A Clinical Case Study: A 57 year old male with sudden onset unexplained bilateral upper and lower limb weaknessFriday 02 November 2018
Mr B, a 57 year old male, non smoker for 11 years, with no health issues apart from high blood pressure presented with a 7 week history of sudden onset bilateral weakness of the arms and shoulders. Mode of onset was attributed to lifting a heavy box at work: the next day he was unable to lift his arms and for the following 6 days he was unable to lift a fork to his mouth. He denied cervical, shoulder, arm or thoracic pain. Gradually he regained some strength but was unable to abduct his arms above 45°. A week or so later he felt severe tightening of the calf muscles bilaterally, followed by bilateral thigh weakness when walking, especially when walking up stairs. When he presented to me, he claimed that walking 100 meters was difficult and that he needed to rest his legs. He denied any sensory changes. Mr B had consulted his GP as soon as he noticed the weakness in his arms. Blood tests were within normal limits except for elevated WBC. No further action was taken by the GP.
DTR C7 and L4 1+, absent DTR C5, C6, L5, S1.
Myotomal Strength Tests
Upper limbs: Unable to abduct shoulders to 90° and unable to hold passively abducted arm up against gravity. Bilateral weakness of wrist extensors, biceps, triceps ECU and finger extensors. Finger flexors strength was retained
Lower Limb: significant bilateral weakness of Quads, Tib Ant, Tib post/ EHL, Hamstrings and Peroneal muscles.
Unable to heel walk but able to toe walk with difficulty.
Facial and jaw muscles unremarkable
Acute Flaccid Myelitis
At the first treatment Mr B was adjusted using Sacro Occipital Technique protocol for Category 1 with SB-. I referred Mr B back to his GP requesting MRI and neurological consult.
At his next appointment 6 days later Mr B reported no change and this appeared to be the case on examination. Further examination revealed positive indicators on the occiput and T7 TVP indicating disruption of the lymphatic system. I treated Mr B using Chiropractic Manipulative Reflex Technique to restore neuromuscular function at T7 and aid return of lymphatic fluid to the spleen. I retested Mr B immediately after treatment and found increased strength in all myotomes but most significant in the quads, hamstrings and deltoids. Mr B was able to abduct his arms to 90 degrees and hold against gravity. He was also able to extend his arms enabling him to put his coat on, which he had not been able to accomplish before treatment.
At 3 day follow-up Mr B reported that he felt better in himself and that the improvements in active shoulder ROM had remained. He also stated that he had found it easier to climb the stairs at home. On this occasion I repeated the CMRT adjustments without Category 1 protocol and will retest him in 5 days time.
Mr B is waiting for appointments for further clinical investigations at the hospital.