Case Study: Patient with Facial Pain and Complex Neurological Dysfunction Successfully Treated with Alternative Therapies

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.



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.



In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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