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OBJECTIVES: The purpose of this case report is to describe a patient who presented with low back pain and episodic right lower quadrant pain who had a long-standing giant Meckel diverticulum with enteroliths. CLINICAL FEATURES: A 49-year-old woman presented to a chiropractic clinic with low back pain and history of intermittent right lower quadrant pain. Lumbar radiography demonstrated calcifications in the pelvic basin that changed position with changes in patient posture. The patient was referred to an abdominal surgeon for consultation and management. INTERVENTION AND OUTCOME: Computed tomography identified calcifications in the small bowel in the region of the ileocecal valve. The patient underwent prophylactic diverticulectomy with no complications. Gross pathology revealed a giant Meckel diverticulum measuring 24 inches (60.9 cm) containing 6 enteroliths. CONCLUSIONS: A timely diagnosis resulted in a favorable surgical outcome for this patient with long-standing giant Meckel diverticulum and enteroliths.

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OBJECTIVE: The aim of this case study is to describe a patient with low back pain due to renal cell carcinoma (RCC). A brief review of RCC, including clinical presentation, diagnostic imaging, treatment, and outcomes, is discussed. CLINICAL FEATURES: A 44-year-old man presented to a chiropractic clinic with chronic low back pain. Lumbar spine radiographs and follow-up computed tomography scan revealed renal calcification, which was first thought to be calcified hematoma, but later, biopsy confirmed that it was RCC. INTERVENTION AND OUTCOME: A nephrectomy was performed. At 7-year follow-up, the patient is healthy. CONCLUSION: Renal cell carcinoma is not uncommon, and its varied clinical presentation may lead individuals to seek a variety of health care providers. Spine practitioners should be aware of the possibility of RCC in the clinical presentation of low back pain.

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OBJECTIVE: The aim of this study is to describe a patient with painful osteoporotic compression fracture and subsequent relief from percutaneous vertebroplasty (PVP). A brief review of vertebroplasty including indications, contraindications, and potential complications is discussed. CLINICAL FEATURES: An 80-year-old woman presented with severe low back pain and no history of trauma. Initial radiographs showed a typical benign, osteoporotic compression fracture of L1. INTERVENTION AND OUTCOME: Percutaneous vertebroplasty was performed because of severe intractable low back pain. The patient had an excellent response to PVP. Postoperative radiographs showed only slight central compression fracture of L1 with partial central filling of the vertebral body with cement, and generalized osteopenia. CONCLUSION: This article provides a case study and an overview of PVP. Percutaneous vertebroplasty may be a viable option for treatment of painful vertebral compression fractures if more conservative measures are unsuccessful.

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OBJECTIVE: This case report describes and discusses the clinical presentation, diagnosis, and management of a patient with a sacral fatigue fracture. CLINICAL FEATURES: A 26-year-old female long-distance runner presented with nonspecific low-back and buttock pain that prevented her from training. INTERVENTION AND OUTCOME: Radiographic findings on the patient's lumbar spine and pelvis were interpreted as normal. Single-photon emission computed tomography and magnetic resonance imaging were performed, revealing a fatigue fracture of the left sacral ala. The patient discontinued training for 6 months and gradually returned to running. CONCLUSIONS: A high index of suspicion should prompt investigation with skeletal scintigraphy, computed tomography, or magnetic resonance imaging. Sacral stress fractures may respond well to conservative measures if diagnosed in a timely fashion.

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OBJECTIVE: To measure changes in the quadriceps femoris angle (Q-angle) after the insertion of full-length flexible orthotics. SETTING: Outpatient health center of Logan College of Chiropractic. SUBJECTS: A total of 40 male subjects were included in the study population. The selected population all demonstrated bilateral pes planus or hyperpronation syndrome. DESIGN: Before-after trial. METHOD: A cohort demonstrating bilateral hyperpronation was recruited. The subjects were cast according to standard protocols provided by the manufacturer. Subject right and left Q-angles were measured with and without the orthotic in place. The landmarks used were marked with a permanent marker, and great care was taken to accurately assess the angles formed. The evaluator was not told whether the measure was before or after orthotic insertion. A modified quailcraft goniometer was used. DATA ANALYSIS: The data set was collected and assessed by the t test. RESULTS: Thirty-nine of 40 test subjects showed reduced Q-angle, which was in the direction of correction. A 2-tailed matched sample showed statistically significant mean reduction in Q-angle measures. There was a minority of patients who showed asymmetrical Q-angle measures. Within this group there was greater symmetry of Q-angle measures after placement of the orthotic. CONCLUSION: Insertion of full-length, flexible orthotic devices significantly improves the Q-angle in hyperpronating male subjects. If the literature accurately links an increase in the Q-angle with a predisposition for knee injury, then the possibility of long-term benefits following the use of flexible orthotics exists. More research is required to determine whether these biomechanical changes are maintained after use of these orthotics.

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OBJECTIVE: To discuss the case of a 42-yr-old weightlifter with osteogenesis imperfecta. CLINICAL FEATURES: The patient had bilateral acute elbow pain and a previous history of more than 35 fractures of the spine and extremities. INTERVENTION: There is no current treatment for osteogenesis imperfecta. Treatment objectives were designed to minimize pain, improve range of motion, and decrease stress on the elbow joints. Nutritional supplementation was used to help maintain bone density. The elbow pain improved with treatment, and the patient has had no new fractures in the last 6 years. CONCLUSION: Although most patients with osteogenesis imperfecta are physically inactive because of the high risk of fracture, some patients with milder forms of the condition may be involved in some athletic activities. Although manipulation is contraindicated in patients with osteogenesis imperfecta, chiropractors may be of service by offering pain relief and rehabilitation, in addition to advice regarding nutrition and supplements.

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