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Diffuse Idiopathic Skeletal Hyperostosis (DISH)


Disease: Diffuse Idiopathic Skeletal Hyperostosis (DISH) Diffuse Idiopathic Skeletal Hyperostosis (DISH)
Category: Bones, joints, muscles diseases

Disease Definition:

The calcification or a bony hardening of ligaments in regions attaching to the spine is known as diffuse idiopathic skeletal hyperostosis (DISH) additionally called Forestier disease, resulting in the stiffening of the upper back, lower back or the neck. Sometimes, this condition might affect beyond the spine in areas like the ankles, hips, hands, elbows, heels, knees and shoulders as well.


Usually, there aren’t any apparent symptoms for diffuse idiopathic skeletal hyperostosis, although pain and stiffness may occur along the affected ligaments. Treatment might not be required for diffuse idiopathic skeletal hyperostosis in case there aren’t any symptoms apparent, though physical therapy might aid in keeping range of motion in the affected joints.


Work Group:

Symptoms, Causes


Depending on which part of the body is affected by diffuse idiopathic skeletal hyperostosis, its signs and symptoms might differ. The upper part of the back (thoracic spine) is the most typically affected. Diffuse idiopathic skeletal hyperostosis may cause some of these signs and symptoms:



This is usually most apparent in the mornings.



When the affected area is pressed, one might feel pain. However, Pain might not be apparent in everyone suffering from diffuse idiopathic skeletal hyperostosis.


Loss of range of motion:

The most apparent sign is loss of lateral range of motion. The spine might be flexed laterally, for instance, as one does side stretches.


Difficulty swallowing or a hoarse voice:

When diffuse idiopathic skeletal hyperostosis affects the neck (cervical spine), these symptoms might be apparent.





There’s a high risk of the following complications in people with diffuse idiopathic skeletal hyperostosis:



It might be difficult to use the affected joint due to loss of range of motion in it. For instance, using the arm could be difficult and painful when someone has diffuse idiopathic skeletal hyperostosis in their shoulder.


Difficulty swallowing:

Dysphagia (difficulty swallowing) may occur in case the bone spurs that are associated with diffuse idiopathic skeletal hyperostosis in the neck (cervical spine) put pressure on the patient’s esophagus. Sleep apnea, which is difficulty breathing while asleep, and a hoarse voice may also be caused by the pressure from the bone spurs. Rarely, this could become serious and might need surgery to remove the bone spurs.



Diffuse idiopathic skeletal hyperostosis affecting the ligament climbing up the outside of the spine (posterior longitudinal ligament) could add pressure on the spinal cord, and result in a loss of feeling and paralysis. 



Diffuse idiopathic skeletal hyperostosis is not a curable condition, but the pain and stiffness caused by it can be decreased in certain ways. Treatment might not be required for most cases of this condition, still in the case of going through symptoms of diffuse idiopathic skeletal hyperostosis, treatment might be recommended to manage the pain as well as to keep the range of motion in the affected joints.


Treatment for pain:

The pain that is caused by diffuse idiopathic skeletal hyperostosis is treated in the same way as other joint ailments.
Pain relievers like acetaminophen might be recommended or nonsteroidal anti-inflammatory medications (NSAIDs) like ibuprofen. Corticosteroid injections might be administered for those who experience more severe pain.


Treatment for stiffness:

The stiffness related to diffuse idiopathic skeletal hyperostosis might be decreased with physical therapy. Exercises might additionally raise the range of motion in the joints. A physical therapist can guide the patient for more specific exercises.



When diffuse idiopathic skeletal hyperostosis causes severe complications, surgery may be needed, which is quite rare. Surgical removal of large bone spurs may be required in case the patient is experiencing dysphagia due to those spurs. Pressure on the spinal cord due to diffuse idiopathic skeletal hyperostosis may also be resolved with surgery.


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