Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders July 2020; Vol. 13; pp. 1–4

Eric Chun Pu Chu, Divya Midhun Chakkaravarthy, Fa Sain Lo, Amiya Bhaumik: From New York Chiropractic & Physiotherapy Centre, and School of Medicine, Lincoln University College, Malaysia. This study cites 14 references.

In the intricate landscape of pediatric health, a 10-year-old boy’s journey through repetitive episodes of torticollis, hospitalization, and traction unveils the rare occurrence of atlantoaxial rotatory subluxation (AARS). This case report not only navigates the complexities of the condition but also sheds light on the transformative impact of chiropractic intervention.

  • Understanding Atlantoaxial Rotatory Subluxation (AARS)
  • AARS involves the loss of normal alignment and stability between the first (atlas) and second (axis) cervical vertebrae.
  • Typically rare, AARS can arise in children due to increased ligamentous laxity following minor trauma.
  • Diagnosis is often challenging, with rotatory subluxation easily missed in emergency settings for patients presenting with neck pain and torticollis.
  • The Crucial Role of C1-C2 Articulation in Children
  • The C1-C2 articulation, responsible for 60% of total rotation in the craniocervical region, is inherently hypermobile in children compared to adults.
  • Non-traumatic C1-C2 instability primarily occurs during childhood, making early diagnosis and intervention critical.
  • Case Report Highlights
  • The 10-year-old boy presented with torticollis, initially diagnosed as acute torticollis by the family doctor.
  • Subsequent hospital assessments revealed AARS through open-mouth odontoid radiographs and dynamic CT scans.
  • Conventional treatments, including traction, cervical collars, and analgesics, provided temporary relief but failed to address the root cause.
  • The Turning Point: Chiropractic Intervention
  • A multidisciplinary spine team referred the patient to a chiropractic clinic after seven months of unresolved symptoms.
  • Following five months of chiropractic treatment, the boy became asymptomatic, regaining nearly full range of neck movement.
  • Multimodal Chiropractic Treatment
  • Chiropractic care included intermittent motorized traction, thermal ultrasound therapy, spinal adjustments, and stretching exercises.
  • The child’s pain medication (acetaminophen) was discontinued by the end of the treatment, and neurological function remained intact.
  • Redefining Diagnosis and Treatment
  • Cervical radiographs, particularly open-mouth views, prove effective in identifying C1-C2 subluxation.
  • The article emphasizes the necessity of ruling out red flags, trauma, and contraindications before proceeding with manual therapy.
  • Chiropractic Approach and Long-Term Management
  • The chiropractic approach aimed to address tight musculature, provide joint mobilizations for pain relief, and incorporate strengthening exercises for stabilization.
  • Regular treatments led to a significant reduction in pain, restoration of cervical mobility, and eventual discontinuation of the cervical collar.
  • Unveiling Gynecomastia and Acetaminophen Effects
  • The case incidentally revealed gynecomastia, highlighting the potential estrogenic effects of acetaminophen.
  • Gynecomastia, a common occurrence in preteen boys, was linked to the temporary hormonal imbalance induced by acetaminophen.
  • The Path Forward: Further Research and Clinical Insights
  • Despite the success in this case, the article underscores the need for larger studies to explore the clinical impact of chiropractic interventions on immune function and calls for continued research in this promising field.

In conclusion, this case report not only unravels the complexities of AARS but also underscores the pivotal role of chiropractic care in addressing such challenging pediatric conditions. As we delve into the nuanced interplay of spine health, neurology, and hormonal influences, the case serves as a beacon for further exploration and understanding in the realm of chiropractic medicine.