The X-Files: September 2007
By Marshall Deltoff
By Marshall Deltoff
This 32-year-old male producer presented with an 18-month history of bilateral shoulder/arm pain.
My sincere appreciation to Dr. Barry Shapiro of Toronto for this anomaly. This 32-year-old male producer presented with an 18-month history of bilateral shoulder/arm pain. The pain extended across the shoulder blades and down into both elbows with paresthesias; the right side was worse. He sustained a ski injury in 1996. The symptomatic areas were aggravated by stress and sitting.
Cervical ranges of motion were restricted in left rotation with extension. C5-C6 and C6-C7 demonstrated fixation. Spinous process approximation was present from T4 through T7. The patient had a history of low back flare-ups for a few years. The left sacroiliac joint was fixated. The patient had been sleeping on his right side with two pillows.
Radiographs (Figure 1) reveal a left T1 hemivertebra, which is congenitally fused to the suprajacent C7 vertebral body. The right first rib appears to articulate with the right C7 transverse process. Additionally, there is an old compression fracture of T12 (Figure 2), related to the skiing accident.
The patient has been treated normally with adjustments in both the lower cervical and upper thoracic regions, including crossed bilateral, combinations, thumb contacts and rotary cervical. The patient has been able to reduce care to a maintenance level, and reports that he is no longer symptomatic.
Hemivertebra Discussion :
• results from improper or failed development of a lateral half of a vertebral body as a consequence of an absence of a primary lateral ossification centre
• triangular or wedge-shaped
• often has a normal rib projecting from the ossified side; the contralateral rib may be missing
• suprajacent and subjacent vertebral bodies are usually deformed to compensate for the deficient wedge-shaped vertebra
• can be multiple
• represent a major etiology for congenital scoliosis
• accompanying scoliosis in 15-20 percent of cases•
Deltoff MN, Kogon PL. The Portable Skeletal X-ray Library. Year-Book Mosby. St. Louis 1997.