Narrative review of the musculoskeletal manifestations of DISH — a systemic bone-forming diathesis of unknown cause — covering the three Resnick-Niwayama diagnostic criteria, spinal and extraspinal findings, traumatic complications, and management principles across every major anatomic region.
When a middle-aged or older patient presents with back pain, spinal stiffness, Achilles tendinitis, or large calcaneal spurs, obtain a thoracic spine or chest radiograph — a single film can establish the diagnosis of DISH and redirect the entire workup.
In any DISH patient with neck pain after even trivial trauma, treat it as an unstable fracture until proven otherwise with CT or MRI, and have a low threshold for surgical fixation given the catastrophic mortality associated with nonoperative management.
Narrative review of the musculoskeletal manifestations of DISH — a systemic bone-forming diathesis of unknown cause — covering the three Resnick-Niwayama diagnostic criteria, spinal and extraspinal findings, traumatic complications, and management principles across every major anatomic region.
When a middle-aged or older patient presents with back pain, spinal stiffness, Achilles tendinitis, or large calcaneal spurs, obtain a thoracic spine or chest radiograph — a single film can establish the diagnosis of DISH and redirect the entire workup.
In any DISH patient with neck pain after even trivial trauma, treat it as an unstable fracture until proven otherwise with CT or MRI, and have a low threshold for surgical fixation given the catastrophic mortality associated with nonoperative management.