title: Tortuosity of the vertebral artery resulting in vertebral erosion.
abstract: OBJECTIVE
  To discuss the case of a patient with unilateral vertebral artery tortuosity and dilatation resulting in vertebral body and transverse foramen erosion. An emphasis is placed on diagnostic imaging.
  
  
  METHODS
  A 45-year-old man had a frozen shoulder and headaches. Previous arm pain, numbness, and a cold extremity were the result of occlusion of the subclavian artery and had been treated with a subclavian-carotid bypass procedure.
  
  
  RESULTS
  As a result of the angiographic detection of the left vertebral artery dilatation and tortuosity and the concomitant hypoplastic right vertebral artery, high-velocity, low-amplitude manipulation of the cervical spine was contraindicated. However, the patient's symptoms were not related to these findings. Alternatively, low-force manipulation of the cervical spine, shoulder range of motion and muscle techniques were used, and the patient's symptoms diminished significantly with improved shoulder range of motion.
  
  
  CONCLUSIONS
  Clinicians need to be alert to clinical presentations and appropriate imaging protocols in cases of suggested vertebral artery anomaly.
authors.affiliation: Logan College of Chiropractic, Department of Radiology, Chesterfield, MO 63006-1065, USA.
authors.forename: D D
authors.initials: DD
authors.lastname: Brahee
authors.forename: G M
authors.initials: GM
authors.lastname: Guebert
mesh_terms: D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D002684:Chiropractic / Q000379:methods; D003937:Diagnosis, Differential; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D020393:Manipulation, Spinal; D008875:Middle Aged; D011859:Radiography; D020069:Shoulder Pain / Q000628:therapy*; D014711:Vertebral Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology*