Objective: The purpose of this case series is to describe the use of diagnostic ultrasound (US) in the detection of occult rib and costal cartilage fractures presenting as chest wall pain to a chiropractic clinic. Clinical features: Three patients presented with chest wall pain and tenderness. Two of the patients presented with acute chest wall injury and 1 carried a previous diagnosis of rib fracture after trivial trauma 2 months earlier.Intervention and outcomes: Diagnostic US was selected as a non-ionizing imaging tool for these patients after negative digital radiography studies. All fractures were considered isolated as there was no associated injury, such as pneumothorax. Both of the acute cases were followed up to complete healing (evidence of osseous union) using US. All patients eventually achieved pain-free status. Conclusion: In these cases, US was more sensitive than radiography for diagnosing these cases of acute rib and costal cartilage fractures. Early recognition of rib injury could avoid potential complications from local manipulative therapy.
Objective: The purpose of this case report is to describe a patient with post traumatic myositis ossificans (PTMO) of the anterior thigh following blunt trauma and discuss the incidence, clinical presentation, management, and imaging findings. Clinical features: An 18-year-old male presented to a chiropractic clinic with a chief complaint of left knee pain and reduced range of motion after an impact injury to his left anterior thigh during hurdling 6 weeks earlier. Immediately after the injury, he presented to the emergency department where radiography of the left knee was negative and he was diagnosed with a muscle sprain. Followup radiography and ultrasonography of the left knee in a chiropractic radiology department revealed ossification consistent with PTMO within his vastus intermedius. Intervention and outcome: The patient underwent a course of rehabilitation for 2 months including ice, class IV cold laser and vibration applied to his anterior thigh, and myofascial release of his quadriceps musculature with targeted and progressive rehabilitative exercises. His left knee pain resolved within 2 weeks of care. He resumed sports participation (American football) pain-free, while wearing protective padding over the affected thigh, 1 month after presentation, which was approximately 2 1/2 months following his injury. Conclusion: This case demonstrates that ultrasonography may have the capability to detect early phases of PTMO approximately 2 weeks prior to radiographic evidence and to monitor progression throughout its course.
BackgroundTo determine whether a discrepancy exists in identifying three musculoskeletal landmarks (medial meniscus, lateral malleolus and lateral epicondyle of the humerus) and whether ultrasound-guided (US-guided) palpation intervention can reduce that discrepancy and improve localization for chiropractic interns.MethodsSixteen chiropractic interns were asked to identify three subcutaneous anatomical landmarks before/ after the intervention and at a 3-day follow-up. The intervention was a three-minute US-guided demonstration of the landmarks after the intern’s initial localization. The primary outcome measure was the change in distance between the intern’s landmark identification. Non-normal data were analyzed with the Friedman’s and Wilcoxon signed rank tests. Discrepancy between examiner-determined landmarks and intern-identified landmarks at the initial time point was assessed with a 1-sample Wilcoxon signed rank test.ResultsAll locations demonstrated an initial discrepancy between examiner-determined landmarks and intern-identified landmarks at the initial time point. Overall, a statistically significant difference was noted in the identification of the medial meniscus (p = 0.012) and lateral malleolus (p = 0.001), but not at the lateral epicondyle (p = 0.086). For the before and immediately after comparison, a significant improvement was found with the medial meniscus (p = 0.005) and lateral malleolus (p = 0.002). The 3-day post-intervention comparison found an improvement only for the lateral malleolus (p = 0.008).ConclusionThis pilot study demonstrated palpatory discrepancy at identifying all three landmarks. Our data suggests that US-guided palpation intervention seems to improve an intern’s ability to palpate two landmarks (medial meniscus and lateral malleolus) post-intervention.
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