Abnormal Head Position with Neck and Shoulder Pain

Dystonia:  Abnormal muscle tone characterized by prolonged muscle contractions.

RV is 53 y/o patient with a 1.5 year history of left neck and shoulder pain which is constant in duration, 5/10 in severity, nonprogressive in nature localized exclusively on the left. Pain is throbbing in character, aggravated by extension and rotation to the right.  Patient has no significant past medical or surgical history and denies any trauma.  Patient had involuntary muscle contractions which pulled her head to the left making walking straight, operating a car and sleeping difficult.

 Treatment to date included chiropractic care, neurologic, orthopedic and physical medicine consultations.  The orthopedic surgeon diagnosed a tear in shoulder and recommended surgery.  The neurologist injected Botox repeatedly on both sides of her neck which resulted in head and neck weakness precipitating nausea.   Facet injections provided no significant relief.  MRI of the brain, cervical and thoracic spine were all normal except  mild degenerative changes at C5/6.

Physical examination was significant:   left rotation of head, downward  gaze , left shoulder and neck was tender to the touch with multiple muscle nodules.  Most striking was her right sternocleidomastoid muscle (SCM) which was contracted, thick and very painful.

Cervical Dystonia is a movement disorder in which sustained muscle contractions cause abnormal postures.

Insertion of several small needles (IMS) into the right SCM provided the patient with complete resolution of her left sided neck and shoulder pain along with a significant reduction in her involuntary head rotation. 

  Understanding the complexity of the musculoskeltal system is essential.  It was contraction of her RIGHT SCM which led to the left head rotation and stretch of left shoulder and neck muscles.  Injection of the left side, the side where the pain was would only have increased her head rotation and pain. 

The Centeno-Schultz Clinic is committed to the highest level of  diagnostic and regenerative medicine.

Elbow Pain Now Addicted to Narcotics

55 year old patient presented with a 2 year history of left elbow pain which was constant in duration, 8/10 in severity, progressive in nature, localized on the lateral (outside) aspect of elbow without any radiations.  Patient drives a city bus and sustained a slip and fall injury in which he struck his left elbow. He denied any neck or arm pain.  Treatment to date had included massage, x-rays, cortisone injections into the joint and oral narcotics.  Narcotics were started “since other therapies had failed”.  Patient had a known addictive personality and was a recovering alcoholic. He was using up to 8 Vicodin /day as prescribed.

On physical examination he had extreme tenderness over the outside aspect of the elbow (lateral epicondyle) and multiple tender points along the extensor muscles in his forearm. His neurologic exam was normal.

Lateral epicondylitis  is theorized to be an injury of repetitive microtrauma/overuse.

It is commonly caused by  commonly associated with playing tennis  and other racquet sports.

It can also be caused by sustained contraction of the extensor muscles in the forearm which result in excessive force on the tendon where it is attached on the bone.  Treatment is two-fold: relax the dysfunctional muscle and promote healing.  This is possible by IMS and prolotherapy.

Following regenerative therapy at the Centeno-Schultz Clinic, patient had reduction in his pain, increase in range of motion and elimination of all narcotics.

Myofascial Pain Syndromes

Myofascial pain syndromes are a large and diverse group of painful conditions that occur in the musculoskeletal system.  They affect muscles and their connective tissue attachments.  They are named according to the location of the painful area.  Common examples include lateral epicondylitis and achilles tendonitis.  Myofascial pain syndromes are unique in that they typically arise and persist in the absence of any detectable injury or inflammation.

What is a myofascial trigger point (MTP) ?  Heguenin defines a MTP as a the presence of exquisite tender nodule in a palpable band of muscle.  They produce referred pain either spontaneously or with compression.

What is intramuscular stimulation (IMS).  It involves the use of small acupuncture like needles to deactivate trigger points and loosen tight (shortened) muscles.

IMS

 

 Gunn MD contends that long term pain relief requires treatment at the affected spinal level to reduce nerve root compression as well as treatment of peripheral trigger points.

Sources of MTP?  Unclear, however Chan Gunn MD advocated that neural injury or compression at a specific spinal level results  in abnormal activity in the peripheral nerve. The goal of IMS is to release muscle shortening, promote healing and decrease spontanesous electrical activity at the trigger points.

So if you are snowboarding and catch an edge and find yourself face planted, you may have injured your C5.6 disc.  It may be a transient pain but the injurymay have  resulted in an irritation of the C6 nerve root.  You may not have neck pain or shooting pain down the arm typcial of a C6 nerve root irriation.  More commonly you will have pain in the muscles of the rotator cuff, the rhomboids, latissimus dorsi, biceps and triceps all of which are innervated by the C6 nerve root.  At the Centeno-Schultz Clinic we understand the importance of treating both the affected spinal level as well as the peripheral trigger points.  Long term success requires treatment of both.