Chiropractic Care in the Management of Inactive Ankylosing Spondylitis: A Case Series.

OBJECTIVE: This report describes chiropractic management for 3 cases of inactive ankylosing spondylitis (AS). CLINICAL FEATURES: A 25-year-old woman presented with chronic, mechanical neck pain and stiffness that was ultimately diagnosed as AS. A 23-year-old man presented with chronic low back and left hip pain that was diagnosed as AS. A 31-year-old man with low back pain presented with a known diagnosis of AS. Physical examination in 2 cases failed to identify systemic findings associated with AS. In the third case, examination revealed a history of ulcerative colitis. Laboratory examination of case 2 yielded a positive HLA-B27, but cases 1 and 3 were HLA-B27 negative. The acute reactants were negative in all 3 patients, indicating an inactive phase of disease. All 3 patients underwent spinal imaging including sacroiliac joint radiography. In case 3, magnetic resonance imaging of the sacroiliac joints was performed. All 3 imaging examinations revealed bilateral, symmetric sacroiliitis. INTERVENTIONS AND OUTCOME: Patients were managed by both a medical rheumatologist and a doctor of chiropractic. Chiropractic care ranged from instrument-assisted spinal manipulation to diversified spinal and soft tissue manipulation and Cox flexion-distraction. Patients were given home stretches and rehabilitation exercises. All 3 patients experienced some relief of their symptoms including pain reduction and improved activities of daily living. CONCLUSION: These 3 patients displayed differences and commonalities in clinical, laboratory, and imaging features. Chiropractic manipulation and rehabilitation seemed to be beneficial in reducing symptomatology and improving musculoskeletal function for these 3 patients. These findings suggest the potential for collaborative or integrative management in similar cases.

Shoulder Internal Derangement and Osteoarthritis in a 25-Year-Old Female Softball Athlete.

OBJECTIVE: The purpose of this report is to describe osteoarthritis and internal derangement of the shoulder in a collegiate softball player. CLINICAL FEATURES: A 25-year-old female softball athlete presented with a history of chronic right shoulder pain. A thorough clinical examination and multiple imaging studies were performed. Osteoarthritis was demonstrated on radiographs, and ligamentous and rotator cuff tendon tears were displayed on magnetic resonance imaging. The patient's treatment plan included full spine manipulation, cold laser therapy, kinesiotaping, stretching, and neuromuscular reeducation of the right shoulder. INTERVENTIONS AND OUTCOMES: The patient reported a decrease in symptoms after 1 month, although treatment was sporadic because of poor patient compliance. CONCLUSION: Osteoarthritis and internal derangement may occur in overhead-throwing athletes, and correct imaging is needed for timely and accurate diagnoses. Following a timely diagnosis, the young patient in this case had a good recovery with multimodal chiropractic care.

Environmental estrogens suppress hormones, behavior, and reproductive fitness in male fathead minnows.

This study explored the possibility that environmental estrogens in sewage effluent may reduce the reproductive fitness of adult male fish by suppressing their reproductive behaviors, including their ability to compete for nests and females. Male fathead minnows (Pimephales promelas) were exposed for three weeks to either blank control, effluent released by a sewage treatment plant (STPE), waterborne estradiol (E2), or a synthetic androgen (methyltestosterone [MT]). Afterward, fish were placed with females and a nest, and their behavior was monitored for 5 d in either the presence or the absence of a competing (unexposed control) male. Males exposed to either the STPE or E2 (approximately 50 ng/L, a level chosen to mimic the estrogenic content of the STPE) had elevated levels of circulating vitellogenin (p < 0.05) and lower levels of 11-ketotestosterone (KT; p < 0.05). Nearly all STPE- and E2-exposed males spawned successfully in the absence of a competing male, but in both cases, exposed males suffered nearly total reproductive failure when they had to compete. Conversely, males exposed to MT (approximately 50 ng/L) outcompeted control males. Behavioral observations suggested that subtle differences in agonistic behaviors, typically associated with circulating androgens (i.e., KT), were responsible. We speculate that male fish exposed to estrogenic effluent in the field are less likely to reproduce successfully within large populations of wild fish, thereby causing abnormal and potentially detrimental patterns of gene flow within those populations.