Sandman K, Sandman T  J Manipulative Physiol The  1981;4: 19-20


ABSTRACT: 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 atlanto-axial subluxation. The case was determined to have erosive cervical spine changes and an increased atlanto-dental interval (ADI), thus contraindicating manipulative therapy. It was concluded that routine examination procedures may not be sufficient for evaluating this condition prior to manipulative therapy.

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