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At least 19 recordsLinked to original sources
PubMedDate not supplied

[Wallenberg's syndrome secondary to dissection of the vertebral artery caused by chiropractic manipulation].

INTRODUCTION: Chiropractic manipulations of the cervical region are techniques that are used more and more frequently to treat a number of osteomuscular pathologies, but can give rise to important complications, such as the dissection of the cervical arteries. Dissection of the vertebral artery generally presents as alternating syndromes, of which Wallenberg s syndrome, either complete or incomplete, is the most frequent. In this paper we review the literature published to date on the pathogenesis, risk factors, clinical features, chronopathology, diagnosis, treatment and prognosis of this complication. CASE REPORT: We describe the case of a young patient who suffered from incomplete Wallenberg s syndrome a few hours after a single session of cervical chiropractic manipulation, and we also show the resonance images that were used to support the diagnosis. CONCLUSIONS: The appearance of a pain in the neck and neurological symptoms in a patient who has undergone chiropractic manipulation in the last few hours or days must lead us to consider a possible dissection of the cervical arteries. Dissection of the vertebral artery usually gives rise to alternating syndromes, the most frequent of which is lateral bulbomedullary infarction or Wallenberg s syndrome due to proximal occlusion of the posteroinferior cerebellar artery. Magnetic resonance angiography of the supra aortic trunks and cranial magnetic resonance scanning are valid techniques for demonstrating the dissection of the artery and the associated ischemic lesion.

Adult↗
PubMed2001

Chiropractic manipulation for the foot: Diversified chiropractic techniques.

There has been increasing acceptance and development of manual methods in providing for the needs of patients with musculoskeletal dysfunction. Several professions have helped fuel this growth, including the chiropractic profession. To date, there has been only a small amount of collaboration between chiropractors and physical therapists. This paper provides a base foundation for one small part of general chiropractic practice, i.e. procedures used for manipulating the foot. Information is provided about the specific diagnostic procedures used by the chiropractic profession in assessing the joints and soft tissues of the foot, followed by descriptions of a number of chiropractic manipulative techniques drawn from the form of chiropractic in widest usage, Diversified technique. For each technique, information is provided on indications for use, patient position, therapist position, hand placements and procedure. In addition, a short discussion on the genesis of Diversified technique is provided.

Chiropractic↗
PubMed2003

Chiropractic manipulation for non-spinal pain--a systematic review.

AIMS: Chiropractic manipulation is mostly used for spinal problems but, in an increasing number of cases, also for non-spinal conditions. This systematic review is aimed at critically evaluating the evidence for or against the effectiveness of this approach. METHODS: Five electronic databases were searched for all randomised clinical trials of chiropractic manipulation as a treatment of non-spinal pain. They were evaluated according to standardised criteria. RESULTS: Eight such studies were identified. They related to the following conditions: fibromyalgia, carpal tunnel syndrome, infantile colic, otitis media, dysmenorrhoea and chronic pelvic pain. Their methodological quality ranged from mostly poor to excellent. Their findings do not demonstrate that chiropractic manipulation is an effective therapy for any of these conditions. CONCLUSIONS: Only very few randomised clinical trials of chiropractic manipulation as a treatment of non-spinal conditions exist. The claim that this approach is effective for such conditions is not based on data from rigorous clinical trials.

Humans↗
PubMed2003

Association of internal carotid artery dissection and chiropractic manipulation.

BACKGROUND: To determine the relationship between chiropractic manipulative therapy and internal carotid artery dissection, a MEDLINE literature search was performed for the years 1966 through 2000 using the terms internal carotid dissection. Literature that included information concerning causation of ICAD, as well as all case studies and series, was selected for review. REVIEW SUMMARY: In reviewing the cases of internal carotid dissection potentially related to CMT, there were many confounding factors, such as connective tissue aberrations, underlying arteriopathy, or coexistent infection, that obscured any obvious cause-and-effect relationship. To date there are only 13 reported cases of ICAD temporally related to CMT. Most ICADs seem to occur spontaneously and progress from local symptoms of headache and neck pain to cortical ischemic signs. Approximately one third of the reported cases were manipulated by practitioners other than chiropractic physicians, and because of the differential risk related to major differences in training and practice between practitioners who manipulate the spine, it would be inappropriate to compare adverse outcomes between practitioner groups. CONCLUSIONS: The medical literature does not support a clear causal relationship between CMT and ICAD. Reported cases are exceedingly scarce, and none support clear cause and effect.

Carotid Artery, Internal, Dissection↗
PubMed1994

Chiropractic manipulation in carpal tunnel syndrome.

OBJECTIVE: To determine if chiropractic manipulation could relieve carpal tunnel syndrome (CTS). CLINICAL FEATURES: A 42-yr-old female suffered from pain, tingling and numbness in the right wrist. Paresthesia along the C6 dermatome, a positive Phalen's test and Tinel's sign was present. EMG testing confirmed the clinical diagnosis of CTS. INTERVENTION AND OUTCOME: Chiropractic manipulations were rendered 3 times per week for 4 wk, to the subject's cervical spine, right elbow and wrist using a low amplitude, short lever, low force, high velocity thrust. Significant increase in grip strength and normalization of motor and sensory latencies were noted. Orthopedic tests were negative. Symptoms dissipated. CONCLUSION: In this case study, chiropractic made a demonstrable difference through objective and subjective outcomes. Further investigations using double-blind, cross-over designs with larger samples are warranted.

Adult↗
PubMedDate not supplied

Stroke after chiropractic manipulation as a result of extracranial postero-inferior cerebellar artery dissection.

OBJECTIVE: To describe a case of dissection of the postero-inferior cerebellar artery (PICA) after cervical manipulation. CLINICAL FEATURES: After cervical manipulation, a 42-year-old woman had a cerebellar syndrome related to an infarct in the area supplied by the PICA, confirmed by computed tomography of the brain. Cerebral angiography showed a normal appearance of the vertebral artery, a cervical extradural origin of PICA, and a dissection of the latter at the C1-C2 level. INTERVENTION AND OUTCOME: Anticoagulant treatment with heparin was implemented. A positive outcome was achieved after 3 weeks. CONCLUSION: Anatomical variations of the vertebral arteries and their branches are not infrequent and may constitute a predisposing factor to complications after neck manipulation.

Adult↗
PubMed1995

Neurologic complications following chiropractic manipulation: a survey of California neurologists.

To obtain an estimate of how often practicing neurologists in California encounter unexpected strokes, myelopathies, or radiculopathies following chiropractic manipulation, we surveyed each member of the American Academy of Neurology in California and inquired about the number of patients evaluated over the preceding 2 years who suffered a neurologic complication within 24 hours of chiropractic manipulation. Four hundred eighty-six neurologists were surveyed, 177 responded; 55 strokes, 16 myelopathies, and 30 radiculopathies were reported. Patients were between the ages of 21 and 60, and the majority experienced complications following cervical manipulation. Most of the patients continued to have persistent neurologic deficits 3 months after the onset, and about one-half had marked or severe deficits. Nearly all of the strokes involved the posterior circulation and almost one-half were angiographically proven. Patients, physicians, and chiropractors should be aware of the risk of neurologic complications associated with chiropractic manipulation.

Carotid Artery Injuries↗
PubMed1983

Brain stem infarction due to chiropractic manipulation of the cervical spine.

A case of brain stem infarction after chiropractic manipulation of the cervical spine is presented. Proposed mechanisms and sites of possible arterial injury are discussed. A diagnosis of vertebral artery occlusion was made using conventional brachial angiography. Digital intravenous angiography, a relatively new and less invasive vascular imaging technique which was used as an adjunct for evaluating the remainder of the cervicocephalic vessels, documented the vertebral occlusion. Chiropractic manipulation, which is increasing in popularity, may be a cause of potentially devastating neurologic disease.

Adolescent↗
PubMed1983

Brain stem infarction due to chiropractic manipulation of the cervical spine.

A case of brain stem infarction after chiropractic manipulation of the cervical spine is presented. Proposed mechanisms and sites of possible arterial injury are discussed. A diagnosis of vertebral artery occlusion was made using conventional brachial angiography. Digital intravenous angiography, a relatively new and less invasive vascular imaging technique which was used as an adjunct for evaluating the remainder of the cervicocephalic vessels, documented the vertebral occlusion. Chiropractic manipulation, which is increasing in popularity, may be a cause of potentially devastating neurologic disease.

Arterial Occlusive Diseases↗
PubMedDate not supplied

The effect of chiropractic manipulation on salivary cortisol levels.

BACKGROUND: The stress response in humans is a healthy response and is necessary for life. The effects of chiropractic manipulation (CM), if any, on stress are ill-defined. Cortisol has been used as an accurate measure of the stress response system in humans. Salivary cortisol is a noninvasive technique to accurately quantify biologically active cortisol. OBJECTIVE: To determine whether basal salivary cortisol levels can be properly detected and whether CM has any direct effect on basal salivary cortisol levels in humans. METHODS: Subjects were adult male students attending a chiropractic college. Salivary samples were collected for 5 weeks. During Week 1, samples were collected by the students at home upon waking. During Weeks 2 through 5, home samples were collected upon waking and were followed by an additional time course of samples collected in a laboratory setting before and after CM. Salivary cortisol was measured by enzyme-linked immunoassay. RESULTS: Chiropractic manipulative therapy did not significantly change basal salivary cortisol levels. The time course of acute changes to cortisol levels was independent of testing week and group. A decrease in salivary cortisol was detected over time on each trial testing day. Overall, cortisol levels significantly decreased from the time of the home samples until the pretreatment laboratory measurement (P <.05). Cortisol levels subsequently decreased from pretreatment to 15 minutes after treatment (P <.05). After treatment, there were progressive decreases in cortisol levels from the 15- and 30-minute time points to the 60-minute time point (P <.05). CONCLUSION: The results of this pilot study suggest that there is no effect of CM on salivary cortisol levels in asymptomatic subjects. As such, we conclude that neither the anticipation of CM nor the spinal manipulative procedure itself induces a state of stress or anxiety.

Adult↗
PubMed2002

[Horner's syndrome in dissection of the carotid artery after chiropractic manipulation].

CASE REPORT: We report on a 37-year old patient with sudden onset of pain of the right scalp and an ipsilateral small pupil, presenting five weeks after chiropractic manipulation of the neck. METHODS/RESULTS: Pharmacologic pupil testing showed a postganglionic Horner's syndrome on the right side. Magnetic resonance angiography confirmed the diagnosis of a dissection of the right internal carotid artery at a subacute stage. CONCLUSION: There appears to be a causal relationship between carotid artery dissection and the chiropractic manipulation of the cervical spine. Ophthalmological signs played the key role in detecting this complication.

Adult↗
PubMed1998

A comparison of active and simulated chiropractic manipulation as adjunctive treatment for childhood asthma.

BACKGROUND: Chiropractic spinal manipulation has been reported to be of benefit in nonmusculoskeletal conditions, including asthma. METHODS: We conducted a randomized, controlled trial of chiropractic spinal manipulation for children with mild or moderate asthma. After a three-week base-line evaluation period, 91 children who had continuing symptoms of asthma despite usual medical therapy were randomly assigned to receive either active or simulated chiropractic manipulation for four months. None had previously received chiropractic care. Each subject was treated by 1 of 11 participating chiropractors, selected by the family according to location. The primary outcome measure was the change from base line in the peak expiratory flow, measured in the morning, before the use of a bronchodilator, at two and four months. Except for the treating chiropractor and one investigator (who was not involved in assessing outcomes), all participants remained fully blinded to treatment assignment throughout the study. RESULTS: Eighty children (38 in the active-treatment group and 42 in the simulated-treatment group) had outcome data that could be evaluated. There were small increases (7 to 12 liters per minute) in peak expiratory flow in the morning and the evening in both treatment groups, with no significant differences between the groups in the degree of change from base line (morning peak expiratory flow, P=0.49 at two months and P=0.82 at four months). Symptoms of asthma and use of 3-agonists decreased and the quality of life increased in both groups, with no significant differences between the groups. There were no significant changes in spirometric measurements or airway responsiveness. CONCLUSIONS: In children with mild or moderate asthma, the addition of chiropractic spinal manipulation to usual medical care provided no benefit.

Adolescent↗
PubMed2002

Hyperhomocysteinemia: a potential risk factor for cervical artery dissection following chiropractic manipulation of the cervical spine.

Despite the increasing incidence of cervical artery dissection (CAD) due to chiropractic manipulation of the cervical spine, risk factors predisposing to vascular damage are still unknown. In the present study we measured fasting total plasma homocysteine (tHcy) concentration in 4 subjects with manipulation-related CAD selected from a larger series of patients with spontaneous dissection of the neck arteries (sCAD) and in a group of 36 control subjects. C677T MTHFR genotypes and 844ins68bp CBS genotypes were also determined. Median tHcy levels were significantly (P = 0.002) higher in patients with manipulation-related CAD (18.2 micromol/l, range 14.3 to 30.0) compared with controls (8.9 micromol/l, range 5 to 17.3) and not significantly different (P = 0.129) from those observed in patients with sCAD (13.9 micromol/l, range 7 to 32.8). No significant difference in the distribution of genotypes was observed in the three groups. Hyperhomocysteinemia may represent a potential risk factor for manipulation-related CAD, leading to structural abnormalities of the arterial wall and increasing the susceptibility to mechanical stress.

Adult↗
PubMed1998

A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain.

BACKGROUND AND METHODS: There are few data on the relative effectiveness and costs of treatments for low back pain. We randomly assigned 321 adults with low back pain that persisted for seven days after a primary care visit to the McKenzie method of physical therapy, chiropractic manipulation, or a minimal intervention (provision of an educational booklet). Patients with sciatica were excluded. Physical therapy or chiropractic manipulation was provided for one month (the number of visits was determined by the practitioner but was limited to a maximum of nine); patients were followed for a total of two years. The bothersomeness of symptoms was measured on an 11-point scale, and the level of dysfunction was measured on the 24-point Roland Disability Scale. RESULTS: After adjustment for base-line differences, the chiropractic group had less severe symptoms than the booklet group at four weeks (P=0.02), and there was a trend toward less severe symptoms in the physical therapy group (P=0.06). However, these differences were small and not significant after transformations of the data to adjust for their non-normal distribution. Differences in the extent of dysfunction among the groups were small and approached significance only at one year, with greater dysfunction in the booklet group than in the other two groups (P=0.05). For all outcomes, there were no significant differences between the physical-therapy and chiropractic groups and no significant differences among the groups in the numbers of days of reduced activity or missed work or in recurrences of back pain. About 75 percent of the subjects in the therapy groups rated their care as very good or excellent, as compared with about 30 percent of the subjects in the booklet group (P<0.001). Over a two-year period, the mean costs of care were $437 for the physical-therapy group, $429 for the chiropractic group, and $153 for the booklet group. CONCLUSIONS: For patients with low back pain, the McKenzie method of physical therapy and chiropractic manipulation had similar effects and costs, and patients receiving these treatments had only marginally better outcomes than those receiving the minimal intervention of an educational booklet. Whether the limited benefits of these treatments are worth the additional costs is open to question.

Adult↗