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Cervical ranges of motion indicated reduced flexion, with right and left rotation decreased by 20%.
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Postural evaluation demonstrated decreased cervical lordosis, anterior head carriage, and bilateral protracted and rounded shoulders. The patient sought chiropractic care in our office at that point, since no traditional, allopathic treatments had been offered to her. She was then referred to a dizziness clinic for evaluation and no specific cause for her dizziness was discovered. An MRI of her brain and cervical spine was performed and the results were also unremarkable. A series of blood and urine tests were performed which reportedly all proved to be within normal limits. The patient initially consulted her family physician in order to rule out possible pathological or systemic causes. She reported that her symptoms had been gradually worsening during the course of the previous two months. She also often slept with her toddler in her arms. The patient stated that her symptoms began more than three months before, during a time when her youngest child was ill and she spent long periods carrying him with her left arm while performing tasks with her right. She had had no history of accident or blunt force impact that could be linked with the onset of symptoms. The patient appeared to be within healthy weight parameters, and had experienced no recent, unusual weight gain or loss. There was no previous history of such symptoms, nor any other muscular or skeletal conditions. She described these symptoms as intermittent, lasting from minutes to a few hours at a time, with a frequency of three to twelve episodes per week. These facial sensations were often accompanied by a sensation of dizziness, throat pain upon swallowing, jerking of left eyelid, and excessive lacrimation on the same side. 3 – 6Ī 37-year-old, right handed mother of two preschool-aged children presented with complaints of posterior and lateral neck pain, occasional facial numbness, and tingling sensation over her left cheek, forehead, tip of her chin and left ear. 3 The sternal head trigger points may further produce autonomic disturbances, such as excessive lacrimation, conjunctivitis, rhinitis, blurred vision, coryza and ipsilateral eyelid droops – most likely due to spasm of the orbicularis oculi muscle. 3 The sternal trigger points can cause pain over the ipsilateral and bilateral forehead, inside and behind the ear. The clavicular division 3 of SCM has also been documented to play an important role in the sense of equilibrium. The clavicular division of SCM trigger points can produce pain over the forehead and around the ipsilateral eye, over the cheek, the tip of the chin, sternoclavicular joint and deep in the throat upon swallowing. 4 Trigger points can be classified as active or latent, with the former causing constant pain and the latter “silent” until aggravated. Compressing the trigger point will commonly elicit a consistent referral pain pattern. The referred pain is often described as deep and dull.
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3 Trigger points usually occur longitudinally along the length of the muscle and are more common in postural axial muscles. They can create a local twitch response or “jump sign”, which is due to involuntary contraction of muscle fibers. 3 Trigger points are typically taut bands of muscle fibers and are “ropy” and sensitive to pressure when compressed. The SCM may develop myofascial trigger points in both heads. Acting bilaterally, it causes both flexion of the lower cervical spine and extension of the upper cervical spine. Acting unilaterally, the SCM causes ipsilateral-lateral flexion, contralateral rotation, and lifts the chin superiorly. 1 The sternal division attaches below the sternum and the deeper clavicular branch attaches posteriorly and laterally onto the clavicle. Both divisions of the muscle attach to the head of the mastoid process and along the superior nucheal line. It is composed of clavicular (short head) and sternal (long head) divisions. The sternocleidomastoid (SCM) muscle has a complex multidirectional pattern of movement.