Diseases & Conditions

Diffuse idiopathic skeletal hyperostosis (DISH)

Diffuse idiopathic skeletal hyperostosis (DISH) is calcification or a bony hardening of ligaments in areas where they attach to your spine.

Also known as Forestier disease, diffuse idiopathic skeletal hyperostosis causes stiffness in your upper back, and may also affect your neck and lower back. Some people experience diffuse idiopathic skeletal hyperostosis beyond the spine in areas such as their heels, ankles, knees, hips, shoulders, elbows and hands.

Diffuse idiopathic skeletal hyperostosis often causes no symptoms, though stiffness and pain along affected ligaments can occur. You may not need treatment for diffuse idiopathic skeletal hyperostosis if you don't have symptoms, though physical therapy may help you maintain range of motion in your affected joints.

Make an appointment with your doctor if you have persistent pain or stiffness in any joint or in your back.

To determine whether you have diffuse idiopathic skeletal hyperostosis, your doctor may begin with a physical examination. He or she will press lightly on your spine and joints to feel for abnormalities. Any pain you experience from the pressure on your spine may be a clue to the diagnosis. Diffuse idiopathic skeletal hyperostosis may cause pain at the point where the affected tendon or ligament attaches to a bone. Your doctor may be able to detect bone spurs.

In order to confirm diffuse idiopathic skeletal hyperostosis, your doctor will order X-rays, which may show calcification along the bones that make up your spine (vertebrae). The calcification has a distinct appearance that doctors sometimes refer to as cascading or flowing. Some compare the appearance to that of candle wax dripping and oozing down your spine.

Other types of imaging, such as computerized tomography (CT) and magnetic resonance imaging (MRI), may be helpful in diagnosing diffuse idiopathic skeletal hyperostosis. These tests can also rule out conditions that may cause similar signs and symptoms, such as ankylosing spondylitis.

While there's no cure for diffuse idiopathic skeletal hyperostosis, there are steps you can take to reduce pain and stiffness if you're experiencing those symptoms. In many cases, treatment may not be necessary. However, if you experience symptoms of diffuse idiopathic skeletal hyperostosis, your doctor may recommend treatments to control pain and maintain range of motion in your affected joints.

Treatment for pain
Treatment for pain caused by diffuse idiopathic skeletal hyperostosis is similar to that of other joint ailments. Your doctor may recommend pain relievers, such as acetaminophen (Tylenol, others) or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others). More severe pain can be treated with corticosteroid injections.

Treatment for stiffness
Physical therapy can reduce the stiffness associated with diffuse idiopathic skeletal hyperostosis. Exercises may also increase your range of motion in your joints. Ask your doctor about specific exercises you can do. He or she may refer you to a physical therapist for further guidance.

Surgery
Surgery may be required in rare cases when diffuse idiopathic skeletal hyperostosis causes severe complications. People who experience difficulty swallowing due to large bone spurs in the neck may need surgery to remove the bone spurs. Surgery may also relieve pressure on the spinal cord caused by diffuse idiopathic skeletal hyperostosis.