Differential Diagnosis and Management for the Chiropractor, Third Edition: Protocols and Algorithms

1047 Pages·2005·36.6 MB·English

by  Thomas Souza

Contents
Ackowledgments xi CHAPTER 4 Thoracic Spine Complaints 89
Introduction Xlll Context 89
General Strategy 89
Relevant Anatomy 90
PART I Musculoskeletal Complaints
Biomechanics 91
CHAPTER 1 General Approach to Musculoskeletal Evaluation 92
Complaints 3 Management 95
Selected Disorders of the Thoracic Spine 99
Context 3
Appendix4--1 102
General S tra tegy 4
Thoracic Diagnosis Table 103
History 8
Examination 20
Management 26 CHAPTER 5 Scoliosis 105
Appendix 1-1 42 Context 105
Appendix 1-2 42 General Strategy 105
Appendix 1-3 44 Idiopathic Scoliosis Etiology 106
Evaluation 107
CHAPTER 2 Neck and Neck! Arm Complaints 45 Management 115
Summary 119
Context 45
Appendix 5-1 123
General Strategy 46
Relevant Anatomy and Biomechanics 51
Evaluation 53 CHAPTER 6 Lumbopelvic Complaints 127
Management 60 Context 127
Selected Causes of Cervical Spine Pain 68 General Strategy 128
Appendix 2-1 72 Relevant Anatomy, Physiology, and
Neck Diagnosis Table 75 Biomechanics 128
Evaluation 131
CHAPTER 3 Temporomandibular Complaints 77 ~anagement 147
Selected Disorders of the Low Back 157
Context 77
Appendix 6-1 166
General Strategy 77
Low Back Diagnosis Table 171
Relevant Anatomy and Biomechanics 78
Evaluation 79
CHAPTER 7 Shoulder Girdle Complaints 175
Management 82
Context 175
Selected TMJ Disorders 86
General Strategy 176
Appendix 3-1 88
v
Relevant Anatomy and Biomechanics 177 Selected Disorders of the Knee 349
Evaluation 179 Appendix 12-1 362
Management 193 Kllee Diagnosis Table 365
Selected Disorders of the Shoulder 202
Appendix 7-\ 214 CHAPTER 13 Lower Leg Complaints 369
Shoulder Diagnosis Table 218 Context 369
General Strategy 369
CHAPTER 8 Elbow Complaints 221 Relevant Anatomy 370
Context 221 Evaluation 370
General Strategy 221 Management 372
Relevant Anatomy and Biomechanics 222 Selected Disorders of the Lower Leg and Posterior
Evaluation 223 Heel 375
Management 228 Appendix 13-1 379
Selected Disorders ofthe Elbow 232
Appendix 8-1 237 CHAPTER 14 Foot and Ankle Complaints 381
Elbow and Forearm Diagnosis Table 238 Context 3Rl
General Strategy 381
CHAPTER 9 Wrist and Forearm Complaints 241
Relevant Anatomy and Biomechanics 382
Context 241 Evaluation 385
General Strategy 241 Management 392
Relevant Anatomy and Biomcchanics 243 Selected Foot Disorders 404
Evaluation 244 Appendix 14-1 412
Management 251 Foot/Ankle/Lower Leg Diagnosis Table 414
Selected Disorders of the Wrist and Forearm 254
Appendix 9-1 265
PART II Neurologic Complaints
CHAPTER 10 Finger and Thumb Complaints 267
CHAPTER 15 Weakness 421
Context 267
Context 42 J
General Strategy 267
General Strategy 421
Relevant Clinical Anatomy 268
Relevant AnatolllY and Physiology 423
Evaluation 269
Evaluation 423
Management 273
Management 429
Selected Disorders of the Finger, Thumb, and
Selected Neurologic and l\1uscular Diseases 433
Hand 280
Appendix 15-1 438
Appendix 10-1 289
\Vrist and Hand Diagnosis Table 291
CHAPTER 16 Numbness, Tingling, and Pain 439
CHAPTER 11 Hip, Groin, and Thigh Complaints 295 Context 439
Context 295 General Strategy 439
General Stratef.,'Y 295 Relevant Anatomy 44 J
Relevant Anatomy 296 Evaluation 442
Evaluation 298 Management 447
Ivlanagement 303 Appendix 16-1 449
Selected Disorders of the Hip, Groin, and Appendix 16-2 449
Thigh 307
Appendix 11-1 317 CHAPTER 17 Headache 451
Hip Pain Diagnosis Table 318 Context 4.5 1
General Strategy 452
CHAPTER 12 Knee Complaints 321 Theories of Causation of Primary Headaches 454
Context 321 Management 461
General Strategy 322 Selected Headache Disorders 468
Relevant Anatomy and Biomechanics 323 Appendix 17-1 472
Evaluation 325 Appendix 17-2 472
Management 336 Headache Diagnosis Matrix 477
vi Contents
CHAPTER 18 Dizziness 481 Management 557
Context 481 Appendix 23-1 561
General Strategy 481 Appendix 23-2 561
Relevant Anatomy and Physiology 483
CHAPTER 24 Hypertension 563
Evaluation 484
Context 563
Management 490
Relevant Physiology 563
Selected Causes of Vertigo 499
General Strategy 564
Appendix 18-1 502
Evaluation 564
CHAPTER 19 Seizures 505 Management 567
Context 505 Appendix 24-1 572
General Strategy 506 Appendix 24-2 573
Definitions and Classifications 506
CHAPTER 25 Lower Leg Swelling 575
Relevant Anatomy and Physiology 510
Context 575
Evaluation 510
General Strategy 575
Management 512
Relevant Physiology and Anatomy 575
Appendix 19-1 517
Evaluation 577
Appendix 19-2 517
Management 578
Selected Causes of Lower Leg Swelling 580
PART III General Concerns
Appendix 25-1 583
CHAPTER 20 Depression 521
CHAPTER 26 Lymphadenopathy 585
Context 521
Context 585
General Strategy 521
General Strategy 585
Terminology and Classification 522
Relevant Anatomy and Physiology 586
Evaluation 524
Evaluation 586
Management 525
Management 587
Appendix 20-1 528
Selected Causes of Lymphadenopathy 589
Appendix 20-2 528
Appendix 26-1 591
CHAPTER 21 Fatigue 531
CHAPTER 27 Skin Problems 593
Context 531
Context 593
General Strategy 531
General Strategy 596
General Discussion 532
Evaluation 597
Evaluation 533
Management 601
Management 535
Appendix 27-1 601
Selected Disorders Presenting as Fatigue 538
Appendix 21-1 544 CHAPTER 28 Vaccination: A Brief Overview 603
Context 603
CHAPTER 22 Fever 547 OPV (Polio) 607
Context 547 MMR (Focus on Measles) 607
General Strategy 548 DPT (Focus on Pertussis) 607
Relevant Physiology 548 Summary 608
Hyperthermia 548 Some Childhood Diseases 609
Evaluation 549 Appendix 28-1 611
Management 551 Appendix 28-2 611
Appendix 22-1 552
CHAPTER 29 Weight Loss 613
CHAPTER 23 Sleep and Related Complaints 553 Context 613
Context 553 General Strategy 613
General Strategy 553 Relevant Physiology 614
Relevant Anatomy and Physiology 554 Evaluation 614
Classification System 555 Management 616
Evaluation 556 Appendix 29-1 619
Contents vii
CHAPTER 30 Weight Gain/Obesity 621 Evaluation 690
Context 621 Management 691
General Strategy 622 Selected Causes of Voiding Dysfunction or
Pain 695
Evaluation 623
Appendix 35-1 698
Management 623
Appendix 30-1 626 Appendix 35-2 698
Appendix 30-2 626
CHAPTER 36 Enuresis 699
CHAPTER 31 Osteoporosis 627 Context 699
Context 627 General Strategy 699
General Strategy 627 Relevant Anatomy and Physiology 700
Relevant Anatomy and Physiology 628 Evaluation 700
Evaluation 628 Management 701
Management 631 Appendix 36-1 703
Appendix 31-1 633
CHAPTER 37 Vaginal Bleeding 705
Context 705
PART IV Gastrointestinal Complaints General Strategy 705
Relevant Anatomy and Physiology 705
CHAPTER 32 Abdominal Pain 637 Evaluation 706
Context 637 Management 706
General Strategy 637 Appendix 37-1 709
Relevant Anatomy and Physiology 638
Evaluation 640
PART VI Cardiopulmonary Complaints
Examination 645
Management 647 CHAPTER 38 Syncope/Presyncope 713
Selected Causes of Acute Abdominal Pain 651 Context 713
Selected Causes of Recurrent Abdominal Pain 656 General Strategy 713
Appendix 32-1 662 Relevant Physiology 713
Appendix 32-2 662 Evaluation 714
Management 716
CHAPTER 33 Constipation 665 Appendix 38-1 716
Context 665
General Strategy 665 CHAPTER 39 Chest Pain 717
Relevant Anatomy and Physiology 666 Context 717
Evaluation 667 General Strategy 717
Management 669 Relevant Anatomy and Physiology 717
Appendix 33-1 673 Evaluation 722
Managen1ent 724
CHAPTER 34 Diarrhea 675 Selected Causes of Chest Pain 726
Appendix 39-1 734
Context 675
Appendix 39-2 734
General Strategy 675
Relevant Anatomy and Physiology 678
CHAPTER 40 Palpitations 735
Evaluation 678
Context 735
Management 680
General Strategy 735
Appendix 34-1 683
Relevant Anatomy and Physiology 736
Evaluation 736
Management 739
PART V Genitourinary Complaints
Possible Causes of Palpitations 742
CHAPTER 35 Urinary Incontinence and Voiding Appendix 40-1 743
Dysfunction 687
CHAPTER 41 Dyspnea (Difficulty Breathing) 745
Context 687
Context 745
General Strategy 687
General Strategy 745
Relevant Anatomy and Physiology 689
viii Contents
Relevant Anatomy and Physiology 748 Appendix 46-1 817
Evaluation 749 Appendix 46-2 817
Management 751
Selected Causes of Dyspnea 754 CHAPTER 47 Tinnitus 819
Appendix41-1 758 Context 819
Appendix 41-2 758 General Strategy 819
Relevant Anatomy and Physiology 819
CHAPTER 42 Cough 761 Evaluation 820
Context 761 Management 820
General Strategy 761 Appendix 47-1 823
Relevant Anatomy and Physiology 762
Evaluation 762 CHAPTER 48 Epistaxis (Nosebleed) 825
Management 764 Context 825
Selected Causes of Cough 768 General Strategy 825
Appendix 42-1 770 Relevant Anatomy 825
Evaluation 826
Management 826
PART VII Head and Face Complaints
Appendix48-1 826
CHAPTER 43 Eye Complaints 775
CHAPTER 49 Sore Throat 827
Context 775
Context 827
Review of General Terminology 77 5
General Strategy 827
General Strategy 776
Evaluation 828
Evaluation 777
Management 829
Management 780
Appendix 49-1 830
Selected Causes of Vision Loss 784
Appendix 43-1 788
Appendix 43-2 788
PART VIII Special Conditions
CHAPTER 44 Facial Pain 791 CHAPTER SO Diabetes Mellitus 833
Context 791 Context 833
General Strategy 791 General Strategy 834
Relevant Neurology 792 Relevant Physiology 834
Evaluation 792 Evaluation 836
Management 793 Management 838
Facial Pain Caused by Neuralgias 796 Appendix 50-1 842
Appendix 44--1 797 Appendix 50-2 842
CHAPTER 45 Ear Pain 799 CHAPTER 51 Thyroid Dysfunction 845
Context 799 Context 845
General Strategy 799 General Strategy 845
Relevant Anatomy and Physiology 799 Relevant Physiology 846
Evaluation 800 Evaluation 846
Management 801 La bora tory Testing and Managemen t 847
Selected Causes of Ear Pain 805 Selected Thyroid Disorders 849
Appendix 45-1 808 Appendix 51-1 852
Appendix 45-2 808
CHAPTER 52 Hyperlipidemia 853
CHAPTER 46 Hearing loss 809 Context 853
Context 809 General Strategy 853
General Strategy 809 Relevant Physiology 854
Relevant Anatomy and Physiology 810 Evaluation 854
Evaluation 810 Management 857
Management 812 Appendix 52-1 865
Selected Causes of Hearing Loss 816 Appendix 52-2 865
Contents ix
CHAPTER 53 Anemia 867 Specific ~anagement Issues 955
Context 867 Appendix 55-1 958
General Strategy 867 Appendix 55-2 958
Relevant Physiology 869
CHAPTER 56 The Female Patient 961
~anagement 871
Selected Anemias 875 Context 961
Appendix 53-1 878 General Strategy 962
Female Hormonal and Reproductive
Physiology 963
PART IX Special Patient Groups Focused Issues 965
Appendix 56-1 990
CHAPTER 54 The Pediatric/Adolescent Patient 883 Appendix 56-2 990
Context 883
General Strategy 883
Sports-related Issues in the Young Patient 900
Appendix
A Region-based Approach to Complaints and
Concerns ofPatientlParent 917 Pharmacology for the Chiropractor:
Appendix 54-1 929 How ~edications ~ay Affect Patient
Appendix 54-2 930 Presentation and ~anagement Outcomes 993
CHAPTER 55 The Geriatric Patient 933 Concensus Document for the Operationally
Defined Use ofI.CD. Codes: Palmer
Context 933
Chiropractic College West Clinics 1027
General Strategy 935
Relevant Anatomy and Physiology 937
Evaluation 940 Index 1029
Focused Concerns 944
x Contents
Acknowledgments
I would like to express my appreciation to those who have ment used in this text. Special thanks to Greg Snow, D.C.
contributed to the editing of the first two editions. This Repeated thanks goes to John Boykin for his photogra
includes many of the department chairs at variolls chi phy and advice. As usual, a task this size is not possibJe
ropractic colleges. In particular, my thanks go to Robert without the dedication and hard work from the editorial
Mootz, D.C., and Dominick Scuderi, D.C. Also, I would and production staff at the publisher, Jones & Bartlett.
like to thank the clinical professors at Palmer College of Special thanks to Chambers Moore,Jenny McIsaac, Anne
Chiropractic \Nest for their help in developing the T.C.D. Spencer, Amy Rose,J ack Bruggeman, and everyone else
(International Classification of Diseases) Code docu- who assisted in this project.
xi
Introduction
What would warrant a third edition? The mere fact that new information is being generated at an ex
ponential rate may seem justification enough, yet another area of need is to refocus based on "trends"
in science and theories applied to disease and health. Additionally, as with the second edition, rec
ommendations from readers have led to changes in format and design.
The most prevalent themes running through the current literature regarding the practice of health
professionals include among others:
• An evidence-based approach to evaluation and management of patients. The most recent trend
is a "best-practices" approach.
• The new knowledge provided by the human genome project and the discovery of the impor
tance of the interaction between genes and the environment. For example, we now know that
patients respond to various medications differently because of genetic predisposition. Some in
volve having or not having a gene and some involve mutations of a given gene. This is also true
for certain sub-groups of patients at risk for various diseases including breast cancer and colorectal
cancer.
• The understanding that many diseases that were thought to be unrelated have a common un-
derlying inflammatory process.
• Recent discoveries about the relationship among disease, diet, and lifestyle.
• The alarming rate of increase of obesity in the U.S.
• An increase in diabetes and hypertension resulting in the development of pre-diabetes and pre
hypertension threshold levels now used as initiating points for management.
As with the previous two editions, there continues to be a dedication to the most current research
regarding the recommendations for the use of evaluation and management tools. An enormous in
crease in the number of papers focusing on the reliability, sensitivity/specificity, and validity of a num
ber of tests (in particular orthopedic tests) has emerged. With this new information, many traditionally
held approaches are being questioned. This focus on clinical research is a more appropriate evalua
tion of patients rather than a memorized list or ritualistic testing.
In the search for an evidence-based approach, no single profession or specialty is safe from scrutiny.
Some studies have questioned the value of chiropractic manipulation/adjusting versus other conser
vative approaches. Others question the use of surgery for conditions that apparently resolve on their
own or simply reach a level of improvement without surgical intervention similar to those patients hav
mg surgery.
WIthin chiropractic there has always been the background concern aboutvertebrobasilar accidents re
lated to cervical adjustments. Researchers have redirected the spotlight on the need for a procedure (i.e.,
cervical adjustments/manipulation) to determine if it is "worth the risk" however rare. Most impo~­
tantly, though, research has supported the rare occurrence of these events and exposed the poor SCI
ence which was used to magnify the effect unjustifiably raising it to the level of relatlVely common
xiii
concern. Other research is indicating that the maneuver itself may be less traumatic than previously
assumed. The jury is out, but the science is mounting toward a cautious, yet supportive case for the
safety of cervical adjusting/manipulation.
The increasing use of medications is staggering. At the very least, this warrants a working knowl
edge of commonly used medications and general classifications of medications to better understand
patient presentations and responses to care. To assist in this goal I have added a quick drug reference.
This may appear antithetical to the drugless approach adopted by chiropractic, yet, far too many
times a patient's diagnosis and outcome from care are influenced by these medications. It is therefore
necessary to have a reference to determine some proposed mechanisms and possible side-effects of
these medications.
Finally, as a spin-off from a project at Palmer College of Chiropractic West, I have included a
table of reference for commonly used ICD-9 (International Classification of Diseases) Codes for
commonly seen conditions that are primarily neuro-musculoskeletal. These tables were developed as
part of a consensus process to address the problems of variability of use in practice and also the lack
of a specific code and/or criteria for commonly seen presentations. These are simply recommended
use guidelines and are not intended as broad-based consensus agreement among all chiropractors. Yet,
these tables may help identify key criteria for the use of many commonly used codes, thereby allow
ing a more standardized approach.
Also added to this new edition are:
• Over 500 new references
• Tables that summarize over 100 additional disorders (less commonly seen emphasis) including:
.. Arthritides
• Myopathies
Neuropathies
ill
Anemias
!II
Cancer/tumors
Ii!
• Inherited disorders
• Summary pages for the following:
• Veretebrobasilar accidents (VBAs)
Vaccination issues
III
Popular diets
II!
Anti-Inflammatory diet
II
As part of a best-practices approach, I have added some key websites after many of the chapters.
Following this introduction are some general websites related to chiropractic, for general searches,
and for evidence-based/guideline resources. These are essential for filling the gap between editions
of the text.
Thomas Souza, D.C., DACBSP
xiv Introduction
National Guidelines Clearinghouse: Guidelines
WEBSITES
from the U.S. Agency for Health Care Policy &
Chiropractic Websites Research, the U.S. Preventive Services Task Force,
and other agencies
American Chiropractic Association
http://www.guidelines.gov
http://www.amerchiro.org/
National electronic Library for Health (NeLH)
International Chiropractic Association
Guidelines Finder: A database containing over
http://www.chiropractic.org/
600 UK national guidelines with links to Internet
downloadable versions
Evidence-Based Sites
http://www.nelh.nhs. uk!g uidelinesfinder
Agency for Health Care Research and Quality
New Zealand Guidelines Group
http://www.ahcpr.gov/
http://www.nzgg.org.nz
Cochrane Database
Prodigy (Practical Support for Clinical Govern
http://www.update-software.com!cochrane/
ance): Clinical guidance products from UKNHS
Center for Evidence-Based Medicine http://www. prodigy.nhs. uk!c linicalguidance
http://www.cebm.netl
Rehabilitation Guidelines: Evidence-based reha
bilitation guidelines from the University of Ottawa
Evidence-Based Medicine
http://www.health.uottawa.calEBCpg/e nglish
http://ebm.bmjjournals.com!
Scottish Intercollegiate Guidelines Network (SIGN)
Practice Guideline Sites
http://www.show.scot.nhs. uk!s ignlindex.html
Alberta Medical Association Clinical Practice Guide
lines Program Databases
http://www.albertadoctors.org/resources/
PUB MED: www.ncbi.nlm.govlPub Med/
guideline.html
CINAHL: www.cinahl.com
British Columbia Medical Services Plan: A list of
guidelines and protocols from the BC Ministry of MANTIS: www.health.index.com
Health Services
COCHRANE LIBRARY:
http://www.hlth. gov. bc/c almsp/protoguides/
www.update-software.com
gps/index.html
DARE: http://agatha.york.ac_uk!darehp
Canadian Medical Association Clinical Practice
Guidelines (CPG) Infobase CLINICAL EVIDENCE:
http://mdm.calc pgsnewlc pgs/index.asp www.clinicalevidence.com
Canadian Task Force Preventive Health Care, PEDro: www.cohs.usyd.edu.au
Canadian Guide to Clinical Preventive Health
Care: Full text of the Task Force guidelines on screen CAMPAIN TECHNOLOGY REPORTS:
ing and other preventive health measures www.campain.umm.edu.ris/ris/web.isa
http://www.ctfphc.org
HSTAT : http://hstat.n1m.nih. gov.!
College of Physicians and Surgeons of Alberta:
HTA-UK: www.ncchta.orglhtapubs.htm
The college is responsible for setting standards of
medical practice in Alberta CCOHTA: www.ccohta.ca
http://www.cpsa.ab.calpublicationsresources/
GUIDE TO HEALTH TECHNOLOGY
policies.asp
ASSESSMENT ON THE WEB:
HSTAT: Full text of practice guidelines, consumer www.ahfmr.ab.ca
information, and consensus statements from U.S. gov
ernment agencies
http://text.n1m.nih.gov
Introduction xv