to donate one month's service fee of $30 for every registered Life West doctor. To date, 500 doctors from Life West have participated in the program. tag:mpamedia.com,2008:post-54270 2009-10-21T12:00:32-07:00 2009-10-21T12:00:07-07:00

A few years ago, I wrote an article (May 22, 2006 issue) reviewing vertebroplasty as a treatment option for painful compression fractures due to osteoporosis. I felt that as chiropractors, we should be aware of the common medical procedures that are available to treat disorders we generally manage; osteoporotic compression fractures being one such entity. From the information available at the time, vertebroplasty was considered a reasonable treatment option for painful osteoporotic vertebral compression fractures.

By Deborah Pate, DC, DACBR A few years ago, I wrote an article (May 22, 2006 issue) reviewing vertebroplasty as a treatment option for painful compression fractures due to osteoporosis. I felt that as chiropractors, we should be aware of the common medical procedures that are available to treat disorders we generally manage; osteoporotic compression fractures being one such entity. From the information available at the time, vertebroplasty was considered a reasonable treatment option for painful osteoporotic vertebral compression fractures. tag:mpamedia.com,2008:post-54031 2009-09-09T12:00:32-07:00 2009-09-09T12:00:07-07:00

If you have been in practice for any length of time, you have had a patient limp in with ankle pain. Simple sprains are often simple to address and treat, but when there is considerable swelling and pain, the question of fracture must be raised. Standards of care dictate that most patients with ankle injuries are X-rayed; statistically, however, only about 15 percent of these X-rays are positive for fracture.

By Douglas R. Briggs, DC, Dipl. Ac. (IAMA), DAAPM and Kymberlie S. Combs, LMT If you have been in practice for any length of time, you have had a patient limp in with ankle pain. Simple sprains are often simple to address and treat, but when there is considerable swelling and pain, the question of fracture must be raised. Standards of care dictate that most patients with ankle injuries are X-rayed; statistically, however, only about 15 percent of these X-rays are positive for fracture. tag:mpamedia.com,2008:post-54017 2009-08-26T12:00:32-07:00 2009-08-26T12:00:07-07:00

Scheuermann's disease (SD) - osteochondritis of vertebral epiphyseal plates or adolescent kyphosis - was first described in 1921 by Holger Werfel Scheuermann, a Danish surgeon, as an osteochondrosis with cause unknown involving the spine and frequently causing lower thoracic kyphosis. The term juvenile kyphosis has sometimes been used to designate this condition.

By Deborah Pate, DC, DACBR Scheuermann's disease (SD) - osteochondritis of vertebral epiphyseal plates or adolescent kyphosis - was first described in 1921 by Holger Werfel Scheuermann, a Danish surgeon, as an osteochondrosis with cause unknown involving the spine and frequently causing lower thoracic kyphosis. The term juvenile kyphosis has sometimes been used to designate this condition. tag:mpamedia.com,2008:post-53860 2009-06-17T12:00:32-07:00 2009-06-17T12:00:07-07:00

The National Guideline Clearinghouse (NGC), a comprehensive database of evidence-based clinical practice guidelines accessible via the Web, has accepted diagnostic imaging guidelines developed recently to "assist chiropractors and other primary care providers in decision-making on the appropriate use of diagnostic imaging for specific clinical presentations."

By Peter W. Crownfield, Executive Editor The National Guideline Clearinghouse (NGC), a comprehensive database of evidence-based clinical practice guidelines accessible via the Web, has accepted diagnostic imaging guidelines developed recently to "assist chiropractors and other primary care providers in decision-making on the appropriate use of diagnostic imaging for specific clinical presentations." tag:mpamedia.com,2008:post-53318 2008-07-15T12:00:32-07:00 2008-07-15T12:00:07-07:00

Stephen M. Perle and Larry Wyatt cover the history of B.J. Palmer, Joy Loban and their use of the radiograph to find subluxations.

By Stephen M. Perle, DC, MS and Larry Wyatt, DC, DACBR Stephen M. Perle and Larry Wyatt cover the history of B.J. Palmer, Joy Loban and their use of the radiograph to find subluxations. tag:mpamedia.com,2008:post-53294 2008-07-01T12:00:32-07:00 2008-07-01T12:00:07-07:00

Radiation exposure: Something to consider.

By Deborah Pate, DC, DACBR Radiation exposure: Something to consider. tag:mpamedia.com,2008:post-53285 2008-07-01T12:00:32-07:00 2008-07-01T12:00:07-07:00

JMPT Abstracts for May 2008.

JMPT Abstracts for May 2008. tag:mpamedia.com,2008:post-53262 2008-06-17T12:00:32-07:00 2008-06-17T12:00:07-07:00

In forensic or medicolegal settings, clinicians frequently are asked to opine as to the significance of various radiographic or advanced-imaging findings. The most common of these are degenerative in nature and appear in the form of reduced disc height, osteophytes, facet joint irregularities and other signs of the normal aging process known most properly as spondylosis deformans.

By Arthur Croft, DC, MS, MPH, FACO In forensic or medicolegal settings, clinicians frequently are asked to opine as to the significance of various radiographic or advanced-imaging findings. The most common of these are degenerative in nature and appear in the form of reduced disc height, osteophytes, facet joint irregularities and other signs of the normal aging process known most properly as spondylosis deformans. tag:mpamedia.com,2008:post-53232 2008-05-20T12:00:32-07:00 2008-05-20T12:00:07-07:00

Over the years, I've always found it ironic that the chiropractic profession will fight tooth and nail (and rightfully so), for the ability to utilize diagnostic assessment tools under the guise of being discriminated against and not being allowed to properly diagnose their patients.

Over the years, I've always found it ironic that the chiropractic profession will fight tooth and nail (and rightfully so), for the ability to utilize diagnostic assessment tools under the guise of being discriminated against and not being allowed to properly diagnose their patients.