The Study: Neck-tongue syndrome
a. Neck–tongue syndrome (NTS) is a rare condition.
b. There are “paroxysmal episodes of intense pain in the upper cervical or occipital areas associated with ipsilateral hemiglossal dysaesthesia brought about by sudden neck movement.” “The pain of NTS is in the distribution of the C2 nerve root.”
c. “The most likely cause of this clinical entity is a temporary subluxation of the lateral atlantoaxial joint with impaction of the C2 ventral ramus against the articular processes on head rotation.”
d. This is a case report of a 47 year old man who suffered with this condition.
e. The cervical x-rays showed a narrowing “of the right paraodontiod space”.
f. The authors reasoned that the patient had “an impacted nerve”.
g. “The cervical musculature was appropriately stretched before spinal adjustment to ensure that NTS was not provoked.”
h. The patient received care at frequency of three times a week for a total of twelve treatments.
i. At the end of 12 visits the patient was significantly improved.
j. Following the period of spinal adjusting, the patient underwent 12 visits of ultrasound, trigger point therapy, “and corrective exercise for neck posture”.
k. At the end of that time the patient was further improved and was given a home exercise regimen.
l. At a 3 month follow up the patient “reported no further trouble.”
This is a rare condition and the care appeared to be effective.
I want to add this quote from the article, “Our patient above benefitted from cervical adjustment and this appears to support that cervical adjustment could be an effective approach for some cases of NTS. However, the atlantoaxial (C1-2) joint is most vulnerable to injury since there are no intervertebral disc fibres and no interlocking joints to limit rotation. Therefore, a careful consideration of applying a minor
manipulation in the upper cervical area is stressed.”
We should always be appropriate in our care and I thank the authors for their admonishment to be careful with care. Although this is a rare condition, I suggest that you read the article and the references if this is of interest to you.
Reviewer: Roger Coleman DC
Editor’s Comments: An unusual condition and likely of little import to the average practitioner, but still the study is rather unique for at least two reasons. First, we actually have chiropractors doing a study on specific adjustments for upper cervical subluxation as visualized on X-ray (my, what a strange concept!) and second, the study is on something other than low back pain. Will someone please contact the Nobel prize committee!
Editor: Mark R. Payne DC
Reference: Chu ECP, Lin AFC. Neck-tongue syndrome. BMJ Case Rep. 2018 Dec 4;11(1). pii: e227483. doi: 10.1136/bcr-2018-227483.
Link to Abstract: https://www.ncbi.nlm.nih.gov/pubmed/30567193