Bony hardening of ligaments where they attach to your spine might cause no symptoms, or it can cause progressive pain and stiffness.
Diffuse idiopathic skeletal hyperostosis (DISH) is a bony hardening of ligaments in areas where they attach to your spine.
Also known as Forestier's disease, this condition might not cause symptoms or require treatment. If it does cause symptoms, the most common are mild to moderate pain and stiffness in your upper back. DISH can also affect your neck and lower back, and some people have DISH in other areas, such as shoulders, elbows, knees and heels.
DISH can be progressive. As it worsens, it can cause serious complications.
You might have no signs or symptoms with DISH. For those who have signs and symptoms, the upper portion of the back is most commonly affected. Signs and symptoms might include:
Make an appointment with your doctor if you have persistent pain or stiffness in any joint or in your back.
DISH is caused by the buildup of calcium salts in the ligaments and tendons and a hardening and overgrowth of bone. But what causes these to occur is unknown.
Doctors have some idea of what can increase your risk of the condition. Risk factors include:
People with DISH are at risk of certain complications, such as:
To determine whether you have DISH, your doctor might begin with a physical examination of your spine and joints. He or she will press lightly on your spine and joints to feel for abnormalities and check your range of motion.
Your doctor will also order imaging tests, such as X-rays, CT scans or MRIs, to look for changes in your spine.
While there's no cure for diffuse idiopathic skeletal hyperostosis, you can take steps to reduce pain and stiffness. Treatment is also aimed at keeping the condition from worsening and at preventing complications.
Because of the relationship between DISH and conditions such as obesity, insulin resistance and type 2 diabetes, treating those conditions might slow or halt the progression of DISH.
Your doctor might recommend over-the-counter pain relievers, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others). More-severe pain can be treated with corticosteroid injections.
Physical therapy can reduce the stiffness associated with DISH. Exercises might also increase the range of motion in your joints. Ask your doctor about specific exercises you can do. He or she might refer you to a physical therapist for further guidance.
Surgery might be needed in rare cases when diffuse idiopathic skeletal hyperostosis causes severe complications. People who have difficulty swallowing due to large bone spurs in the neck might need surgery to remove the bone spurs. Surgery might also relieve pressure on the spinal cord caused by DISH.
To help you manage pain and stiffness and to halt progression of the disease, try these self-care measures:
You're likely to start by seeing your family doctor or a general practitioner. After an initial evaluation, your doctor might refer you to a specialist such as a rheumatologist, physiatrist, orthopedic surgeon or neurologist.
Here's some information to help you get ready for your appointment.
Make a list of:
For DISH, some basic questions to ask include:
Don't hesitate to ask other questions.
Your doctor is likely to ask you questions, including:
December 22nd, 2020