Physical examination shows few abnormalities. Thoracolumbar and cervical spine mobility may be mildly or moderately decreased, and tenderness may be present over the thoracic spine. Occasionally, anterior cervical osteophytes can be palpated at the posterior aspect of the pharynx. Later in the disease, rheumatic abnormalities are extensive, but pain is often minimal and spinal motion is only moderately limited. Advanced ligamentous calcification can be seen in the iliolumbar and patellar ligaments.
Periarticular osteophytes are usually conspicuous.
X-rays of the spine typically show flowing ossification along the anterolateral aspect of at least four contiguous vertebral bodies, preservation of disk height, and the absence of marginal sclerosis and apophysial joint ankylosis. Painful spurs may be managed by orthotics or local corticosteroid injections. Patients should be reassured that DISH does not cause permanent disability. All rights reserved.