Select Page

Severe Left Neck Pain with Dystonia

Exit forum ID Forum Discussion Severe Left Neck Pain with Dystonia

This topic contains 3 replies, has 3 voices, and was last updated by   Jamie Hansen December 23, 2019 at 8:52 am.

Viewing 4 posts - 1 through 4 (of 4 total)
  • Author
    Posts
  • #8831

    Jamie Hansen
    Keymaster

      Hey Everyone,
      I’m in the middle of this case and getting pretty good results, but i want to make sure im communicating realistic expectation. Any and all feed back are greatly appreciated.

      1st Order:
      36 M
      SX Loc: Left Lat Neck, and pain into left intra-scapular, head shakes when coming to midline
      Quality: Pulling head to the left, “chronic spasm like”
      Intensity:
      Current- constant 9/10 does not “real pain” more serious discomfort
      P+: Constant, Left Rotation, bringing head to mid-line creates dystonia, left lat flexion jiujitsu (doing it for 15yrs)
      P-: Hot tub, meditation

      2nd Order:
      -Started 6yrs ago as stress level increased
      -Extremely stressed/high stress job stress graded 9/10
      -no headaches
      -Working DX was C4/5, DDD, adhesion, emotional/stress mgmt
      -At consult it was suggested we get an MRI done, before treatment and possible meet with a neurologist he appreciated this greatly got an MRI and met with the neuro it showed:
      C4/5 bulging and dorsal bony ridge complex effaces subarachnoid space.
      C5/6 Left bulging disc effaces subarachnoid space.
      -Neurologist said its dystonia and not to be to concerned about it.

      EXAM:
      UCF 5/25
      CF 38/60
      CTF 68/90
      Rot
      L 43/90
      R 62/90

      On Visit 9 currently:
      UCF has plateued at 15/25
      CF maxed out at 58/60
      CTF maxed at 88/90
      Currently working on rotation after 1st treatment right rot. is up to 80/90 left is up to 74/81

      My real questions are as followed.
      I am occasionally going back to his UCF as there is still some mild adhesion but his range seems to not improving there. Is there something I am missing with this?

      Regarding his dystonia he states that he feels that its “decreasing to some extent”. There is still significant adhesion in his NR’s at scalenes and multifidi so I am optimistic that i will be able to continue to improve his range.

      Has anyone ever seen a patient with cervical dystonia? If yes how did you manage the patients expectations.

      Thanks Everyone!

      #8834

      Adam Holen D.C.

        Nice work! I have not seen a patient with cervical dystonia before so someone else may have more direct experience, but I’ll do my best to help.

        If his dystonia keeps pulling his head to the left (or any direction out of neutral), it may be just protective. Most of cervical rotation takes place at the C1-C2 joint (most mobility within the cervical spine that is), so a constant contraction of these muscles can limit their ability to lengthen (UCF) even without adhesion or very mild.

        Like an overtrained runner who’s SLR is limited without any adhesion or disc problems, the suboccipital muscles can likely act the same in this unique case. I would need to be fact-checked on that to be certain, but that’s how it makes sense to me.

        With that, I wouldn’t get too caught up in the 15/25 measure. However, there’s 1 thing I would try which is the inferior oblique muscle. There’s a video on here somewhere for advanced cervical material, which would be up your alley, Joe. It’s at least worth assessing if you haven’t already.

        That’s all I’ve got for treatment stuff. As for communication just hammer home that you’re making his neck healthier, but cervical dystonia is an “unknown” condition, meaning multiple things can cause/contribute so taking MSK off the list is a big step. When his case is settled, if he’s still not doing well enough, then I’d venture into more invasive measures.

        #8841

        Matthew Buffan
        Participant

          Joe, Great work on this tough case! They have made massive functional improvement! Communicate that clearly every time you see them.

          I do not have experience with this patient presentation. There is research citing genetic factors for dystonia at this website(https://www.mayoclinic.org/diseases-conditions/cervical-dystonia/symptoms-causes/syc-20354123). Any family history for this problem?

          As for treatment I would re-check the nerves in the suboccipital region and continue to clear the nerve roots thoroughly. My logic is that the body will prioritize protective tension of the nervous system. I know at the last cervical seminar someone was having instrument work done along the occiput of the greater/ lesser or a cutaneous branch thereof. I would also follow the brachial plexus out to the NVB at subscap to see if any significant peripheral dysfunction is restricting the nerve.

          As for load factors: Is he still participating in Ju Jitsu? That’s not going to help his load balance & case reach max improvement. What is he doing for stress relief? Gentle QiGong or Tai Chi would be a better option for moving stress relief than a martial art.

          He’s lucky to have found you and you are doing great work to get him to max MSK improvement.

          #8850

          Jamie Hansen
          Keymaster

            Hi Adam and Matt!
            Thank you so much for your input on this case.
            It is challenging but currently he is happy with how we progressing.
            Great recommendation with the checking the occipital nerves. As i was not that familiar with those protocols i was able to get some reps in with Chris prior to his treatment.
            He has stopped Jujitsu completely, and is working on reducing his stress load.
            I am hoping to be able to provide an update in a the next couple of weeks.

            Joe

          Viewing 4 posts - 1 through 4 (of 4 total)

          You must be logged in to reply to this topic.