Presentation
- A 68 y-o man was driving alone and was T-boned on his left front side, spinning the car 180˚ to the right
- Dashboard and knee airbags deployed
- Although he was discharged the night of the accident, his later pain led to a CAT scan and an MRI, which were unremarkable
- He was very bruised, had sore left shoulder and neck, and developed headaches
- Other symptoms included extreme fatigue, brain fog, cognition problems, breakdowns, tremors, apathy, light sensitivity, low sex drive, episodic incontinence and poor sleep
- Five of his teeth had been chipped in the accident
- He saw me 6-weeks after the accident c/o tinnitus and headaches
Evaluation, clinical reasoning & treatment strategizing
- His main complaint was shoulder, neck and jaw pain, along with frontal headache
- He had been told he had left-sided allodynia, especially in the shoulder and torso
- The right-sided tinnitus only rose to prominence once other symptoms abated
- He described it as high pitched, that when bad was pulsating
- His cervical ROM was poor in flexion, lateral flexion and rotation
- He had a droopy right eyelid
Treatment
- At certain times he had PT, DC, psychotherapy and NMT all on the same day
- My focus was to reduce sympathetic overload and provide pain mechanism education
- Initial treatment began with SCM, scaleni, deep head of masseter, trapezius and all the shoulder muscles
- Next, was added the extra-oral routine and palatine muscles
- Once his stress levels allowed he permitted intra-oral jaw muscle work and supra and infrahyoids. Always SCM
- I worked the mimetic muscles as part of his headache treatment
- Later, I worked on RCL, the cranial bones and the mastoid bone routine
- A year after the accident he saw the esteemed neurologist, Dr. Bob Gerwin MD in Bethesda MD for a two-hour consultation. The conclusion was all symptoms corresponded to Barré Liéou syndrome (cervicogenic headache from WAD). He confirmed the importance of SCM as a main contributor to symptoms
Results and follow-up
- Once his headaches, shoulder, neck and jaw pain abated, tinnitus was his main reason for visiting
- He could have weeks where it was half what it used to be
- He was very stressed while going through the litigation process, and through his work as a landlord and this exacerbated the tinnitus symptoms
- Control of his stress was paramount
- He saw me weekly, then monthly for 4 years.
- I have not seen him professionally since the pandemic began in early 2020, but he told that he is doing well after meeting him by chance in a car repair shop that he had recommended