Case history
Case history
A 60-year-old man presents with a 6-year history of back pain and pain in his feet, predominantly over the heels. The back pain is constant and the pain over the heels gets worse with walking. His BMI is 41 kg/m² and he has a history of hypertension and type 2 diabetes mellitus. On physical examination, he has a stooped posture and swelling over the Achilles tendon. Rotation over the cervical spine is limited to 45 degrees. Examination also reveals slight tenderness and decreased range of motion of the shoulders and elbows. Cervical spine has little, if any, motion.
Other presentations
Patients with cervical involvement may present with dysphagia or dyspnoea. Rarely, a fracture following relatively low-energy trauma may be the first presentation of DISH.[4] Restrictive lung disease in some patients is caused by involvement of other skeletal components, such as the sternocostal and costochondral junctions, as a result of limited expansion of the thoracic cage.[4]
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