Objective: To describe the presentation and management of a patient with primary spontaneous pneumothorax after thoracic spinal manipulation. Pneumothorax is a documented rare adverse event of thoracic manipulation but prior to this report, has not been documented as occurring following routine chiropractic manipulation.
Clinical Features: The patient was a tall, thin 25-year-old male who experienced sharp chest and thoracic spine pain after receiving manipulation to the thoracic spine. He was evaluated for chest, rib, and back pain and difficulty taking a deep breath. X-rays were ordered to rule out rib fracture. Though x-rays showed no fracture, they revealed a small pneumothorax in the apex of the left lung.
Intervention and Outcome: The patient was not experiencing respiratory distress and was told to monitor his symptoms over the following days. Repeat x-ray examination was performed 4 days later and showed resolution of the pneumothorax. He was still experiencing some chest pain and difficulty obtaining a full breath with exertion, so a multi-phase rehabilitation program was developed to improve his tolerance to cardiovascular activity. After 8 weeks of rehabilitation, he made a full return to activity without complication.
Conclusion: This case describes a report of primary spontaneous pneumothorax following routine chiropractic manipulation. It illustrates the need for proper evaluation and screening of patients who may be at risk of adverse events from thoracic spine manipulation.
Author keywords: Chiropractic; Pneumothorax; Adverse Events; Chest Pain
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