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Diffuse Idiopathic Skeletal Hyperostosis (DISH)

J. Christopher Hawkins, DO, Aaron Gustin, DO and Jason M. Seibly, DO, FACOS Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Characterized by calcification and ossification of soft tissues, primarily ligaments and entheses; most commonly in the spine, especially thoracic segments

  • Synonym(s): Forestier disea...

DIAGNOSIS

HISTORY

  • Most commonly asymptomatic

  • Diagnosis often made incidentally on imaging studies

  • Back and neck pain are the most common complaints.

  • Stiffness and reduced range of motion in the peripheral...

TREATMENT

GENERAL MEASURES

  • Largely asymptomatic: no need for specific therapy

  • Symptomatic relief of pain and stiffness:

    • Pain control with analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs)

    • Physical...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

Seek immediate medical attention if neurologic symptoms develop or if involved in significant trauma (e.g., fall, car accident). 

DIET

No special ...

REFERENCES

1
Mader R, Verlaan JJ, Eshed I, et al. Diffuse idiopathic skeletal hyperostosis (DISH): where we are now and where to go next. RMD Open.  2017;3(1):e000472. {L-End} [View Abstract on O...

ADDITIONAL READING

  • Holton KF, Denard PJ, Yoo JU, et al; and Osteoporotic Fractures in Men (MrOS) Study Group. Diffuse idiopathic skeletal hyperostosis and its relation to back pain among older men: th...

CODES

ICD10

  • M48.10 Ankylosing hyperostosis [Forestier], site unspecified

  • M48.14 Ankylosing hyperostosis [Forestier], thoracic region

  • M48.15 Ankylosing hyperostosis [Forestier], thoracolumbar region

  • M48.12...

CLINICAL PEARLS

  • DISH is typically asymptomatic. The diagnosis is often discovered incidentally on radiographic studies.

  • Clinical characteristics and radiographic findings may be confused with those of ...

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