An episode of vertigo is similar to dizziness as the person does feel dizzy but it also differs from dizziness in that the person actually feels as if they are moving or that their environment is moving. The most common cause of vertigo is due to changing positions. Going from sitting to standing, bending over and then standing straight again, or standing up from a position of lying down can cause vertigo. These episodes of vertigo are called BPPV, or benign paroxysmal positional vertigo and are typically not serious and can be effectively treated. Other causes of vertigo include inner ear disturbances such as inner ear infections, decreased blood flow to the brain, a tumor present in the nerve tissues called an acoustic neuroma, trauma to the head or neck, episodes of migraines, arteriosclerosis, diabetes and a condition called Meniere’s disease. An episode of vertigo can last for only a few minutes or as long as a few hours. Aside from the feeling of motion that is not actually present, nausea and vomiting may also occur as well as unusual eye movements, increased sweating, a ringing in the ears, hearing loss, trouble with walking and talking and vision changes.  

Reduce the Frequency

While most cases of vertigo are harmless, it is important to tell your doctor about any episodes that are present. A health history will include questions about the duration and frequency of vertigo, if any recent trauma such as whiplash has occurred and if there are any other symptoms present with the feelings of movement. Lab testing and an EEG may be helpful in examining blood sugar levels and heart rhythm as well. If something other than vertigo is suspected, a CT scan may be requested by the primary care physician to rule out any trauma to the brain or neck. If the cause of vertigo  has been diagnosed as being caused by an inner ear infection, treatment will include antibiotic medication. There are medications that can also be used for other causes of vertigo as well as vestibular rehabilitation exercises that work to place the body in specific positions that would normally cause vertigo and to repeat these positions until the vertigo is no longer present. There are simple ways to reduce the frequency of vertigo including changing positions slowly, eating small amounts of healthy snacks between meals to keep blood sugar levels steady, seeking medical attention immediately following any head or neck  trauma and receiving care promptly if an ear infection is suspected. For people who are at high risk for stroke, high blood pressure and high cholesterol, seeking immediate care when vertigo is present can help to avoid a more serious outcome.

References Cited in this Article

www.mayoclinic.com

www.emedicinehealth.com

www.neurologychannel.com

There are many times of fractures, the main categories are displaced, non-displaced, open, and closed.  With displaced and non-displaced fractures, it refers to the way the bone actually breaks.  In a displaced fracture, the bone breaks into two or more segments.  When the bone is broken in many segments the fracture is considered a comminuted fracture.  A non-displaced fracture occurs when the bone cracks part way or all the way through but maintains its normal alignment.  In a closed fracture, there is no puncture or break in the skin; however, in an open fracture the bone actually protrudes through the skin with a visible wound present.  Open fractures are extremely dangerous because of the risk of bone infections due to the skin and bone being exposed to the environment.

Fracture types

There are many different types of fractures including: a Greenstick fracture, Transverse fracture, Oblique fracture, Comminuted fracture, impacted fracture, Pathologic fracture, and stress fracture.  Greenstick fractures mean the bone is bent.  A Transverse fracture means the fracture is at a right angle to the axis of the bone.  In an Oblique fracture, the break is in a curved fashion.  A Comminuted fracture occurs in several pieces.  Impacted fractures occur when the two ends of bones are forced together causing a break.  Pathologic fractures are caused by disease processes or weakened bone.  Finally, stress fractures are caused by injuries such as repetitive stress. 

Treatment

The initial treatment of fractures includes splinting and stabilization of the extremity in the anatomical location, ice, and elevation.  Fractures of the neck and back require the body to be placed on a stiff board or the neck to be placed in a hard collar in acute situations.  This is performed to limit spinal cord involvement and movement.  Some physicians choose to operate on fractures in certain situations depending on where the bone is broke, and the severity of the break.

Chiropractic care

After the bone has healed for the appropriate length of time, Chiropractic care may be beneficial to improve range of motion and joint function.  The attending physician at the time of the fracture injury will recommend when this should be performed.   

Discitis is a rare sub-acute spinal infection of the vertebral discs that can occur in any age group; however, it most commonly affects children.  It may be difficult to diagnose Discitis because patients have few symptoms with the initial presentation.  However, they do start to develop severe low back pain as the infection spreads.  Children will not develop generally develop a fever as seen with other infections; however, they will refuse to flex their spine to touch their toes because of extreme pain.  Researchers believe that discitis starts with an infection inside of the end plates that later develops in the disc itself.  Thankfully, spinal infections such as Discitis, Osteomyelitis, and epidural abscesses can be diagnosed via MRI (magnetic resonance imaging).  MRI will determine the presence of an infection, the severity, and if the spinal cord is impacted.  The most effective treatment for Discitis is immobilization with a plaster cast; in certain instances antibiotics are also prescribe.   

Chiropractic care and Discitis

Chiropractors do not treat infections of the spine.  This is out of their scope of practice as a Chiropractic physician.  Infections of the spine must be referred out to the appropriate primary care physician such as a medical doctor for pharmaceutical administration or a neurosurgeon if surgical intervention is necessary and appropriate.  Some spinal infections will show up on x-ray when severe, others require the use of a soft-tissue imaging modality such as MRI or CT scan.  Infections obliterate the spinal column crossing joints; they eat the bone and everything around it.  If left untreated, the patient could be permanently paralyzed due to spinal cord involvement or dead.  The physician will take a detailed case history, through physical examination; take necessary lab work and special imaging to diagnose the onset of a spinal infection such as Discitis.  Since children don’t exhibit a fever, it’s extremely important for parents, teachers, and coaches to realize the signs and symptoms of the child not wanting to flex their spine-this will ultimately save their life. 

Are you a sufferer of Chest Pain?  Chest pain is a dangerous symptom that should not go unnoticed or diagnosed.  It’s especially important whether the pain is acute, chronic, mild or severe in nature as well.  Chest pain can be caused by a number of conditions including but not limited to cardiac conditions such as: angina, myocardial infarctions, aortic dissection, coronary spasm, pericarditis, and other heart-related conditions.  Chest pain can also be due to digestive problems such as: heartburn, esophageal spasm, hiatal hernia, Achalasia, gallbladder or pancreas conditions.  In addition, chest pain may also be due to musculo-skeletal conditions like the following: rib subluxations or fractures, Costochondritis, inflamed muscles or nerves.  Respiratory causes of chest pain could be the following: pulmonary embolism, pleurisy, pneumothorax, and pulmonary hypertension.  Other causes of chest pain could also include panic attacks, shingles, or metastasis (cancer). 

Chest pain due to cardiac conditions

When chest pain is due to a heart attack or other heart problems the patient will experience the following symptoms: pressure and tightness in the chest, a crushing-type of pain that radiates to the arm, back, neck, shoulder, or jaw especially in the left arm, pain that lasts more than a few minutes that goes away or comes back in a different intensity, or shortness of breath, dizziness, sweating, or nausea. 

Chest pain due to non-cardiac conditions

When chest pain is due to a non-cardiac condition the patient will experience the following symptoms: a burning sensation behind the sternum, a sour taste in the mouth, difficulty swallowing, and pain that increases when you cough or breathe deeply, and chest tenderness. 

Diagnosis and treatment

Diagnosis of chest pain is not always clear or straightforward.  Your physician will take a detailed case history, perform a physical examination, and perform possible laboratory tests, x-rays, CT scan, or MRI.  Once a diagnosis is established, the physician will employ a specific treatment program with one or more of the following: pharmaceutical administration, surgery, chemotherapy, diet, exercise, Chiropractic care, acupuncture, or massage treatments.

About CT Scan

CT Scan, sometimes referred to as a CAT scan, is used to help doctors diagnose medical issues.  CT scan uses x-rays and high-tech computers to produce pictures of the body.  These pictures can be placed on a monitor, CD or printed out for viewing purposes.  CAT scans provided more detail than x-ray machine and scans internal organs, soft tissues, bones and blood vessels.  These pictures help doctors diagnose conditions such as cancer, infectious disease, heart problems and musculoskeletal disorders.  This tool is the best for scanning the chest or pelvic areas because it provides cross-sectional and detailed views of various tissues.  This tool is helpful to chiropractors because it helps diagnose spinal problems and injuries to the skeletal structures because it shows clear images of tiny bones and tissues.   Physicians use CAT scans for the following medical issues: injuries to the lungs, heart or other internal organs; tumors or guiding biopsies; measure bone density to help detect osteoporosis.   

 Qualifications for CT Technologist

Individuals can receive a certificate, associates, or bachelor’s degree in radiology.  Associate degrees are the most common form of education among CT Technologists today.  Others receive certificates, which typically take 21-24 months to obtain.  The Joint Review Committee on Education in Radiologic Technology has 213 programs for certificates, 397 programs for associate degrees, and 35 programs for bachelor’s degrees.  All programs include classroom and clinical work in physiology, radiation physics, and principles of imaging, medical terminology and several other topics.  High School students interested in this profession should take high school courses in chemistry, biology, physics and math.  Some states require that technologists obtain a license to operate machinery.  For the specific state license require, an individual should contact the states’ health board.  The American Registry of Radiologic Technologists (ARRT) administers exams to get licensed by the state.  Technologists eligible for certification must graduate from an accredited program approved by ARRT.  The student must also pass an examination.  Many employers would rather hire someone who has a certificate than someone who does not.  The ARRT certification requires that 24 hours of continuing education be completed every 2 years.  It’s important that radiologic technologists pay attention to detail and work well with others.  They must also be sensitive to their patients needs.

How it works

MRI is an abbreviation for Magnetic Resonance Image.  It is different from an x-ray because it takes pictures of organs, bones and muscle tissue without using radiation.  Instead of radiation, the MRI uses strong magnetic fields and radio frequency energy that generate images which can be viewed on a computer.  The MRI creates images that allow patients to view a healthy and unhealthy image of the affected area.  Before the test begins, the patient must fill out a medical history information sheet and remove all metal jewelry from their body.  Some things that may affect the test are pacemakers, metal implants, dentures, aneurysm clip, or a neurostimulator.  It is important that the patient tell the doctor if he/she has ever had surgery on involving the heart, eye, ear, brain or blood vessels.  Once he/she is ready they will lie on a narrow bed and the doctor will push them into a machine tube.  It generally takes 20-30 minutes for the procedure, but it depends what the doctor is screening for.  The patient may be asked to wear earplugs because certain scanners may produce loud noises.  The loud noises are completely normal and the patient should not be alarmed.  The MRI is painless and the machine never touches the patient’s body.  Once the images are complete the doctor or radiologist will review them with the patient.  Chiropractors use images from MRI’s to get a better understanding of the medical condition with the patient.  The high quality images are helpful when chiropractors are deciding on which method of treatment to use for the patient. 

Benefits and Risks of an MRI

An MRI is a non-invasive technique that does not expose the patient to harmful radiation.  The images from an MRI are very detailed and can help identify problems with soft tissue structures more accurately than an X-ray.  This is a valuable took when it comes to early diagnoses for serious conditions like tumors or cancer. 

Risks- If a patient has a metal plate in his/her body, it can distort the image.  Patients who have pacemakers or any metal implants near the eyes cannot be scanned by an MRI because the magnet can move the metal around.  Some patients may feel claustrophobic during an exam because they are in a magnetic tube.  Typically, the patient may hold a buzzer while being scanned and if they are not comfortable, they can push the buzzer to let the staff know they feel uncomfortable. 

A ruptured, or herniated, disc is a condition in which a small section of the nucleus of a spinal disc is pushed out into the spinal column through a tear in the outer shell of the disc. The result of this rupture can irritate nerves nearby, causing pain, weakness and numbness into the area of the body that is innervated by the involved nerve. If the ruptured disc is located in the lumbar spine, pain, numbness and weakness may be felt into the buttocks and lower extremities. If a disc in the cervical spine becomes ruptured, the pain, numbness and weakness may be felt into the shoulders and upper extremities. While pain from a ruptured disc is common, some people may experience a ruptured disc and feel no symptoms at all. Age related disc degeneration is the most common cause of a ruptured disc. As the disc ages, it loses some of its water content and becomes less flexible. The inflexibility of the disc combined with the instability of the aging vertebral column can lead to a rupture. Along with age, smoking, obesity, height and certain occupations that involve strain to the back are factors that can increase the risk of sustaining a ruptured spinal disc. Normally, a ruptured disc is not considered a medical emergency, although treatment can help a patient recover more quickly if they are experiencing painful symptoms from the herniation.

Help with a Diagnosis

As chiropractic physicians deal with musculoskeletal disorders of the body, many people will often first seek chiropractic care when experiencing back pain or extremity pain. During an initial visit, a health history and physical exam will be performed to help with a diagnosis. Other tests such as straight-leg raising and cross-leg raising will be done to make a determination of the type of dysfunction present in the spine. If either of these tests produces pain into the back or legs, a neurological exam will be performed that includes reflex testing, walking ability and balance and muscle strength. An x-ray may be taken to rule out other spinal dysfunction as it does not show this type of injury on plain film but may show problems with the vertebrae. An MRI may be ordered for the exact location of the ruptured disc to be seen and for the severity of the rupture to be determined. Studies have shown the some people who have suffered a ruptured spinal disc may find pain relief from sessions of acupuncture and massage therapy. Chiropractic manipulations also offer pain relief and provide a decrease in pressure on the affected disc. The decrease in pressure results in greater range of motion in the spine as well as less inflammation and pain. In some patients, if cauda equina syndrome is suspected or if their neurological testing produces results that are questionable, chiropractic care is not indicated for treatment and they will be referred to the appropriate specialist for care.

References Cited in this Article

www.mayoclinic.com

www.spineuniverse.com

The anatomy of the rotator cuff includes four muscles; the supraspinatus, the infraspinatus, the subscapularis and the teres minor. Several tendons are also present and this group of muscles and tendons cover the head of the humerus and allows the arm to rotate. A rotator cuff tear is a common shoulder injury and in most cases the supraspinatus muscle is the muscle that tears, although it can occur in any of the four muscles or tendons. A tear of the rotator cuff can occur from a sudden trauma, can accompany another injury to the shoulder region such as a fracture or a dislocation, or can be the result of overuse of the muscles of the rotator cuff. The most common cause of a rotator cuff tear is overuse of the muscles. Overhead movements such as those common in tennis, rowing, weight lifting and baseball increase the chances of injuring or tearing the rotator cuff. Symptoms of a rotator cuff tear include pain when attempting to lift the arm or lowering the arm when raised, a feeling of weakness and audible cracking when rotating the arm or moving it into certain positions. Atrophy, or wasting, of the muscles from lack of use may also occur if not treated in a timely fashion.

Avoid Surgery

A health history, thorough physical examination and at times, diagnostic imaging are used to diagnose a rotator cuff tear. An MRI is better able to show a tear of the rotator cuff as MRI’s are able to produce pictures of the soft tissues of the body. An examination of the neck may also be done to rule out the presence of a pinched nerve that may be present and referring pain into the shoulder area. Ruling our rheumatoid arthritis and osteoarthritis will also be done. In cases of a rotator cuff tear that does not require surgical intervention, conservative care may be appropriate in helping the muscles of the rotator cuff heal in a timely manner. In the acute stage of injury, rest and icing will be recommended to reduce inflammation. A sling may be necessary if movement during the day causes movement of the arm that produces pain. Strengthening exercises will follow the resting period as well as friction massage and rehabilitation. These forms of treatment can help to reduce pain and restore function to the shoulder and arm. Chiropractors can offer these medical treatments and the results are generally positive and long-lasting. In most cases, even patients who are 50 or 60+ years of age will respond well to this treatment plan and avoid surgery.

References Cited in this Article

www.aaos.org

www.dynamicchiropractic.com

An MRI, or magnetic resonance imaging, is a radiological device used to see structures of the body, including soft tissues. First performed on a human being in 1977, an MRI uses a powerful magnet, along with radio wave pulses, to generate a detailed picture of organs and other structures in the body. The MRI is an appealing diagnostic tool because it can show physicians more thorough information compared to x-rays, ultrasounds and CT scans. Because MRI’s can provide accurate views, they can be used for many reasons in any number of locations of the body. An MRI of the head can find aneurysms, damage to nerves of the eyes and ears, bleeding in the brain or find evidence of damage from a stroke. MRI imaging can be used to look at the heart and lungs, breast tissue, search for prostate cancer, locate arthritis in joints and provide clear images of spinal degeneration. A magnetic resonance angiography, or MRA, is a form of MRI that can be used with or without contrast and focuses on blood vessels and their flow. An MRA can detect aneurysms, tears in the lining of vessels and blocked arteries. There are three types of MRI machines, open, closed or standing.

Diagnostic Imaging

When a patient presents at a chiropractic clinic seeking care for a health issue, the physician will take a complete health history, physical examination, perform neurological and orthopedic tests, depending on what the health complaint may be, along with vital signs. If, after these tests, it is determined that there is no underlying condition that would be a contraindication to chiropractic care, the physician will treat the patient with manipulation and other modalities to help relieve the pain. When the treatment plan is followed and there is no improvement after a certain amount of time, the chiropractor may need some diagnostic imaging to see if there is something present that is hindering the progress of healing. An x-ray is usually the first step for diagnostic imaging but an MRI may be ordered to get a more detailed picture of the spine and its surrounding musculature. An MRI will show any damage to the vertebra and the spaces between them, nerve injury/impingement, spinal deformities and any dysfunction of the spinal muscles. This advanced form of diagnostic imaging is the best way for a chiropractic physician to get a clear picture of the musculoskeletal structures to arrive at an accurate diagnosis, to find out whether further chiropractic care is indicated or if the patient needs to be referred to another medical specialty for care.

References Cited in this Article

www.howstuffworks.com

www.webmd.com

www.spineuniverse.com

A CT scan is a computerized tomography scan that takes several x-rays from different angles to get cross-section images of the body. The images appear as slices and the radiologist and primary care physician can look at the individual slices or combine them to get a 3-D image of the bodily structures. Because of the slices and 3-D ability, CT scans are more visually helpful compared to a regular x-ray. A CT scan can provide images of bones and soft tissues to help a physician make a diagnosis while treating a patient. Because a CT scan can provide images of soft tissues, a physician may order these scans for views of the brain and also look for any blockage in arteries and veins using a contrast for better enhancement of the blood flow. If a contrast CT scan is ordered, contrast material is given to the patient either orally, through an intravenous line (IV) or rectally, for the viewing of the intestines. Unlike an MRI or ultrasound, during a CT scan, a patient will be exposed to a higher level of radiation, more than received during an x-ray. Although this exposure is brief, someone who is pregnant is not allowed to receive a CT scan due to the radiation risks to the unborn baby.

A Great Tool for Viewing

CT scans are often ordered by a chiropractic physician when simple x-ray images are not enough. This diagnostic imaging tool helps the chiropractor to see bodily structures that require a more detailed understanding of the dysfunction that is present and causing the patient pain. It is a great tool for viewing spinal structures as well as joints of the extremities. A CT scan allows a good view of fractures found in the spine and other bones of the body and will also show any disc herniation that may be present. Although inferior to an MRI, CT scans are effective enough to be routinely ordered by chiropractors for, most commonly, bony structures. Typically, a chiropractic office does not have a CT unit on site due to the cost of the unit and the amount of space it takes up so therefore a patient who needs a scan will be referred to an imaging clinic for the test. Once a CT scan has been performed, the images are stored in a computer and read by a radiologist. The results are then given to the chiropractic physician who will be able to determine if chiropractic treatment is indicated for future care for the patient or if they need to be referred to a specialist for a different treatment plan.

References Cited in this Article

www.mayoclinic.com

www.spineuniverse.com