From Dr. Natalie Meiri’s Clinical Pearl Stories:

Chiropractic Care of Neck and Wrist Pain After a Car Accident

This was a 17 year old male patient with neck and right wrist pain following a  car accident.  The patient was the driver of a vehicle that was rear ended while stopped at an intersection. And he presented to our office 10 days later.  To be HIPAA compliant, I will call him Zack instead of his real name. 

Zack came to my office in a lot of pain. He had been in a low speed car accident. He relayed how his neck was “whipped back and forth”.  Moreover, his right wrist was injured when he was pushed forward into the steering wheel during the impact. Zack had been trying to brace himself on the steering wheel.

He hadn’t gone to the hospital after the car accident. But Zack’s pain started right after the car accident and got progressively worse.  Moreover, he was unable to participate in football at school and had difficulty sleeping due to the pain. Zack tried NSAIDS (e.g aspirin) and/or acetaminophen (e.g. tylenol) which helped very little.  Finally, his mother brought him to my office.

 

Zack’s Examination

Zack presented to my office with his neck forward in antalgia (away from pain) and guarding/holding his right painful wrist with his uninjured left hand. 

Upon examination, I found positive tests for sprains in his cervical spine (neck) and right wrist.  A sprain is a joint injury in which some of the fibers of a supporting ligament are torn or ruptured.  However, the continuity of the ligament (ligaments connect bones to bones within a joint) remains intact.

Zack’s thoracic spine diagnosis was a strain. Tendons connect bones to muscles. A strain is an overstretching and tearing of musculotendinous tissue (tendons connect bones to muscles).

 

Zack’s X-Rays

Firstly, Zack’s x-rays taken in my office showed a loss of cervical (neck) lordosis (straightening of normal curve) consistent with cervical myospasm (muscle spasm).

Secondly, his thoracic (mid back) x-rays showed a left convexity (abnormal curve) consistent with thoracic myospasm. 

Thirdly, Zack’s right wrist x-rays were noted as “normal” findings (e.g. no fractures found). 

I would order further imaging (e.g. MRI) if there was no improvement after 12 visits or possibly sooner if necessary.

 

 

What Happens During A Whiplash/Car Accident/Rear-end Collision?

 

Acceleration/deceleration (whiplash) injury to the cervical spine (neck) is a common mechanism of injury in patients seeking chiropractic care.  There is considerable research to indicate the “typical” phases of events following a rear-end collision.  The biomechanics of whiplash is as follows:

 

Phase One–When a vehicle is rear-ended, your torso (trunk of body) is forced back into the seat and at the same time moves upward. This upward movement is accompanied by straightening of the cervical spine as it is being compressed axially. Axial compression is a  type of force, especially on the vertebral column, in which the body weight falls centrally on a particular bone, causing bony impaction. The head and neck then begin to extend (tilting head backwards).

 

 Phase Two–As the head and neck are extending, the vehicle has reached its peak acceleration. Energy stored in the seat from the backward movement of  the body into the seat may add more acceleration to the torso as a “diving board” effect. The upward (vertical) movement of the torso may allow ramping over the headrest, adding an element of extension. If the driver’s foot is taken off the brake, acceleration may be prolonged.

 

 Phase Three-Acceleration diminishes while the head and torso are thrown forward. It may be accentuated if the driver’s foot is reapplied to the brakes.

 

Phase Four-As the body moves forward, a seat belt and shoulder harness (if worn) will restrain the torso, allowing the head to decelerate forward.

 

“Global Hyperextension”

Lastly, “Global hyperextension” (excessive movement of a joint backwards) may be the most prominent injury mechanism in whiplash. In other words, in hyperextension, the joint has been forced to move beyond its normal range of motion causing the tissues around the joint to be damaged. 

 

As was the case with Zack, low–speed rear impact injury crashes account for as much as 80% of rear impact collisions. The range of speed in these motor vehicle accidents are between 6 and 12 mph. And research indicates that patients with symptoms of whiplash injury from motor vehicle accidents respond well to chiropractic treatment!

 

 

This post is about Chiropractic Care of Shoulder Girdle Pain: Calcific Tendinitis.  Calcific tendinitis is a shoulder condition where calcium slowly accumulates in the rotator cuff tendon.  Most of the cases are in the supraspinatus (muscle in back of shoulder) tendon. Calcific tendinitis can occur in any age group, but occurs mostly in 30-60 year olds. Women seem to be more affected than men. It may either happen insidiously (comes on slowly) or subsequent to a fall or other major trauma.

If you have shoulder girdle pain from calcific tendinitis, Chiropractic can provide relief!

 

Chiropractic Care of Shoulder Girdle Pain: Calcific Tendinitis- CAUSES

 

The exact cause of calcific tendinitis is unknown.  However, there are many proposed hypotheses/theories on the causes: abnormal activity of the thyroid gland, metabolic diseases (e.g. diabetes), and genetic predisposition. The most recognized cause is the degenerative and “multiphasic” theories (acute and chronic phase).

 

Degenerative Theory of Calcific Tendinitis

 

Rotator cuff muscle strains can be caused by falls on an outstretched arm and minor or repetitive stresses to a tendon. Most injuries are to the supraspinatus tendon.  The following is what happens next:

 

First, due to the comparatively poor blood supply near the insertion (where muscle attaches to bone) of the supraspinatus muscle, nutrition to this area may not meet the demands of the tendon tissue. Second, an inflammatory response (due to injury or repetitive use) starts in the tendon.  This creates a tendinitis that arises in the tendon. Third, there is a release of various enzymes/proteins and then the resulting “dead tissue” may appear as “foreign” to your body. Fourth, your body may react by laying down scar tissue or even calcific deposits. And this is referred to as calcific tendinitis.

 

Acute phase of Calcific Tendinitis

 

In the acute (develop severely suddenly and last a short time) phase of this condition, you will have severe shoulder pain that increases with any shoulder movement. Furthermore, you will find yourself in a supportive posture, holding the arm against your side to avoid movement. Sometimes, the pain is intense as the body tries to reabsorb the calcium.

 

Chronic Phase of Calcific Tendinitis

 

In the chronic phase, the presence of the calcium deposits doesn’t cause as much inflammation, so the pain is less. 

Firstly, there may be a bursitis (painful swelling of a small, fluid-filled sac called a bursa) secondary (resulted from tendinitis) to the calcific tendinitis.  So bursitis, as a primary condition (occuring on own) resulting from local trauma, is rare. It is very common to have bursitis as a secondary progression from tendinitis.

Secondly, acute bulging of the tendon compresses the bursa against the coracoacromial arch (portion of top outer edge of shoulder blade).

Thirdly, this swelling of the bursa produces limitation of motion and pain. The subacromial and subdeltoid bursae are most frequently involved.

 

 

 

Arthritis has a “geriatric” connotation, yet it may affect any age group. The term means joint disease/ disorder. Arthritis can be due to many causes such as degeneration or destruction that is age-related or trauma related, infectious, inflammatory, and/or autoimmune.  This post is about Psoriatic arthritis, an autoimmune related arthritis affecting the neck, back and limb joints. 

 

What is autoimmune arthritis?

 

Firstly, inflammatory arthritis is due to an autoimmune disease. The immune system doesn’t work properly and releases inflammatory chemicals. Secondly, the resulting inflammation attacks joint tissues and can cause joint swelling, cartilage/bone damage, and muscle loss. Thirdly, the inflammatory chemicals may activate nerves around the joints and other parts of the body and lead to pain as well. Lastly, because most of the inflammatory forms of arthritis are systemic (effects entire body), symptoms related to inflammation may occur in other parts of the body, including skin rashes, eye inflammation, hair loss, dry mouth, and fever.

Inflammatory arthritis includes a group of arthritis accompanied by joint pain, swelling, warmth, tenderness in the joints, and morning stiffness that lasts for an hour. And joints affected are many joints throughout the body at the same time.  Moreover, inflammatory forms of arthritis are much less common than osteoarthritis (wear and tear arthritis), which affects most people at the later stages of life. 

 

Psoriatic Arthritis

The typical age (is mostly adults) and gender of occurrence varies with this autoimmune arthritis. The common joints involved are hand, foot, cervical (neck) joints, thoracolumbar (mid back, low back) joints and the sacroiliac joints (joints linking your pelvis and lower spine). Furthermore, in some cases hyperostosis (too much growth of bony tissue) occurs at the sternoclavicular joint (joint between the sternum (breastbone) and clavicle (collarbone). 

Involvement of the fingers or toes may create dactylitis (also called “sausage” appearance). So this is due to localized, painful swelling that causes digits to look like sausages. There are many patterns yet most times the proximal (closest to body) and distal (furthest from body) interphalangel (finger) joints are involved. 

 

Arthritis Mutilans

Arthritis mutilans is described as the most severe deforming type of psoriatic arthritis. It is characterized by digital (finger/toe) shortening associated with severe osteolysis (bone tissue destruction) of peripheral (limb) joints.

 

Skin Lesions (Psoriasis)

Firstly, prior to the onset of psoriatic arthritis, eighty percent of people have skin lesions (damage or abnormal change in the tissue). However, only about 20% of those with skin lesions (psoriasis) from psoriatic autoimmune disease also have the joint involvement (arthritis).

Secondly, the skin lesions maybe quite obvious as “silvery scales” on the extensor (muscle whose contraction extends/ straightens a limb) surfaces of the arms and legs.  In addition, there may be subtle patches in the gluteal cleft (groove between the buttocks), scalp or umbilicus (belly button).  In general, the more pronounced or involved the skin symptoms, the worse the arthritis is.

Thirdly, in addition to possibly having scaly (psoriasis) skin, there may also be nail changes. This includes pitting, discoloration and splintering. Lastly, other skin lesions may occur in the hands and feet.

 

Cause

Multiple genetic and environmental factors (e.g. stress) have been associated with an increased risk for psoriatic arthritis. A family history of psoriatic arthritis can put you at risk. Also, there is a genetic predisposition associated with various HLA (human leukocyte antigen).

Psoriatic arthritis can be mild or severe (arthritis mutilans). Scientists do not fully understand why changes in immune activity cause the disease/ arthritis.

Laboratory Findings

 

Seronegative

Laboratory evaluation is negative for rheumatoid factor (IgM antibody). Hence, Psoriatic Arthritis is called a seronegative arthritis.

 

Erythrocyte Sedimentation Rate (ESR)

ESR is a blood test that gives your doctor an idea of the inflammation levels in your body. An ESR test measures the rate of fall (sedimentation) of red blood cells (erythrocytes) in a test tube. Lab testing will reveal elevations in erythrocyte sedimentation rate (ESR) in Psoriatic Arthritis cases.

 

HLA B-27

HLA-B27 is a genetic test to see whether you have the protein human leukocyte antigen B27 (HLA-B27) on the surface of your cells. If you test positive for HLA-B27 then you are likely to have one of the autoimmune disorders associated with the presence of HLA-B27.  Psoriatic Arthritis is one of those conditions.

 

Serum Uric Acid

A uric acid test measures the amount of uric acid in the blood. Uric acid is a waste product found in blood when the body breaks down chemicals called purines. Elevated levels in Psoriatic Arthritis is thought to be a byproduct of rapid skin cell turnover (due to psoriasis) and systemic inflammation.

 

Complete Blood Count​​ (CBC test )

Mild Anemia develops in autoimmune disease such as psoriatic arthritis and is found in the CBC test.  Anemia occurs if your body makes too few red blood cells (RBCs), destroys too many RBCs, or loses too many RBCs.

First, if you have anemia, your body does not get enough oxygen-rich blood. Second, the lack of oxygen can make you feel tired or weak. Third, you may also have shortness of breath, dizziness, headaches, or an irregular heartbeat.

 

Imaging and X-Ray

Radiographic (x-ray) findings help confirm the diagnosis.

 

 

Arthritis has a “geriatric” connotation, yet it may affect any age group. The term means joint disease/ disorder. Arthritis can be due to many causes such as degeneration or destruction that is age-related or trauma related, infectious, inflammatory, and/or autoimmune.  This post is about Rheumatoid arthritis, an autoimmune related arthritis affecting the neck, back and limb joints. 

 

What is autoimmune arthritis?

 

Firstly, inflammatory arthritis is due to an autoimmune disease. The immune system doesn’t work properly and releases inflammatory chemicals. Secondly, the resulting inflammation attacks joint tissues and can cause joint swelling, cartilage/bone damage, and muscle loss. Thirdly, the inflammatory chemicals may activate nerves around the joints and other parts of the body and lead to pain as well. Lastly, because most of the inflammatory forms of arthritis are systemic (effects entire body), symptoms related to inflammation may occur in other parts of the body, including skin rashes, eye inflammation, hair loss, dry mouth, and fever.

Inflammatory arthritis includes a group of arthritis accompanied by joint pain, swelling, warmth, tenderness in the joints, and morning stiffness that lasts for an hour. And joints affected are many joints throughout the body at the same time.  Moreover, inflammatory forms of arthritis are much less common than osteoarthritis (wear and tear arthritis), which affects most people at the later stages of life. 

 

1. Rheumatoid Arthritis

 

Rheumatoid Arthritis is an autoimmune disorder causing an inflammatory arthritis occurring mostly in 25-55 year old women. The common joints involved are hand, ankle, foot, toes, wrist, knee, elbow, shoulder (glenohumeral joint, acromioclavicular joint), neck (atlantoaxial joint, first and second cervical vertebrae of spine) and hips (femoracetabular joints). 

 

Rheumatoid Arthritis often starts as finger or wrist pain. The joints involved most frequently are the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints of the (base of) hands. You may feel the joints are swollen and that in the morning it takes over an hour to be able to move the fingers comfortably. Furthermore, you may feel fatigue and have possible weight loss.

 

So pain, warmth and associated periarticular (around the joint) soft tissue swelling, stiffness, and range of motion restrictions are signs and symptoms. Also at some point, the body or limb will be affected bilaterally (both sides).

 

Cause

 

Rheumatoid Arthritis is an autoimmune disorder causing an inflammatory arthritis. What happens is the joint forms a reactive pannus. And the pannus is a hypertrophied synovium (overgrowth of lining of joint).  This pannus invades and erodes contiguous (nearby) cartilage and bone, causing swelling and eventual erosion. Finally, later changes include flexor (finger folding soft tissue) contractures and ulnar deviation (bend abnormally toward your little finger) of the fingers.

 

Is rheumatoid arthritis genetic or environmental?

 

Multiple genetic and environmental factors have been associated with an increased risk for rheumatoid arthritis (RA). Associations have been seen with being female, a family history of RA, and with exposure to tobacco smoke.

 

Also, if you possess the class 2 human leukocyte antigen (HLA), you have a genetic predisposition to getting Rheumatoid Arthritis (RA). Observations in studies show that HLA genes play an important role in the etiopathogenesis (cause and development of disease) of  RA. Scientists say the genes provide a sort of ‘prearthritic’ immunological background on which the triggering factors for RA thrive.

 

Laboratory Findings

 

Rheumatoid Factor

A positive rheumatoid factor test result indicates that a high level of rheumatoid factor was detected in your blood. A higher level of rheumatoid factor in your blood is closely associated with autoimmune disease, particularly rheumatoid arthritis. A positive rheumatoid factor (IgM antibody) is found in 75% of people with Rheumatoid Arthritis. A rheumatoid factor test is the most useful test to diagnosis rheumatoid arthritis.

 

Erythrocyte Sedimentation Rate (ESR)

ESR is a blood test that gives your doctor an idea of the inflammation levels in your body. An ESR test measures the rate of fall (sedimentation) of red blood cells (erythrocytes) in a test tube. Lab testing will reveal elevations in erythrocyte sedimentation rate (ESR) in Rheumatoid Arthritis cases.

 

C–Reactive Protein (CRP) Test

The CRP test measures the level of C–reactive protein.  This is a protein made by your liver. Blood levels may be higher when you have inflammation or an infection.

 

Complete Blood Count​​ (CBC test )

Anemia (often hypochromic and normocytic) develops in autoimmune disease such as Rheumatoid Arthritis and is found in the CBC test. Anemia occurs if your body makes too few red blood cells (RBCs), destroys too many RBCs, or loses too many RBCs.

First, if you have anemia, your body does not get enough oxygen-rich blood. Second, the lack of oxygen can make you feel tired or weak. Third, you may also have shortness of breath, dizziness, headaches, or an irregular heartbeat.

Hypochromic normochromic anemia is the type of anemia in which the circulating red blood cells (RBCs) are the same size (normocytic) and have a paler than normal red color (hypochromic).

 

Imaging and X-Ray

 

Radiographic (x-ray) findings usually confirm the diagnosis. However, these are not evident in the early stages of the disease.

 

 

2. Juvenile Rheumatoid Arthritis

Juvenile means the disease starts around ages 5-10 years old. Juvenile Rheumatoid Arthritis has the same findings as adult Rheumatoid Arthritis.  Common joints involved are hand, foot, wrist, knee, elbow, heel, hip, and cervical spine (neck).

 

Laboratory Findings

 

Lab work is similar to the adult type with the addition of urinalysis, and other laboratory tests.

 

Imaging and X-Ray

 

Radiographic (x-ray) findings are similar to the adult type with the possible addition of growth disturbances of  bone and epiphyseal (growth plate of bone) injuries due to the autoimmune disease.

Treatment at Meiri Chiropractic

 

Firstly, inflammatory autoimmune disease/arthritis have an unpredictable course of remission and relapses. Secondly, treatment/management includes chiropractic manipulation treatment to keep the spine and extremity (arms and legs) joints flexible.  Thirdly, stretching and postural exercises are very helpful. Finally, Chiropractic manipulation should be as gentle as possible considering the inflammatory nature of these diseases.

 

Indeed, long-term use of pain medication/drugs can cause gastric and renal (kidney) consequences.  In conclusion, chiropractic along with the use of anti-inflammatory approaches in diet and supplement recommendations are beneficial in management of inflammatory arthritis.

 

At Meiri Chiropractic we spend the time necessary to examine, diagnose and treat every neuromusculoskeletal condition and various ailments you have.  Chiropractic is a holistic and natural way to not only treat existing conditions, but to keep your body in its best working condition.  We have been offering effective chiropractic care in Palm Beach County since 2006.  Many of our patient reviews note our excellence.  Call us today at 561-253-8984 to make an appointment or to find out more about Rheumatoid Arthritis: Autoimmune Disease and Chiropractic .