Interesting Cases from Past Practice

Posted On: February 3, 2017

I am Dr. David Johnson and I have been practicing as a Chiropractic physician on Chicago’s North Shore since 1988. I was the first chiropractor ever in Lake Forest. Later in my career I received my Doctor of Physical Therapy degree in 2010.

As I have seen a wide variety of patients over the years I would like to share some of those experiences to help educate people interested that are interested such as chiropractic and physical therapy students. I will of course not use names or too many specifics so as to maintain anonymity for the patients.

The first case was a woman who came to me with a sciatic problem. She was in her early fifties. I took weight-bearing x-rays of her spine and pelvis. She had significant pelvic un-leveling as the result of having had a procedure when she was younger to build a new hip socket in her pelvis for a congenital hip dysplasia. This had in effect shortened the limb. Her spine had a significant corresponding compensatory scoliosis. She new she was to wear sole lift in her shoe but had never had as she didn’t like the bulkiness of the built up shoe.

On the clinical exam I could find nothing with my orthopedic tests that would provoke her pain, which she describes as a sharp lancinating pain that shot down her leg. I did ranges of motion and she had no pain. I did various straight legs raise maneuvers and couldn’t ferret it out. I tried to perform maneuvers like Kemp’s quadrant test to see if I could get a pain response to no avail.

Finally I got to my neurologic testing and tapped her patellar reflex and oh my, did she have hyperactive reflexes. They were 4+ bilaterally with clonus that wasn’t sustained. I next stroked a Babinski’s and it was not only up-going but it spread into hip flexion. I new this woman was in trouble and I told her that she needed to see a neurologist immediately. I had her wait while I called one.

I got the doctor on the line. I told him I had a woman whom I thought may have tethering of her spinal cord in a fairly severe scoliosis caused by her limb length discrepancy. He scoffed at me and said, “Do you know how rare that is?” I replied “Look I don’t know what is going on with this woman but she has hyperactive reflexes and an up-going Babinski’s will you see her?” He said, “Fine send her over.”
She went to see him that day or the next.

In about 10 days I got a call fro him and he explained he had her sent up to Mayo where they found a tethered cord in the scoliosis causing a it to drag her cerebellum down through her foramen magnum causing an Arnold Chiari malformation. She had had a craniectomy at Mayo and it relieved the cord tension and subsequently her symptoms.

The woman was happy, he was happy and I was relieved. Needless to say that neurologist referred many a patient my way.

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