Our Patient
Our patient, a 28 year-old male, had been suffering for over two years with unexplained facial and upper body pain. He had seen two separate neurologists and undergone MRIs of his brain and cervical spine, with no concrete diagnosis.
The patient’s symptoms included:
- Pains in the face, anterior neck, chest and rib cage
- Bilateral pain in the TMJ region
- Numbness and tingling down the upper and lower extremities
- Dermatomal patterns radiating to the fingers
- Obsessive compulsive disorder, anxiety, and acute panic attacks
The Challenge
The patient was referred by a neurologist to our movement disorder specialist, suspecting that he may have facial dystonia. The patient denied any past traumas or surgeries that might be responsible for his condition. However, his health history revealed past episodes of asthma, pneumonia, severe chronic tonsillitis during childhood, extensive dental work and dental braces worn as a teenager.
Exam and Diagnosis
Our clinical exam revealed a mild sway-back posture with winged scapula and severe forward-head carriage. He had a Class 2 bite, with the lower first molar positioned further towards the back of the mouth than the upper first molar. His jaw deviated severely to the right when opening his mouth. A bilateral arm flexion and abduction test revealed moderate scapular dyskinesis.
Diagnostic ultrasonography revealed thickening of the infraspinatus fascia and excessive nerve tension in the upper arm, with densification points along the median and ulnar nerves that reproduced pain symptoms in the neck, chest and hands when compressed. There were also multiple fascia densifications and trigger points in his jaw and facial region that reproduced facial cramping when compressed.
We attributed the patient’s history of disease in the respiratory and masticatory systems to his head-forward compensation pattern, developed to maintain an open airway. This led to scapular and humeral dysfunction and spreading fascia densification along nerve pathways, causing nerve entrapment.
Our Treatment Approach
Our treatment approach was multi-modal, encompassing:
- Stecco-method fascia manipulation
- Nano energy ultrasound guided shockwave on median and ulnar nerves
- Ultrasound guided shockwave therapy of the median and ulnar nerves
- Neurodynamic nerve mobilization
- Dynamic neuromuscular stabilization (DNS) for breathing, and to enhance scapular and cervical stability
- Temporomandibular joint (TMJ) therapy
Final Results
After therapeutic interventions, the patient was 80 percent symptom-free. He was given a personalized exercise protocol to continue at home.
Conclusion
When a patient presents with complex and unexplained symptoms, it is crucial to review past conditions to look for trauma, surgeries and visceral pathology. Fascia is the most important component of the musculoskeletal system, connecting muscles and organs and facilitating the free movement and gliding of nerves and blood vessels.
In this case, the patient’s past history of respiratory conditions triggered a cascade of compensation patterns that ultimately led to severe fascia densification, trigger points, and nerve entrapment that was responsible for his pain and dysfunction.
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