Neck-Tongue Syndrome treated with Prolotherapy
What is Neck-Tongue Syndrome?
We see all sorts of patients with a wide variety of conditions here at Caring Medical. One very rare, but very interesting condition is Neck-tongue syndrome. Neck-tongue syndrome is an uncommon condition characterized by pain on one side of the neck with or without numbness in the neck, accompanied by simultaneous numbness of the tongue on the same side as the neck pain. The symptoms occur with sharp turning of the neck. The neck pain is generally felt in the sub-occipital region. Tongue spasms may occur in some cases. Neck-tongue syndrome has been seen in instances of arthritis affecting the C1-2-3 articulation.
This syndrome is noted in patients with degenerative disease of the neck, but also in those without it. Many of the documented cases of neck-tongue syndrome occur in otherwise normal, young adults. Neck-tongue syndrome is divided into two categories. Complicated neck-tongue syndrome consists of those cases where there is presence of an underlying disease process, such as degeneration or inflammatory pathology.Uncomplicated neck-tongue syndrome is trauma related or idiopathic.
What is the cause of neck-tongue syndrome?
The probable cause of neck-tongue syndrome is compression of the 2nd and 3rd cervical root in its course between the atlas and axis during sharp neck rotation. “Abnormal subluxation of the lateral atlanto-axial joint upon rotation of the head, strains the joint capsule, and causes pain. When subluxed, there is impaction of the C2 ventral ramus against the articular processes of the lateral atlanto-axial joint.”
“Afferent fibers from the lingual nerve traveling via the hypoglossal nerve to the second cervical root provide a plausible explanation for compression of that root causing the numbness of half of the tongue.”
Documented cases and symptoms of neck-tongue syndrome
Orrell and Marsden documented two cases of neck-tongue syndrome involving severe pain at the occiput with numbness to the tongue and palate. In both of these cases, treatment involved having the patients wear cervical collars at all times. This reportedly controlled the symptoms.
Webb et al. also examined cases of neck-tongue syndrome in the Journal of Rheumatology in 1984.
- Case 1 was initially diagnosed with having atypical migraines. Besides posterior neck pain, this patient experienced pain that radiated forward over the whole hemicranium to the maxillary region of the face and periorbitally. Exam showed a loss of joint space at the left lateral atlantoaxial joint with sclerosis. A cervical collar worn continuously for 8 months was said to eliminate the symptoms.
- Case 2 described their pain as suboccipital neck pain radiating to the occiput and side of the head, jaw, anterior neck, and tongue. These symptoms were induced by virtually any neck movement, even nodding. Exam showed mild scoliosis at all levels, with secondary spondylosis. Moderate degenerative changes were noted from C1-C4. Posture control, isometric neck exercises, and use of cervical collar x 8 months reportedly controlled the symptoms.
- Case 3 had symptoms of left sided neck pain radiating to the occiput, with left sided numbness of the tongue. This only occurred when rotating the head while swimming. Exam showed normal cervical spine. This patient was noted to have instability of the atlantoaxial facets during rotation. (See atlantoaxial instability)
- Case 4 had a cervical fusion surgery. Sharp movements of the neck caused abnormal sensations on the left side of the neck, head, and tongue. Exam showed degenerative changes at C4-7. Symptoms were reportedly completely prevented with a cervical collar.
The probable cause of neck-tongue syndrome concluded by Webb et al: “The lingual nerve has communication loops with the hypoglossal nerve as the 2 pass together over the hypoglossus muscle below the tongue; a similar communication occurs between the hypoglossal nerve and a loop connecting the 1st, 2nd, and 3rd cervical nerve roots. These intercommunications would allow the possibility of sensory disturbance to be experienced along ½ the tongue whenever there was compression or other irritation of the 2nd or 3rd cervical root nerve.”
Many of the subjects in the various studies experienced high cervical pain radiating to the same side of the tongue with the experiences lasting about 3 minutes or less.
Trauma as a cause of neck-tongue syndrome: 2 cases by Lance and Anthony
- Case 1 experienced a hit on the head by a swing as an 8 year old child. At age 26 he experienced upper neck pain on the right side with right sided tongue numbness.
- Case 2 presented with sharp pain in the right occipital region with numbness of the right half of the tongue.
In this study by Lance and Anthony, neck-tongue syndrome is described as “attributable to instability of the upper cervical spine causing unilateral compression of the 2nd and possibly 3rd cervical root.” Lance and Anthony concluded, “The mechanical disability of the upper cervical spine that induces compression of the second cervical root on sudden rotation of the neck almost certainly involves some degree of unilateral subluxation of the facets of the atlantoaxial joint and instability of the upper cervical spine. The instability causes asymmetrical slipping of the atlantoaxial facets.”
A person with instability of the upper cervical spine, or C1-C2 (atlanto-axial) instability, a rapid rotation of the head can cause the symptoms of neck-tongue syndrome. (See Figure.) Although such treatments as utilizing a cervical collar, performing isometric neck exercises, and posture control, are important modalities in C1-C2 instability, they do not treat the root of the problem of neck tongue syndrome. They also provide only temporary relief.
It is our opinion that stabilization of the atlantoaxial facets is what is necessary to resolve neck-tongue syndrome. A more permanent solution option to consider is Prolotherapy. These regenerative injections directed at the weakened ligaments can stimulate fibroblastic growth and repair of the subluxed, unstable atlantoaxial areas. Prolotherapy can help the symptoms of neck-tongue syndrome by stabilizing the excessive movement at the atlantoaxial facets.