Case Study: Ultrasound Guided Dry Needling for Vertigo Treatment in Patient with Skull Trauma

Our Patient

Our patient is a 30 year-old male with head trauma, suffering from persistent vertigo and neck pain. Prior attempts to resolve his condition had been unsuccessful, primarily due to misdiagnosis and ineffective treatments. Apparently the musculoskeletal component of vertigo had been overlooked.


Our Diagnosis

Immediately recognizing the potential link between the patient’s neck pain and vertigo, we used high-resolution ultrasound imaging to explore the neck region. Imaging revealed trigger points in the suboccipital muscles and the broader neck region.

The Challenge

We needed to devise a strategy to effectively target the trigger points while minimizing any risks related to the patient’s skull trauma.

Our Treatment Plan

We employed ultrasound-guided dry needling to eliminate the trigger points in the patient’s neck muscles. During the procedure, one needle unintentionally touched the dura mater – the tough membrane layer beneath the skull and vertebral column – causing a referred pain reaction. This event speaks to the importance of precision in dry needling procedures.


Our Results

Ultrasound-guided dry needling of trigger points in the patient’s neck muscles immediately relieved his vertigo symptoms and eliminated his neck pain.


While ultrasound-guided dry needling is primarily used for musculoskeletal pain, it can also impact vertigo symptoms by addressing trigger points in the neck region. Our treatment approach emphasizes the importance of careful planning and consideration in cases involving head trauma. It also highlights the significance of personalized treatment, viewing each patient as a unique case. Skill and accuracy during needling procedures is essential for successful treatment of trigger points, and risks must be carefully weighed.



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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