| INTRODUCTION: Renal cell carcinoma accounts for 3% of adult malignancy and 95% of neoplasms arising from the kidney. One third of the patients have metastatic disease at the time of presentation and are asymptomatic with the diagnosis made incidentally from a radiological study obtained for other reasons. Typically, skeletal metastases are purely lytic. This study chronicles the management, outcome and final diagnosis. CLINICAL FEATURES: A 69-year-old male began experiencing middle back pain after twisting while working and presented for chiropractic care two weeks later. He also had a 10-year history of low back pain and a 2-month history of weakness at the knee. Plain film radiography was assessed as negative for pathology by a medical radiologist and a chiropractic radiologist. INTERVENTION AND OUTCOME: After six days of care utilizing atlas orthogonal adjusting, the outcome assessment revealed significant improvement in the pain, but a regression in strength of the right quadriceps and peroneus muscles. The patient was referred for an M.R.I. study, which revealed a mass on the kidney and large erosive bone lesion of the L4 vertebrae. The diagnosis of renal cell carcinoma was later confirmed. DISCUSSION: Progressive muscle weakness is one of the “red flag” signs in a back pain case. Consideration must be given to the possibility of an underlying condition of higher morbidity. Advanced imaging is necessary to detect occult disease processes like renal cell carcinoma. With back pain and neurological signs, metastatic disease must be considered as a possibility. The chiropractor’s role as primary care clinician includes the process of clinical reasoning and referral when the clinical picture becomes unclear and red flag signs arise. This abstract is reproduced with the permission of the publisher. |
