The patient was a 25-year-old woman who was referred to a physical therapist for a chief complaint of pain at the base of the occiput and left upper quarter region, as well as bilateral hand paresthesias. The findings of the history and physical examination were discussed with the patient's physician, who then ordered magnetic resonance imaging of the cervical spine, which revealed protrusion of the cerebellar tonsils 1 cm below the foramen magnum, consistent with a type 1 Chiari malformation.

J Orthop Sports Phys Ther 2012;42(5):483. doi:10.2519/jospt.2012.0409

KEY WORDS: cervical spine, magnetic resonance imaging, neck pain

The patient was a 33-year-old woman with a chief complaint of midthoracic spine pain. Anterior-posterior and lateral radiographs of the thoracic spine revealed superior and inferior endplate deformities and a mild reduction of stature of the T9 vertebral body, which were suspicious for a fracture. Computed tomography scans revealed cortical irregularity of the vertebral body of T9, however, magnetic resonance imaging of the thoracic spine was negative. Given the magnetic resonance imaging findings, the smooth, well-defined cortical defect, and the absence of paraspinal hemorrhaging on the computed tomography scan, it was hypothesized that this may not have been an acute fracture. Rather, the cortical irregularity of the anterior vertebral body of T9 seen on computed tomography could have instead represented normal nutrient vascular channels. The patient was referred to an orthopaedic surgeon, who recommended conservative management by a physical therapist.

J Orthop Sports Phys Ther 2010;40(8):533. doi:10.2519/jospt.2010.0412

KEY WORDS: computed tomography, magnetic resonance imaging, radiographs