A case is presented in which a 35-year-old female, with previously diagnosed rheumatoid arthritis located predominately in the upper extremities and cervical spine, presented to a chiropractic college clinic for evaluation and possible therapy. The prior diagnosis was confirmed through routine physical, orthopedic and roentgenologic examination, however, since the patient was a potential candidate for manipulative therapy, it was decided that the routine films should be supplemented with flexion-extension studies and tomographic studies to evaluate for cervical spine erosion and potential for pathologic atlantoaxial subluxation. The case was determined to have erosive cervical spine changes and an increased atlantodental interval (ADI), thus contraindicating manipulative therapy. It was concluded that routine examination procedures may not be sufficient for evaluating this condition prior to manipuluative therapy.
Author keywords: rheumatoid arthritis, cervical spine, chiropractic therapy, contraindications
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